prof. isaac f. adewole fas vice-chancellor university of ibadan, ibadan & president-aortic...
TRANSCRIPT
Prof. Isaac F. ADEWOLE FAS
Vice-Chancellor
University of Ibadan, Ibadan
&
President-AORTIC
SOCIAL SUPPORT FOR CANCER MANAGEMENT:
ISSUES AND CHALLENGES
Greetings
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The University.......
3
Acknowledgements
• Hon Minister of Health• Leadership –FMH• OC-ICW
CANCER IN NIGERIA
• BURDEN-101,800 Cases• MORTALITY-75,400 Cases• RISK OF GETTING CANCER BY 75- 11.9%• RISK OF DYING FROM CANCER BY 75- 9.6%• PROFILE-LATE PRRESENTATION,POOR
SURVIVAL
Globocan-2008
EAS Incidence &Mortality- Both Sexes
Cancer Incidence-Both Sexes
Cancer Control Continuum
Prevention• Diet/Exercise• Sun Exposure• Alcohol • Tobacco
Control• Chemo-
prevention
Early Detection•Cancer screeningPap testMammogramPSA/DREFecal occult blood testColonoscopy•Awareness of cancer risk, signs, symptoms
Diagnosis• Oncology/
surgery consultation
• Tumor staging• Patient
counseling & decision making
• Clinical trials • Informed
Decision Making
Treatment• Chemotherapy• Surgery• Radiation • Symptom
management• Psychosocial• Maintenance
therapy
Survivorship• Long-term follow-
up/ surveillance• Manage late-effects • Rehabilitation• Coping• Health promotion• Prevention• Palliative Care
Phases of Cancer Care
Adapted from: http://cancercontrol.cancer.gov/od/continuum.html. Accessed July 25, 2011.
End of Life
• Support patient & family
• Hospice• Informed
decision making
The Multi-disciplinary approach to cancer
10
Mental Health
Physical Therapy/
Occupational Therapy
Neurology/ Neuropsychology
Endocrinology
Cardiology
Gynecology/UrologySexual Healht/Fertility
Pulmonary
PainManagement
IOM, 2006
Specialty/Primary Care
The Cancer Trajectory
TIME
HE
ALT
H
Diagnosis
Treatment
Remission
RecurrenceRecovery
Survival
Dying
Problems experienced by Cancer PatientsKnowledge of the diagnosis and disease
Inadequacy of informationUncertainty about prognosisguilt about causalitystigma of cancerfear of a painful and undignified deathworries about reaction of family and friendssurgery often mutilating and can cause body
image problems and loss of physical/sexual function
Chemotherapy/ radiotherapyFear of Side effects/complications
DETERMINANTS OF HEALTH AND WELLBEING
• Cancer affects individuals and their families• Treatment also posses challenges • People diagnosed with cancer and their
families must not only live with and manage the challenges and risks posed to their physical health, but also overcome psychosocial obstacles that can interfere with their health care and diminish their HEALTH and FUNCTIONING
Cancer care for the whole patient…….
Health is determined not just by biological processes but by people’s emotions, behaviors, and social relationships. Sadly, these factors are often ignored or not defined as part of health care.
Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs.http://www.nap.edu/catalog/11993.html
Cancer care for the whole patient…….
Health is determined not just by biological processes but by people’s emotions, behaviors, and social relationships. Sadly, these factors are often ignored or not defined as part of health care.
Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs.http://www.nap.edu/catalog/11993.html
What is Social Support?
The support or care given to a patient who has a serious or life-threatening condition or disease such as cancer, from the time of diagnosis and throughout the course of illness. It is usually provided either by a specialist who works with a team of other health care professionals, such as doctors, nurses, registered dieticians, pharmacists, and social workers or by families, friends, and the community in general.
Social Support in Cancer Management
• Social support in cancer management is a form of supportive care offered at various stages of management
• It can be offered at the following stages– Screening – Diagnosis– Treatment– Follow-up– End of life care
Social Support Vs Hospice Care
• Different • Share the same principles of comfort and
support, social support begins at diagnosis and continues during cancer treatment and beyond.
• Social support addresses the emotional, physical, practical, and spiritual issues of cancer. Family members may also receive social support
The need for Social support in Cancer Management
Supportive Care Makes Excellent Cancer Care Possible
• …is the prevention and management of the adverse effects of cancer and its treatment. This includes the management of physical and psychological symptoms and side effects along the continuum of cancer experience from diagnosis through ant-cancer treatment to post-treatment care. Enhancing rehabilitation, secondary cancer prevention, survivorship and end of life care are integral to supportive care.
Multinational Association for Supportive Care in Cancer, 2010
An alternative to Cancer Care?
• Social support is given in addition to cancer treatment.
• When a patient reaches a point at which cancer treatment is no longer warranted, social support becomes the major focus of care. It will continue to be given to alleviate the symptoms and emotional issues of cancer.
Value of Social Support Networks
• A study examined mechanisms through which social relationships influence quality of life (QOL) in breast cancer survivors among 3,139 women from the Pathways Study who were diagnosed with breast cancer from 2006 to 2011 and provided data on social networks (the presence of a spouse or intimate partner, religious/social ties, volunteering, and numbers of close friends and relatives), social support (tangible support, emotional/informational support, affection and positive social interaction)..
• Kroenke at al….2011
Value of Social Support Networks…….2
• The study showed that the strongest mediator and type of social support that was most predictive of QOL outcomes was “positive social interaction.” However, each type of support was important depending on outcome, stage, and treatment status. Larger social networks and greater social support were related to higher QOL after a diagnosis of breast cancer. They advised that effective social support interventions need to evolve beyond social-emotional interventions and need to account for disease severity and treatment status
Another Study……………………..
Younger cancer patients reported worse symptoms, a smaller social support network, and fewer close friends and relatives than older patients. Having someone to discuss decisions and seeing friends or relatives often was associated with longer survival.
Novotny et. al .(2010) A pilot study assessing social support among cancer patients enrolled on clinical trials: a comparison of younger versus older adults. http://dx.doi.org/10.2147/CMAR.S9668
Alleviating stress
– A strong social support system can alleviate stress by providing individuals with another person to share their problems with.
– When individuals have someone to confide in who cares about what they are going through and listen to their problems, they may find it easier to deal with cancer challenges they are facing.
– In addition, people in an individual’s support system may be able to give ideas or recommendations for how to overcome these challenges.
Increasing a person’s self confidence and feelings of value
• Individuals can listen to the challenges of others and may even have ideas about how they can overcome their own challenges
• Being part of a strong social support system can make an individual feel loved and important.
Decreasing feelings of loneliness and isolation
• Social support systems can also be fun! Individuals can call on members of their social support system when they want to participate in an activity or just talk about what is going on in their lives.
• Without friends and other social supports many people are more likely to feel lonely, isolated, and bored – this can increase risk for developing mental health conditions such as severe depression and death
Informal Social Support Network
• Direct support professionals• Family members• Friends• Health care providers• Co-workers• Social workers• Teachers• Anyone that is trusted
PSYCHOSOCIAL CARE
The purpose of health care is to :
…..continuously reduce the impact and burden of illness, injury, and disability, and . . . improve . . . health and functioning.”
To accomplish this,• good quality health care must attend to patients’
psychosocial problems and provide services to enable them to better manage their illnesses and underlying health.
IOM. 2006. Performance measurement: Accelerating improvement. Washington, DC: The National Academies Press.
“wealth of cancer-related communitysupport services.”
• The burden of illnesses and disabilities in the United States and the world is closely related to social, psychological, and behavioral aspects of the way of life of the population. (IOM, 1982:49–50)
• Health and disease are determined by dynamic interactions among biological,psychological, behavioral, and social factors. (IOM, 2001:16)
• Because health . . . is a function of psychological and social variables, many events or interventions traditionally considered irrelevant actually are quite important for the health status of individuals and populations.(IOM, 2001:27)
Issues that may need social support is a spectrum
• Recovery and longer term survival
• Target patients and family
• Recurrence/death
• Emotional turmoil
• Futility of treatment
• Exhausted treatment options
• Facing death• Farewells• Process of dying• Pain and
palliative care
Three Domains of Social Support in Cancer Management
Social support care
Emotional Support
Information sharing supportInstrumental/
Material support
Helgeson, Vicki S. and Cohen, Sheldon, "Social Support and Adjustment to Cancer: Reconciling Descriptive, Correlational, and Intervention Research" (1996). Department of Psychology. Paper 265.
Emotional Support
• Emotional support involves the verbal and nonverbal communication of caring and concern.
• It includes – listening, "being there," empathizing,
reassuring, and comforting, spiritual and psychological.
• Emotional support can help to restore self-esteem or reduce feelings of personal inadequacy by communicating to the patient that he or she is valued and loved
Informational Support
Informational support involves the provision of information used to guide or advise.
Information may enhance perceptions of control by providing patients with ways of managing their illness and coping with symptoms. Will limit socio-cultural misconception of cancer
Learning how to manage the illness also may enhance patients' optimism about the future and thus reduce feelings of future vulnerability.
Informational support also can help to ameliorate the sense of confusion that arises from being diagnosed with cancer by helping the patient understand the cause, course, and treatment of the illness.
Instrumental/Material Support
Instrumental support involves the provision of material goods: Transportation, money, or assistance with household chores.
This kind of support may offset the loss of control that patients feel during cancer treatment by providing tangible resources that they can use to exert control over their experience.
Provision of instrumental support, however, also may increase feelings of dependence and undermine self-efficacy in patients (Wortman & Dunkel-Schetter, 1987).
Strategic Operation of Social Support
Household level support
• Relatives/parentsCommunity
level support
•Cancer survivors; Spiritual leaders
Facility level support
The University of Stellenbosch Gynae-oncology Model
• The Community Outreach program has strong social support component– They are using cancer survivors at out
reach posts– Transportation for cancer patients from
outreach post to the hospital– A strong network of support group that
act as liaison between oncologist and newly diagnosed patients
Issues and Challenges in Nigeria
• It is a new concept• There will be the need for capacity building
process– Health care providers– Social support experts such as Doula that are
been used in childbirth• Competing health infrastructural demands
• Nigerian misconception about “healing and disease”
Issues and Challenges in Nigeria
• After being diagnosed with cancer people tend to loss their old social support and may have a hard time building new social support systems and may need extra help.
• The traditional African family system provided this in the past but this may not be available anymore.
• The issue of assisting cancer patients as they build their social support during management is very important
Issues and Challenges in Nigeria
• Medical professionals can also be part of individual social support system, particularly for those with severe cancer conditions. This is usually difficult as one medical professional will have to attend to so many patients. Asking questions concerning side effects they are experiencing may become difficult. (for some medications can include trouble sleeping (insomnia), sleepiness, weight gain or loss, increased anxiety, headaches, dizziness, nausea or vomiting, diarrhea, and sexual problems.)
Issues and Challenges in Nigeria
• Keeping track of changes in an individual patient’s behavior and moods may require spending a lot of time with the person to notice subtle changes and those others, such as doctors, are not able to. This calls for more social support staff for cancer management
Issues and Challenges in Nigeria
• Inadequate direct support professionals to encourage cancer patients to try new activities and assist them in building their social support systems. Training personal and developing innovative social support programmes by cancer institutions and organizations
BURNING ISSUES• How and where do patients talk about social support
or decide what they need?• Who pays for professional social support services?• How do patients find the place for social support in
Nigeria• Are social support for the patient alone?• Can family members also receive social support?• Are there research in Nigeria that shows the benefits
of social support?• Does Nigerian government finance social support
research?• Is ethnicity an important variable in help-seeking
behaviors
WAY FORWARD• Nigerian community has strong family
ties as well as robust spiritual environment and hence– Social supportive care for cancer patient is
feasible– Household and community strategic
approach is feasible• Cancer patients at every level needs
some form of social supportive care
CONCLUSIONS• Social support, whether from a trusted group or
valued individual, has been shown to reduce the psychological and physiological consequences of stress, and may enhance immune function.
• Whether formal (such as a church or social club) or informal (meeting with friends), provide a sense of belonging, security, and community.
• Social support is now proven to be a life-saver. People that are supported by close relationship, friends or family, or fellow members of church, work, or other support groups are less vulnerable to ill health and premature death.
PARTING SHOT
A major need to acknowledge, recognise and address Psychosocial Needs diagnosis, prognosis available treatments ways to manage their illness and health.
Good Communications………………………
Thank You