health psych exam 4

cancer

a group of diseases characterized by the presence of new cells that grow and spread beyond control

any cell capable of division can transform into it (all plants and animals susceptible)

tumors

consist of group of cells

neoplastic tissue cells

most common

have nearly unlimited growth that can rob host of nutrients and provide no beneficial effects

can be benign or malignant

benign cells

remain localized

malignant cells

spread and establish secondary colonies

invade other tissues and break down the body

four main groups of malignant growths

carcinomas

sarcomas

leukemias

lymphoma

carcinomas

cancers of epithelial tissue

sarcomas

cancers of connective tissues (bone muscles cartilage)

leukemias

cancers of the blood

lymphoma

cancers of lymphatic system, less common

cancer death peak

1991 after 100 years of rising deaths

gradual decline in death rates since then

why cancer death rates are decreasing

improved treatments part of it

lung cancer rates have dropped

diets have improved

more physical activity

cancers that account for about half of all cancer deaths in the US

lung, breast, prostate, and colorectal

mortality rates for these is declining

stomach cancer

gone from being the cancer with the highest mortality rate to the lowest

liver cancer

incidence and mortality rate is growing

melanoma (potentially fatal form of skin cancer)

increasing but death rate is falling due to improved treatment options and early detection

thyroid cancer

increasing rates in men

falling in women

pancreatic cancer

increasing and highly lethal

inherent risk factors for cancer

ethnicity, advancing age, family history/genetics

ethnicity in cancer

can play a big part in risk where:

African Americans have poorer outcomes than European Americans (higher rates of nearly every cancer and higher mortality rates)

asian Americans, native Americans, and hispanic Americans all have lower cancer rates than European Americans

advancing age

increase risk for everybody as the chances of developing and dying of cancer goes up as we age

family history and genetics

can play an important role in factoring your risk

of all cancers, 5% to 10% are due to inherited genetic mutations

enviornmental risks

exposure to radiation, asbestos, pollutants (pesticides, herbicides, motor exhaust, other chemicals)

radon

a natural radioactive gas

can cause lung cancer in miners and in homes that have high amounts of this gas leaking up through the ground

some diseases

may increase risk for certain cancers, as well as chronic information and chronic infections

incidence of cancer in young adults

72,000 diagnosed with cancer each year (15-39) (in the US every 8 minutes)

6-8x more common than all pediatric cancers combined

most common cancers among young adults

leukemia and lymphoma

germ cell

CNS

thyroid

melanoma of the skin

bone tumors

soft tissue and kaposi sarcoma

mortality of cancer in young adults

approx 9000 YA die each year

accounts for approximately 10% of deaths (4th leading cause of death)

survival rates for YA have not much changed in the past decade (although improvements in other age groups)

why mortality rates in YAs

delayed diagnosis

limited understanding of the biology and etiology of cancers in this pop

low access to and participation in clinical trials

unique psychosocial and supportive care needs

physical health among breast cancer survivors

poor self rated health is a risk factor for many chronic conditions among survivors

30% of all suffer from pain and fatigue that can persist for years

inflammation promotes tumor initiation, metastases, pain, and fatigue

does psychological distress influence self rated health and physical symptoms among breast cancer patients and survivors

sample 1 between surgery and treatment

sample 2 between treatment and survivorship

• pain higher, fatigue higher, general health and sleep quality generally the same

behavioral risk factors for cancer

not necessarily cause of disease, but do predict likelihood of development or mortality

most cancer risk factors relate to behavior and lifestyle

specifically smoking and diet

behavioral risk factors for cancer

smoking and diet

alcohol, physical inactivity, exposure to UV light, sexual behavior, psychosocial factors

smoking and cancer

cause of 1 out of 3 cancer deaths in the US

single largest risk for cancer mortality worldwide

clear link in lung cancer rates, 25x more likely to get lung cancer

perceived risk is seen as much lower for those who smoke, optimistic bias concerning chances of dying from cigarette related causes

marijuana and cancer risk

evidence is mixed, largely because its a new area of study

some research suggests more damaging to tissue than tobacco due to how it is smoked, how long it is inhaled for, etc

smoke contains same cancer causing agents and tobacco

diet and cancer risk

carcinogenic foods, almost always because or contaminants or additives (preservatives)

certain fungi may grow on natural foods have been linked to stomach cancers

high fat diet can raise cholesterol levels, risk for testicular cancer in men

obesity shown to increase factors of esophageal, breast, endometrium, and kidney cancers

processed sugars, non-complex carbs may enhance cancer risk vis indirect and direct pathways

foods that may protect against cancer

adequate amount of fruits and vegetables less likely to develop (mediterranean diet especially protective)

may reduce risk of stomach cancer 19%, esophageal 20%, lung 12%, colorectal 2%

alcohol and cancer

not as strong as smoking or eating imprudent diet

can increase risk of cancers of mouth, esophagus, breast, and liver

liver has primary responsibility for detoxifying alcohol, excessive/persistent use leads to cirrhosis of liver where cancer is more likely to develop

risk varies by exposure and not equal in all countries

people who smoke and drink heavily have very high risks for certain cancers exceeding that of two independent risk factors together

sedentary lifestyle and cancer

increases risk for some types including colon, endometrium, breast, lung, and pancreas

physical activity can reduce risk for these cancers

indirectly, benefits of weight loss associated with increased physical activity also lowers risk of cancers associated with obesity

intervention research shows 30 minutes of daily activity can reduce cancer risk

UV light exposure and cancer

well known cause of skin cancer

cumulative and occasional sever sunburns relate to risk of skin cancer

risk has risen in the US since the mid 1970s though mortality is generally low

malignant melanoma: most fatal form of skin cancer, often light skinned people,.much damage that eventually leads occurs during childhood

also strong genetic component

right amount of sun can be helpful (vitamin d production) and vitamin d can lower risk associated with many cancers

skin cancer and skin tone

white fair skinned individuals at greatest risk for skin cancer due to UV exposure

darker skin tones can still get sunburnt and still develop cancer due to UV exposure

sunscreen is recommended for all individuals

sexual behaviors and cancer

also contribute to cancer deaths, especially cancers resulting from AIDS (kaposis sarcoma nd non-hodgkins lympnoma)

exposure to HPV increases risk for cervical and oral cancer

HYP is necessary for development of cervical cancer, but not everyone will develop

RISKY sexual behavior is most/biggest serious risk factor for cancer

risky sexual behavior and cancer

having many sexual partners increases risk, but only if not safe sex

not wearing condoms associated with increased risk for STIs HPV etc which increases cancer risk

untreated STIs can lead to cancer development due to replication of abnormal or damaged cells

having multiple partners at one time can increase risk

psychosocial risk factors and cancer

no major findings that link personality traits to increased risk

factors show the strongest relationship come from negative emotionality and tendency to repress emotion

evidence between personality and cancer is weak

living with cancer

fear, anxiety and anger

often treatment is worse than the course the disease would take on its own

social support is necessary for patients to increase likelihood of survival

psychologists can assist patients in how to cope with their diagnosis and treatment while also providing emotional support

depression and anxiety throughout cancer trajectory

typically highest at point of diagnosis

tend to reduce over time

anxiety heightens around time of scans, oncology visits, etc

persistent anxiety and cancer

fear of cancer recurrence

adjustments to life with cancer or in survivorship

depression and cancer

hopelessness

thoughts that life will never return to normal

grief around life prior to cancer

problems with medical treatments for cancer

surgery, radiation, chemotherapy all have side effects- painful, unpleasant, long lasting

oncologists recently have added hormonal treatment and immunotherapy to their arsenal

surgery is most common treatment recommended for non-metastasized, recover time and emotional toll can be difficult

radiation may have severe side effects including burns, hair loss, nausea, vomiting, fatigue, sterility

chemotherapy shares many side effects with radiation and can cause additional stress on patient and their social support group

adjusting to a diagnosis of cancer

a challenge but some better than others

factors that include a poor reaction to a diagnosis include negative emotionality and social inhibition

optimism is strongly related to adjusting well due to diagnosis, but relationship to long term outcomes less clear

due to lack of evidence its recommended “people with cancer should not feel pressured into adopting particular coping styles to improve survival or reduce the risk of recurrence” (Petticrew et al)

social support for cancer patients

marriage reduces chance of dying men by 27% and women by 19%

emotional support of partner more important than economic benefits and better healthcare options

peer support groups are helpful to those who dont have marital support, poor marital support (people with strong marital support didn’t get as much out of support groups)

psychological interventions for cancer patients

group and individual therapy can help cope with a diagnosis

effective intervention should accomplish at least one out of two: improve emotional wellbeing, increase survival time, or both

generally yield short term benefits

may focus on cognitive behavioral stress management skills or focus on providing social support and opportunity to express emotions

CBT has shown significantly decreased depression in breast caner survivors

no one size fits all, find what works best

coronary arteries

supply blood to the heart muscle, the myocardium

when the heart beats

it twists potentially damaging the coronary arteries

if they heal correctly there is no issue, but buildup of plaque which include cholesterol, lipids, and connective tissues can thicken artery walls and constrict blood flow to the heart

arteriosclerosis

occurs when the arteries harden and lose their ability to be flexible

coronary artery disease (CAD)

damage to the coronary arteries through atherosclerosis or arteriosclerosis

no outward symptoms when this begins to occur

ischemia

plaque narrow the arteries and restrict blood supply to the myocardium

plaque deposits may rupture obstructing the artery and blocking blood to the heart

coronary heart disease (CHD)

any damage to the myocardium from insufficient blood supply

heart attack

a myocardial infraction is a medical term for when a coronary blockage results in the death of myocardial tissue

stroke and blood pressure

atherosclerosis and arteriosclerosis can affect the arteries of head and neck, restricting blood supply to the brain resulting in a possible stroke

if blood to certain part of brain is restricted or blocked, lack of oxygen to that portion of the brain results in cell death

5th most frequent cause of death in the US

can also be caused by air bubble or disease

high blood pressure (hypertension) is good way to predict heart attack or stroke

medication and lifestyle changes are best way to lower high blood pressure

death rates for CVD

despite reductions, remains the leading cause of death worldwide

inherent risk factors

result from genetic or physical conditions that cannot be readily modified

does not mean destined to get, being identified can help those people know what to look for and what changes to make in their own life to avoid

inherent risk factors in CVD

advancing age is primary risk for CVD

family history, people who have family history of CVD are more likely to end up with it

gender: men at greater risk, men often diagnosed 8-10 years earlier, women more likely to die from first heart attack, women more likely to suffer from ‘atypical’ symptoms including fatigue, nausea, and shortness of breath

race and ethnicity Africa Americans in the US have 30% greater risk for cardiovascular death than white Americans. native, asian, and hispanic Americans have lower rates

physiological conditions in CVD

hypertension

serum cholesterol level

problems in glucose metabolism

inflammation

hypertension

single most important risk factor for CVD

produces no overt symptoms, and sudden spike can occur with no warning

serum cholesterol level

level of cholesterol circulating through the blood stream

related, not perfectly, to dietary cholesterol

LDL cholesterol is referred to as bad, HDL is considered good

inflammation

part of atherosclerosis

when tissue is damaged, white blood cells migrate to injury and defend against potential invaders

when white blood cells arrive, if the serum levels of cholesterol are high, cholesterol will be high in white blood cells

the plaque that forms inside arterial walls are collected white blood cells

behavioral factors in CVD

lifestyle can contribute to risk of CVD:

smoking

weight and diet

physical activity

smoking and CVD

leading behavioral risk factor for cardiovascular death in the US

accounts for about 35% of risk for heart attack worldwide

weight and diet

can increase risk factors of CVD

obesity as independent risk for CVD is difficult as obesity is related to other risks such as blood pressure, type 2 diabetes, total cholesterol, LDL, and triglycerides

diets high in sodium may contribute to higher risk however potassium intake will decrease risk

physical activity and CVD

important in reducing risk of CVD

owning a television and car both increase risk because they reduce

psychosocial factors and CVD

educational level and income

social support and marriage

stress anxiety and depression ‘

hostility and anger

anger and cardiovascular reactivity

suppressed anger

educational level and income and CVD

often linked together as SES

low SES increases risk factors

social support and marriage and CVD

the better social support one has, the less likely they are to die of CVD

marriage as form of social support, shows reduced risk of CVD in married couples

stress anxiety and depression and CVD

big effect on CVD rates and on each other

people who had heart attacks also experienced more work and financial stress

more work related stress led to an increase in hypertension over the course of 8 years

anxiety and depression can predict development of CVD and its progression

hostility and anger and CVD

found to be indicative of CVD risk

how a person reacts to their anger could be a CVD predictor

anger and cardiovascular reactivity and CVD

linked due to increased blood pressure and heart rate due to frustration, harassment, or laboratory stress task

suppressed anger and CVD

could be more toxic than forcefully expressing it

can ruminate over what made them angry, creating a cycle of repetitive thoughts that could lead to more damage from constant stress than one outburst

preventing first heart attacks

reducing hypertension will lower risk significantly

lowering serum cholesterol through dietary changes, increased exercise, drug therapy, or combination can help

modifying psychosocial risk factors such as lowering stress, anxiety, anger, and depression can lower risk factors

rehabilitating cardiac patients

cardiac rehabilitation program to help change lifestyle and lower risk of additional complications after being diagnosed with CVD

will help patients stop smoking, change their diets, and show how to get physical activity daily

adherence is major problem with these programs

anxiety and depression most common psychological symptoms experienced following treatment or diagnosis

physiology of diabetes

disorder caused by insulin deficiency

islet cells of pancreas produce several hormones including insulin

job of insulin is to lower blood sugar levels when they get too high

preventing release of insulin (diabetes) resulting in the body being unable to absorb and use the sugar

type 1 diabetes

insulin dependent- patient requires insulin to be added to their blood

onset often occurs before age 30

weight is not a factor

caused primarily by genetics

no SES correlation

kidney damage (overworking to filter glucose and damages blood vessels)

5% of diabetics

type 2 diabetes

most common and often result of lifestyle and SES

being sedentary, poor, and overweight (70%) increase the risk of developing type 2 diabetes

can occur any time

related to overweightness

cardiovascular damage (strains heart and damages blood vessels)

90-95% of diabetics

gestational diabetes

body produces more hormones and gains weight during pregnancy, leading to insulin resistance

more likely to develop type 2, can increase birthweight

pre diabetes

higher than normal glucose levels but not quite high enough to qualify as type 2

disparities in diabetes

type 2 more common in non-white people

men are more likely to develop type 2

hyperglycemia

high blood sugar

short term complications: blurred vision, fatigue, frequent urination, increased thirst, nausea or vomiting, rapid breathing

long term complications: nerve damage (weakens walls of blood vessels and interferes with signal sending), kidney damage or failure, blindness, coma, death

diabetic ketoacidosis (DKA): buildup of ketones in blood, liver breaks down fat which produces ketones

more dangerous in long term

hypoglycemia

low blood sugar

short term complications: confusion, hunger, shaking, sweating, weakness, seizures, coma

long term complications: hypoglycemia unawareness, acquired brain injury

more dangerous in short term

type 1 diabetes management

insulin (shots, pump)

blood sugar monitoring (meter, continuous glucose monitor)

frequent endocrinology appts

dietitian appts (carbohydrate counting)

type 2 diabetes management

lifestyle changes (diet, exercise)

pills (metformin)

insulin shots (mixed insulin)

doctor/dietician appts

bariatric surgery

health psychology involvement with diabetes

stress pays two potential roles in diabetes: possible cause of diabetes and factor in blood sugar regulation

little evidence linking stress as cause, but stronger evidence that stress affects glucose metabolism and control (stress shown small but significant effect on blood sugar levels)

depression has been shown raise blood glucose levels (negative emotions can adversely affect diabetes)

eating disorders and diabetes (binge eating in type 2, bulimia and insulin omission in type 1)

social support and accurate information are important for diabetes control

diabetes and sleep

specific diabetes routines improves treatment adherence

poor sleep quality is associated with higher blood pressure sugars/poor treatment adherence

physiology and weight

stable weight occurs when energy intake (calories) is equal to energy output (physical activity)

if this is imbalanced either weight gain or weight loss occurs

metabolic weight

how and when we eat is in part controlled by chemicals in our body

leptin, insulin, ghrelin

leptin

protein that signals when more food is needed

insulin in physiology

helps hypothalamus understand when we have eaten enough

ghrelin

stimulates the appetite and decreases metabolism

why are some people obese

setpoint model

genetic explanations

positive incentive model

setpoint model

states that the body has an internal thermostat that determines what a persons bodyweight should be

even when an individual loses weight, the body remembers the set point and will activate leptin and ghrelin to try and get the body back to the ‘ideal’ weight

genetic explanations of obesity

link weight to genetics

one a time when humans needed too tore more fat to survive and so we have evolved to have a “thrifty” metabolism, storing fat when were able to