Module 12a - Life Threatening Illness

What has happened to life expectancy since the pandemic?

Life expectancy has gone down .6 years compared to pre pandemic and only in 2023 has stopped that trend but it hasn’t gone up to where it was pre pandemic

Leading causes of death

Cancer

Heart Diseases

Injuries/accidents

Cerebrovascular diseases

Chronic respiratory diseases

Adapting (coping - classifications)

Coping often switches from emotion to problem-focused

Coping strategies:

1. Behavioural

2. Cognitive

3. Role of family and close others

Coping Classifications - Behavioural Adjustments 

Lifestyle changes - diet, exercise, etc 

Developing regular activities 

Coping Classifications - Cognitive Adjustment

Using positive reappraisal strategies to improve psychosocial functioning

• Fining meaning in illness

  • Post traumatic growth

• Gaining a sense of control over illness

  • Taking control over health

• Restoring self-esteem

  • Comparisons to other less fortunate people

    • “I have a heart condition, but thats better than x, y, z"

Coping Classifications - Role of family and close others

• Low perceived social support related to poor adjustment

• Cycle of dependence can emerge due to patient helplessness

• Self help and support groups can help cope

  • Sense of common humanity 

Coronary Heart Disease Definition 

Illnesses that result from the narrowing and blocking of the coronary arteries, which supply the heart with O2 rich blood

Definitions associated with coronary heart disease:

Atherosclerosis: thickening or hardening of the arteries

Angina Pectoris: pain associated with restricted O2 flow

Myocardial infraction: heart attack

Symptoms of a heart attack

**different for different people

Most common = chest pain and discomfort

Women = sometimes no chest pain

Pressure, tightness, pain, squeezing, aching in chest, arms, neck, jaw or back

Nausea, indigestion, heartburn, abdominal pain

Shortness of breath

Cold sweat, fatigue, feeling lightheaded and dizzy

Coronary Heart disease Non-modifiable risk factors

Age: +45 increased risk 

Sex and gender 

Ethnicity: African Americans, indegnous community 

Genetics and family history 

Coronary Heart disease Modifiable risk factors

Hypertension

Cigarette smoking

Physical activity

Diabetes

Obesity

Coronary Heart disease Modifiable psychosocial risk factors

Hostility

Mental Illness

Stress

Low social support

Treatment delay

**because less likely to partake in health promoting behaviours

Therefore, Coronary Heart disease is influenced in a biopsychosocial way

Coronary Heart Disease - positive factors 

Regular exercise 

• Strengthens heart muscles, pumping ability 

• More blood flow, O2 increases, capillaries widen 

Optimism 

• Women in Women’s Health Initiative: those who were optimistic had a 30% lower rate of caridac mortality 

Why are women protected at younger ages relative to men

Higher levels of HDL

Estrogen diminishes Sympathetic nervous syetm arousal

Higher risk of CHD after menopause

Less research, media attention, diagnosis and treatment

Different reporting of symptoms

Types of treatment for CHD - Medical Treatment

Atherosclerosis - narrowing of arteries

• balloon angioplasty - opening vessels

• Bypass surgery - shunt in to redirect blood flow through healthier vessels

Heart Attach

• Role of delay = medical intervention is dependant on this

• Clot-dissolving medical frees blocked arteries

• Angioplasty or bypass

Accompanied by strong emotional reactions

• High anxiety or denial

• Worse if prior distress = can impair recovery

CHD - Rehab

Promote recovery adn reduce risk factors

• provide information

• Advocate lifestyle changes

  • Workout

  • Quit smoking

  • Dietary changes

  • stress management

• Adherence is variable and affected by

  • Self-efficacy - those who believe they can get better = more adherence

  • Social support

  • Motivation

Psychosocial consequences of CHD

Work

• Most return to work within 1 year

Family Relationships

• Cardiac patients with strong social support recover faster and survive longer BUT

• Family may promote cardiac invalidism - CHD person becomes too dependant on support system and looses sense of control 

• Prior family problems may be exacerbated by the heat attack 

Psychosocial Intervention and CHD

Can reduce mortality by 25% in first two years

Education

Counselling

Stress management

Multi-component

Timing of the intervention matters - right away is bad because denial and emotion focused coping

Best time = 2+ months after when shifting to problem focused coping

Attendance matters

Cancer definition

Disease of the cells characterized by uncontrolled cell proliferation that usually forms a malignant tumor

Cancer cells do not adhere to each other as strongly as other cells, more easily spread (metastasize) through blood or lymph system

Five types of cancer

1. Carcinomas - starts in skin cells or lining of organs 

2. Melanomas - starts in melanin of skin 

3. Lymphomas - immune cells (WBC)

4. Sarcomas - tumors in bonds, fat, muscles, connective tissues, cartilage anywhere in body 

5. Leukemias - Cancer of blood, circulating not forming solid 

Physica effects fo cancer

Proliferation of cancer cells at each site interferes with normal cell development and functioning

Produces pain as it creates pressure on tissues and nerves and blocks flow to body fluids

Most experience severe pain in later stages

Cancer death routes - Direct

Spreading to vital organ and taking nutrients the organ needs causing organ to fail

Cancer death routes - indirect

By weakening the person, impairing appetite and immune functioning

Cancer prognosis and causes 

Causes involve an interplay of genetic and environmental factors 

Prognosis depends on the site and on how early the cancer was detected 

** dependant on what type of cancer and time period

Cancer Non-modifiable risk factors

Genetics/family history - unclear how much is genetic vs upbringing/lifestyle

Sex/gender - Males = prostate cancer, breast cancer = women

Age - increasing age = increasing incidence

Ethnicity - Indigenous community - less access to health care systems

Cancer Modifiable risk factors

Lifestyle factors 

• smoking 

• stress

• diet 

• Alcohol 

• physical inactivity 

• UV radiation (sun) 

• Chemical hazards 

• Viral infection (HPV = cervical cancer) 

Diagnosing and Treating Cancer

Physician tests for breast, colon, prostate, skin, testes, cervix 

Self-adminstered testing for some cancers - breast, skin, testes 

Warning Signs of Cancer

C hange on bowel or bladder habits

A sore that does not heal

U nusal bleeding discharge

T hickening or lump in the breast or elsehwere

I indigestion or difficulty swallowing

O bious change in wart or mole

N agging cough or hoarseness

CAUTION

Diagnostic Procesures

Indicators = blood and urine tests for abnormal level so hormones or enzymes

Radiology imaging (x-ray, CT scan, MRI) to look for tumors

Biopsy - analysis of suspicious tissue

Age and Cancer Treatments 

Age often inappropriately affects treatment choice with those over 60 receiving less radiation and chemotherapy (from doctor and patient perspective)

Cancer Treatment Options

Surgery

• If cancer is localized

Radiation (specific target)

• External beam therapy

• Internal radiation therapy

Chemo

• Oral or injection drugs targeted at cells the reproduce rapidly

Side effects and Problems of Cancer

Physical side effects: 

• Nausea, fatigue, burning, loss of appetite, sterility, bowel/bladder dysfunction, reduced bone marrow function

Anxiety in anticipation of treatment

Adherence is good among most adults, but not for adolescents or minority groups

Psychosocial Impact of Cancer

Cancer is associated with pain, disability and disfigurement

Threat of recurrence - fear

Treatment is aversive

Prognosis is poorer for those who do not cope well

Most adapt well - most difficult in early months or when symptoms worsen or recur, or with disability and pain

Psychosocial Impact of Cancer - IMPACTS what?

Physical condition 

Site of cancer, age and gender

Impact on emotions 

Most problems are transitory 

Impact on relationships 

Withdrawal from social support 

Psychosocial Impact - COPING with Cancer

Positive patterns of coping (better adjustment)

• Seeking or using social support

• Focusing on the positive

• Distancing → people in study viewed it as a challenge

Negative patterns of coping (poorer adjustment)

• Cognitive escaping = avoiding

• behaviour espcaping = avoidng

Psychosocial Interventions of Cancer 

Cognitive-behavioural approaches, mindfulness-based stress reduction, exercise, writing and expressive disclosure 

Psychotherapeutic interventions 

• Individual therapy 

• Family therapy 

• Group interventions 

• Support groups 

GOAL: to help patients and families cope