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Professional Caregivers

157731476_47There are many reasons you and your loved one should consider working with a counselor. For example, people with head and neck cancer may experience anxiety or depression during the cancer journey. Researchers evaluated 60 patients with head and neck cancer after completing radiation therapy and found that 20 percent had depression.1Bjordal K, Kaasa S. Psychological distress in head and neck cancer patients 7-11 years after curative treatment. Br J Cancer. 1995 Mar;71(3):592-7.

How professional interventions can help

Researchers have evaluated the benefits of various types of education/counseling for caregivers and/or for people with cancer, which are listed below. Read the list, identify areas that you think may help you and, when you seek counseling services, request help in those areas:

  • Improved coping strategies: You both may experience emotional distress during the cancer journey. A contributing factor to emotional distress can be a passive coping style.2Verdonck-de Leeuw IM, Eerenstein SE, Van der Linden MH, Kuik DJ, de Bree R, Leemans CR. Distress in spouses and patients after treatment for head and neck cancer. Laryngoscope. 2007 Feb;117(2):238-41. Some people under stress may avoid dealing with a challenge or deny a particular problem’s existence. This can also happen to caregivers, and counseling can help you recognize when you may be avoiding or denying the challenges associated with caregiving and provide you with active problem-solving methods you can use. Sometimes just a few counseling sessions—with the goal of developing proactive coping strategies—lead to improvements for several months.3Northouse LL, Mood DW, Schafenacker A, et al. Randomized clinical trial of a family intervention for prostate cancer patients and their spouses. Cancer. 2007 Dec 15;110(12):2809-18.
  • Improved confidence: Even a few counseling sessions over the course of a few weeks can improve confidence in caregiving abilities for several months.Maintaining confidence as a caregiver can help you maintain your quality of life over time.4Nijboer C, Triemstra M, Tempelaar R, Sanderman R, van den Bos GA. Determinants of caregiving experiences and mental health of partners of cancer patients. Cancer. 1999 Aug 15;86(4):577-88.
  • Reduced anxiety: You are likely to experience anxiety during the cancer journey. Researchers found that up to 40 percent of cancer caregivers experienced anxiety, and that counseling reduced or eliminated anxiety.3, Northouse LL, Mood DW, Schafenacker A, et al. Randomized clinical trial of a family intervention for prostate cancer patients and their spouses. Cancer. 2007 Dec 15;110(12):2809-18.5, Janda M, Steginga S, Langbecker D, Dunn J, Walker D, Eakin E. Quality of life among patients with a brain tumor and their carers. J Psychosom Res. 2007 Dec;63(6):617-23.6Badger T, Segrin C, Dorros SM, Meek P, Lopez AM. Depression and anxiety in women with breast cancer and their partners. Nurs Res. 2007 Jan-Feb;56(1):44-53.
  • Improved family relationships: It’s not unusual for a cancer patient’s partner to act as his or her caregiver. It’s also not uncommon for a patient to become uncomfortable with his or her appearance after head or neck surgery. This discomfort can disrupt the couple’s sexual relationship. Counseling has been shown to improve this relationship for a few months, and repeated counseling has been shown to sustain this improvement.3Northouse LL, Mood DW, Schafenacker A, et al. Randomized clinical trial of a family intervention for prostate cancer patients and their spouses. Cancer. 2007 Dec 15;110(12):2809-18.
  • Cessation of smoking or excessive alcohol consumption: Your loved one might need help to stop smoking or drinking excessively. Researchers assessed patients who were newly diagnosed with head and neck cancer and found that approximately 40 percent of the people had alcohol dependence or abuse.7Kugaya A, Akechi T, Okuyama T, et al. Prevalence, predictive factors, and screening for psychologic distress in patients with newly diagnosed head and neck cancer. Cancer. 2000 Jun 15;88(12):2817-23. Counseling services can help a person with head and neck cancer to stop smoking and/or consuming excessive amounts of alcohol, which can reduce the risk factors for developing additional tumors.8, American Cancer Society (ACS). Cancer Facts and Figures 2012. Atlanta, GA: American Cancer Society, Inc. 2012.9Breitbart W, Holland J. Psychosocial aspects of head and neck cancer. Semin Oncol. 1988 Feb;15(1):61-9.

Best practices for counseling

Researchers evaluated outcomes for both the person with cancer and the caregiver and found that both will achieve best outcomes if counseling is done together.10, Northouse L, Williams AL, Given B, McCorkle R. Psychosocial care for family caregivers of patients with cancer. J Clin Oncol. 2012 Apr 10;30(11):1227-34.11Scott JL, Halford WK, Ward BG. United we stand? The effects of a couple-coping intervention on adjustment to early stage breast or gynecological cancer. J Consult Clin Psychol. 2004;72(6):1122-1135.

If your friend or family member does not want to seek professional services, you can still seek these services for yourself. Counseling for the caregiver alone has demonstrated benefit.3Northouse LL, Mood DW, Schafenacker A, et al. Randomized clinical trial of a family intervention for prostate cancer patients and their spouses. Cancer. 2007 Dec 15;110(12):2809-18.

If there are barriers to seeking counseling, it can be a good idea to discuss your needs with a mental health specialist. Alternatives to traditional counseling include phone therapy sessions, which have been shown in six-week increments to reduce anxiety and depression among patients and their caregivers.6Badger T, Segrin C, Dorros SM, Meek P, Lopez AM. Depression and anxiety in women with breast cancer and their partners. Nurs Res. 2007 Jan-Feb;56(1):44-53.

Support groups

You both may want to consider joining a support group. Support groups are typically small, with perhaps 10 to 12 members, and most members will have a similar disease state or caregiving role.12Meier A, Lyons EJ, Frydman G, Forlenza M, Rimer BK. How cancer survivors provide support on cancer-related Internet mailing lists. J Med Internet Res. 2007 May 14;9(2):e12.Katz MR, Kopek N, Waldron J, Devins GM, Tomlinson G. Screening for depression in head and neck cancer. Psychooncology. 2004 Apr;13(4):269-80. Studies have demonstrated that people’s quality of life improves if they participate in a support group.13Ashbury FD, Cameron C, Mercer SL, Fitch M, Nielsen E. One-on-one peer support and quality of life for breast cancer patients. Patient Educ Couns. 1998 Oct;35(2):89-100.

There are other alternatives besides a live support group. Another option is participating in online communities specific to the disease state.12Meier A, Lyons EJ, Frydman G, Forlenza M, Rimer BK. How cancer survivors provide support on cancer-related Internet mailing lists. J Med Internet Res. 2007 May 14;9(2):e12.Katz MR, Kopek N, Waldron J, Devins GM, Tomlinson G. Screening for depression in head and neck cancer. Psychooncology. 2004 Apr;13(4):269-80. Your loved one may become uncomfortable with his or her appearance post-surgery, which can lead to isolation from people.14Gaziano JE. Evaluation and management of oropharyngeal Dysphagia in head and neck cancer. Cancer Control. 2002 Sep-Oct;9(5):400-9. Online communities permit members to participate and receive or give support, yet remain anonymous.12, Meier A, Lyons EJ, Frydman G, Forlenza M, Rimer BK. How cancer survivors provide support on cancer-related Internet mailing lists. J Med Internet Res. 2007 May 14;9(2):e12.Katz MR, Kopek N, Waldron J, Devins GM, Tomlinson G. Screening for depression in head and neck cancer. Psychooncology. 2004 Apr;13(4):269-80.15Ziebland S, Chapple A, Dumelow C, Evans J, Prinjha S, Rozmovits L. How the internet affects patients' experience of cancer: a qualitative study. BMJ. 2004 Mar 6;328(7439):564.

Exercise programs

Researchers found that participating in an exercise program can decrease the levels of anxiety in both cancer patients and their caregivers.6Badger T, Segrin C, Dorros SM, Meek P, Lopez AM. Depression and anxiety in women with breast cancer and their partners. Nurs Res. 2007 Jan-Feb;56(1):44-53. Consider an exercise program in conjunction with counseling if either of you is experiencing high levels of anxiety.

These nurses, they do much, much more than provide medical care. They are counselors and friends at the same time. Lynn H. (wife of a tongue cancer survivor)

References

1 Bjordal K, Kaasa S. Psychological distress in head and neck cancer patients 7-11 years after curative treatment. Br J Cancer. 1995 Mar;71(3):592-7.

2 Verdonck-de Leeuw IM, Eerenstein SE, Van der Linden MH, Kuik DJ, de Bree R, Leemans CR. Distress in spouses and patients after treatment for head and neck cancer. Laryngoscope. 2007 Feb;117(2):238-41.

3 Northouse LL, Mood DW, Schafenacker A, et al. Randomized clinical trial of a family intervention for prostate cancer patients and their spouses. Cancer. 2007 Dec 15;110(12):2809-18.

4 Nijboer C, Triemstra M, Tempelaar R, Sanderman R, van den Bos GA. Determinants of caregiving experiences and mental health of partners of cancer patients. Cancer. 1999 Aug 15;86(4):577-88.

5 Janda M, Steginga S, Langbecker D, Dunn J, Walker D, Eakin E. Quality of life among patients with a brain tumor and their carers. J Psychosom Res. 2007 Dec;63(6):617-23.

6 Badger T, Segrin C, Dorros SM, Meek P, Lopez AM. Depression and anxiety in women with breast cancer and their partners. Nurs Res. 2007 Jan-Feb;56(1):44-53.

7 Kugaya A, Akechi T, Okuyama T, et al. Prevalence, predictive factors, and screening for psychologic distress in patients with newly diagnosed head and neck cancer. Cancer. 2000 Jun 15;88(12):2817-23.

8 American Cancer Society (ACS). Cancer Facts and Figures 2012. Atlanta, GA: American Cancer Society, Inc. 2012.

9 Breitbart W, Holland J. Psychosocial aspects of head and neck cancer. Semin Oncol. 1988 Feb;15(1):61-9.

10 Northouse L, Williams AL, Given B, McCorkle R. Psychosocial care for family caregivers of patients with cancer. J Clin Oncol. 2012 Apr 10;30(11):1227-34.

11 Scott JL, Halford WK, Ward BG. United we stand? The effects of a couple-coping intervention on adjustment to early stage breast or gynecological cancer. J Consult Clin Psychol. 2004;72(6):1122-1135.

12 Meier A, Lyons EJ, Frydman G, Forlenza M, Rimer BK. How cancer survivors provide support on cancer-related Internet mailing lists. J Med Internet Res. 2007 May 14;9(2):e12.Katz MR, Kopek N, Waldron J, Devins GM, Tomlinson G. Screening for depression in head and neck cancer. Psychooncology. 2004 Apr;13(4):269-80.

13 Ashbury FD, Cameron C, Mercer SL, Fitch M, Nielsen E. One-on-one peer support and quality of life for breast cancer patients. Patient Educ Couns. 1998 Oct;35(2):89-100.

14 Gaziano JE. Evaluation and management of oropharyngeal Dysphagia in head and neck cancer. Cancer Control. 2002 Sep-Oct;9(5):400-9.

15 Ziebland S, Chapple A, Dumelow C, Evans J, Prinjha S, Rozmovits L. How the internet affects patients' experience of cancer: a qualitative study. BMJ. 2004 Mar 6;328(7439):564.