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PSYCHO-ONCOLOGY

dr. A.Jayalangkara Tanra, SpKJ, PhD

 .PSYCHO-ONCOLOGY Psycho-oncology mencoba mempelajari pengaruh kanker pada fungsi psikologis dan peranan variabel psikologis & behavioral pada resiko kanker dan kemungkinan bertahan hidup (Survival rate).  Penelitian psycho-oncology mrp studi intervensi yang berusaha mempengaruhi perjalanan penyakit pasien kanker.

Sementara studi lain menemukan bahwa pemberian psikoterapi menurunkan angka rekurensi dan angka mortalitas pada penderita kanker. Hasil penelitian dari David Spiegel menyatakan bahwa seorang penderita kanker yang mendapat psikoterapi akan bertahan hidup lebih lama daripada yg tidak. .

Gangguan mental yang paling sering didiagnosis/ditemukan adalah : .gangguan depresif mayor (13%) .delirium (8%) . Kurang lebih separuh dari pasien kanker mengalami gangguan mental/kejiwaan.dll .gangguan penyesuaian (68%) .

Zabora et al.49%  . 2004)  Pain .24%  Depression . Carlson et  al.26%  Fatigue .  e.. 2001.The Prevalence of Distress  Rates range from 35% to 70%  (depending on the study. country etc.g.26%  Anxiety .

or chlorotrianisene)  Hypoxia (especially in patients with pulmonary involvement or severe anemia)  Nutritional deficiencies (such as thiamine. & B12)  Infections (especially in immunosuppressed hosts)  Vascular disorders (especially in patients with coagulopathies)  Endocrine & hormonal abnormalities  . diethylstilbestrol.Medical conditions associated with delirium in cancer patients : Metabolic encephalopathy  Vital organ failure  Electrolyte imbalance (such as hypercalcemia in patients with bony metastases or those receiving tamoxifen. folic acid.

electrolyte imbalances . additive effect of narcotics and many other drugs known to cause depression. etc.Causes of mood disorders common in cancer patients :    Drugs chemotherapeutic agents such as prednisone. Tumor effects hormone-secreting tumors central nervous system tumors Associated medical conditions uremia viral encephalopathies . such as antihypertensives. dexamethasone. vincristine. etc. benzodiazepines.

anxiety. and disability  Fear of abandonment and loss of independence  Fear of disruption in relationships.  Walaupun pikiran dan keinginan bunuh diri sering muncul pada pasien kanker. anger. disfigurement. and guilt.Reaksi-reaksi psikologis seseorang yg mengetahui bhw dirinya menderita kanker : Fear of death. role functioning. . namun angka insidensnya sedikit lebih tinggi daripada populasi umum. and financial standings  Denial.

character pathology.Suicide vulnerability factors in cancer patients : Depression and hopelessness  Poorly controlled pain  Mild delirium (disinhibition)  Feeling of loss of control  Exhaustion  Anxiety  Preexisting psychopathology (substance abuse. major psychiatric disorder)  Family problems  Treats and history of prior attemps of suicide  Positive family history of suicide  Other usually described risk factors in psychiatric patients  .

Some examples of reasons for referral  Anxiety  Depression  Adjustment  Pain  Grief  Difficulties with self image  Sexual dysfunction  Relationship issues  Difficulties around treatment decisions .

activity scheduling Training in problem solving. distraction.Intervention strategies (Knight. 2004) Cognitive Behavioural Therapy (CBT) : Depression and conditioned aversive responses Supportive and expressive therapies: exploration meaning. expression of emotion Behavioural techniques: relaxation. coping . assertiveness.

utamanya bila pernah terjadi konflik dalam keluarga. .Kesimpulan  Dokter harus hati-hati dalam menilai tanda-tanda psikiatrik dan medik pada setiap pasien kanker. dan family exhaustion. family abandonment.  Perhatian khusus harus diberikan kepada faktor keluarga.