| Each year millions of Americans are
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| | symptoms to help the patient control pain
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| diagnosed with cancer. Nearly 500,000 of
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| | and remain comfortable, and will help the
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| those will be diagnosed with breast or
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| | patient and his or her family members
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| prostate cancer. Many of our patients
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| | maintain dignity.
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| will have, or have had cancer. It is
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| | When the depression or anxiety is being
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| important to understand the range of
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| | made worse by symptoms or medication, the
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| emotions, causes of distress and
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| | counselor can advocate for the client,
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| interventions available to help them.
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| | help the client communicate with his/her
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| There are many things that affect how a
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| | physician and educate the client about
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| patient adjusts to cancer. It is
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| | possible interventions.
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| difficult to predict how a person will
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| | Fatigue
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| cope. The following factors influence how
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| | Fatigue occurs in 14% to 96% of people
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| a patient adjusts to cancer: The type of
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| | with cancer, and has physical,
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| cancer, cancer stage, and chance of
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| | psychological, and behavioral causes.
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| recovery.
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| | People with cancer may describe it in
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| The phase of cancer such as newly
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| | different ways, such as saying they feel
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| diagnosed, being treated, in remission,
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| | tired, sluggish, weak, exhausted, weary,
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| or recurrent cancer.
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| | worn-out, heavy, or slow. To be treated
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| Individual coping abilities.
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| | effectively, fatigue related to cancer
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| Friends and family available to support
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| | and cancer treatment needs to be
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| the patient.
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| | distinguished from other kinds of
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| The patient's age.
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| | fatigue.
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| The availability of treatment.
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| | Fatigue can become a very important issue
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| Beliefs about the cause of cancer.
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| | in the life of a person with cancer. It
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| Adjusting to a diagnosis of cancer is an
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| | may affect the person's self-esteem, his
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| ongoing process in which the patient
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| | or her daily activities and relationships
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| learns to cope with emotional distress,
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| | with others, and whether he or she
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| solve cancer-related problems, and gain
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| | continues treatment. Some of these
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| control over cancer-related life events.
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| | treatments may include adjusting the
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| To add to the stress, patients are faced
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| | dosages of pain medications,
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| with many challenges that change as the
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| | administering red blood cell transfusions
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| disease and its treatment change. There
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| | or blood cell growth factors, diet
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| are, however, certain predictable times
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| | supplementation with iron and vitamins,
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| when a patient is more likely to
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| | use of antidepressants or stimulants,
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| experience significant crisis. These
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| | exercise, and helping the patient
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| include hearing the diagnosis, receiving
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| | identify a reasonable schedule so as not
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| treatment, completing treatment, hearing
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| | to tire too quickly.
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| that the cancer is in remission, hearing
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| | Since fatigue is the most common symptom
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| that the cancer has come back, and
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| | in people receiving outpatient
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| becoming a cancer survivor. Each of these
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| | chemotherapy, patients should learn ways
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| events involves specific coping tasks,
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| | to manage the fatigue. According to the
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| questions about life and death, and
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| | American Cancer Society, patients should
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| common emotional challenges.
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| | be taught the following:
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| Patients are better able to adjust to a
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| | The difference between fatigue and
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| cancer diagnosis if they are able to
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| | depression
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| continue fulfilling normal
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| | Possible medical causes of fatigue
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| responsibilities, cope with emotional
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| | (dehydration, electrolyte imbalance,
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| distress, and stay actively involved in
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| | breathing problems, anemia)
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| activities that are meaningful and
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| | To observe their rest and activity
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| important to them. In counseling,
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| | patterns during the day and over time
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| patients can learn to develop coping
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| | To engage in attention-restoring
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| strategies to change problem situations,
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| | activities (walking, gardening,
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| manage emotional distress, and understand
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| | bird-watching)
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| what impact cancer may have on his or her
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| | To recognize fatigue that is a side
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| life. Patients who adjust well are
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| | effect of certain therapies and
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| usually committed to recovery and
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| | medications
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| actively involved in coping with cancer.
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| | To participate in exercise programs that
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| Distress can occur when a person feels
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| | are realistic
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| that he or she does not have the
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| | To identify activities which cause
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| resources to manage or control the
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| | fatigue and develop ways to avoid or
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| cancer. Patients who have the same
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| | modify those activities
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| diagnosis and are undergoing the same
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| | To identify environmental or activity
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| treatment may have very different
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| | changes that may help decrease fatigue
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| experiences and ways of expressing
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| | The importance of eating enough food and
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| distress. Anxiety and depression are
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| | drinking enough fluids
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| common among patients with cancer. It is
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| | Respiratory therapy may help with
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| important, however, to ferret out whether
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| | breathing problems
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| the anxiety and depression are solely
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| | To schedule important daily activities
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| emotionally based or are caused/made
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| | during times of less fatigue, and cancel
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| worse by insomnia, fatigue, pain or side
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| | unimportant activities that cause stress
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| effects of medication.
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| | To avoid or change a situation that
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| Anxiety
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| | causes stress
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| Anxiety is a normal reaction to cancer
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| | To observe whether treatments being used
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| and may increase feelings of pain,
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| | to help fatigue are working
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| interfere with one's ability to sleep,
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| | Pain Management
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| cause nausea, and interfere with the
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| | Pain is another major cause of insomnia,
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| patient's (and his or her family's)
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| | anxiety and depression. Counselors can
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| quality of life. Persons with cancer
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| | work with physicians and patients to
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| will find that their feelings of anxiety
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| | create a comprehensive pain management
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| increase or decrease at different times.
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| | plan.
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| Contrary to what one might expect,
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| | Physical Interventions include:
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| patients with advanced cancer experience
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| | Muscle/bone pain may be treated with heat
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| anxiety due not to fear of death, but
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| | (a hot pack or heating pad); cold
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| more often from fear of uncontrolled
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| | (flexible ice packs); massage, pressure,
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| pain, being left alone, or dependency on
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| | and vibration (to improve relaxation);
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| others. Many of these factors can be
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| | exercise (to strengthen weak muscles,
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| alleviated with treatment. Helping
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| | loosen stiff joints, help restore
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| patients identify their own cycles and
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| | coordination and balance, and strengthen
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| plan for those times is a useful activity
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| | the heart); changing the position of the
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| in therapy.
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| | patient; restricting the movement of
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| Patients may benefit from other treatment
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| | painful areas or broken bones;
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| options for anxiety, including:
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| | stimulation; controlled low-voltage
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| psychotherapy, group therapy, family
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| | electrical stimulation; or acupuncture.
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| therapy, participating in self-help
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| | Thinking and behavior interventions give
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| groups, hypnosis, and relaxation
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| | patients a sense of control and help them
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| techniques such as guided imagery, or
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| | develop coping skills to deal with the
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| biofeedback. Medications may be used
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| | disease and its symptoms. Beginning these
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| alone or in combination with these
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| | interventions early in the course of
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| techniques. It is important not to avoid
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| | treatment is useful so that patients can
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| anxiety-relieving medications for fear of
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| | learn and practice the skills while they
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| becoming addicted. A side benefit of many
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| | have enough strength and energy.
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| of the antianxiety medications is that
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| | Thinking and Behavioral interventions
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| they cause muscle relaxation which can
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| | include:
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| often ease some of the aches and pains
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| | Relaxation and imagery: Simple relaxation
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| patients are experiencing.
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| | techniques may be used for episodes of
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| Depression
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| | brief pain (for example, during cancer
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| While some patients become anxious,
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| | treatment procedures).
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| others become depressed, and even others
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| | Hypnosis: Hypnotic techniques may be used
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| are both anxious and depressed.
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| | to encourage relaxation and may be
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| Depression affects about 15% to 25% of
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| | combined with other thinking/behavior
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| cancer patients. Affecting men and women
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| | methods. Hypnosis is effective in
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| with cancer equally. People with cancer
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| | relieving pain in people who are able to
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| will experience different levels of
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| | concentrate and use imagery and who are
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| distress. Issues which may contribute to
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| | willing to practice the technique
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| depression in cancer patients include:
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| | regularly.
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| Fear of death.
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| | Redirecting thinking: Focusing attention
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| Interruption of life plans.
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| | on distractors other than pain or
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| Changes in body image and self-esteem.
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| | negative emotions including counting,
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| Changes in social role and lifestyle.
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| | praying, or saying things like "I can
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| Money and legal concerns
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| | cope," music, television, talking,
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| Guilt at not being around for their
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| | listening to someone read, or looking at
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| children
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| | something specific. Patients can also
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| Regret for delaying diagnosis
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| | learn to monitor and evaluate negative
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| Survivor guilt (If the patient survives
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| | thoughts and replace them with more
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| and his/her friend does not)
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| | positive thoughts and images.
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| People diagnosed with cancer will react
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| | Support groups and religious counseling:
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| to these issues in different ways and may
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| | Since depression tends to increase pain,
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| not experience serious distress. It is
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| | and pain tends to increase depression,
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| also important to remember that patients
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| | support groups help many patients. Many
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| and their family members or caregivers
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| | online support groups for patients and
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| need to be evaluated for depression
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| | their families can be helpful for those
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| throughout their treatment. Children are
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| | patients who have restricted movement.
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| also affected when a parent with cancer
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| | Visit:
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| develops depression, and often develop
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| | Sleep
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| emotional and behavioral problems.
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| | Finally, sleep problems can contribute to
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| There are many misconceptions about
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| | depression, anxiety and the patient's
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| cancer and how people cope with it, such
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| | ability to manage pain. Sleep disorders
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| as the following:
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| | that are related to cancer may be treated
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| All people with cancer are depressed.
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| | by eliminating the cancer and side
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| People with cancer should be shielded
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| | effects of cancer treatment. To promote
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| from stress
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| | rest and treat sleep disorders the
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| Depression in a person with cancer is
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| | following may be considered:
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| normal.
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| | Create an environment that decreases
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| Treatment does not help the depression.
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| | sleep interruptions and promotes sleep
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| Everyone with cancer faces suffering and
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| | by:
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| a painful death.
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| | Lowering noise.
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| Depression and anxiety are always mental
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| | Dimming or turning off lights.
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| health issues
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| | Adjusting room temperature.
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| Sadness and grief are normal reactions to
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| | Aromatherapy
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| the crises faced during cancer, and will
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| | Keeping bedding, chairs, and pillows
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| be experienced at times by all people.
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| | clean, dry, and wrinkle-free.
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| Because sadness is common, it is
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| | Using bedcovers for warmth.
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| important to distinguish between normal
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| | Placing pillows in a supportive position.
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| levels of sadness and depression. An
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| | Encouraging the patient to dress in
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| important part of cancer care is the
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| | loose, soft clothing.
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| recognition of depression that needs to
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| | Encourage regular bowel and bladder
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| be treated. This is depression that
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| | habits to minimize sleep interruptions.
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| causes a person to lose pleasure in most
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| | Increasing consumption of fluids and
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| activities more often than not for at
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| | fiber during the day.
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| least two weeks and can be accompanied by
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| | Taking medication for incontinence before
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| sleep and appetite changes, suicidal
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| | bedtime.
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| thoughts, confusion and difficulty
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| | Eating a high-protein snack 2 hours
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| concentrating. Counselors with a
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| | before bedtime.
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| knowledge of cancer and cancer treatment
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| | Avoiding heavy, spicy, or sugary foods 4
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| can help people deal with their
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| | to 6 hours before bedtime.
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| depression. Specific goals of these
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| | Avoiding drinking alcohol or smoking 4 to
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| therapies include the following:
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| | 6 hours before bedtime.
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| Assist people diagnosed with cancer and
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| | Avoiding drinks with caffeine within 12
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| their families by answering questions
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| | hours of bedtime
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| about the illness and its treatment,
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| | Exercising (which should be completed at
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| explaining information, correcting
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| | least 2 hours before bedtime).
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| misunderstandings, giving reassurance
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| | Keeping regular sleeping hours.
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| about the situation, and exploring with
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| | Stretching before bed
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| the patient how the diagnosis relates to
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| | Journaling to get closure on the day and
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| previous experiences with cancer.
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| | "vent" stressors
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| Assist with problem solving, improve the
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| | Setting a regular routine so your body is
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| patient's coping skills, and help the
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| | "cued" to get sleepy
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| patient and family to develop additional
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| | Massage
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| coping skills. Explore other areas of
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| | Medications may also be used to help
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| stress, such as family role and lifestyle
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| | relieve sleep problems.
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| changes, and encourage family members to
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| | As a clinician working with a cancer
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| support and share concern with each
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| | patient, there are many things you can do
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| other.
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| | to aid him/her in leading the highest
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| Ensure that the patient and family
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| | quality of life. It is important to
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| understand that support will continue
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| | remember that patients with cancer who
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| when the focus of treatment changes from
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| | are seeking counseling are often in
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| trying to cure the cancer to relieving
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| | crisis, so write down suggestions or
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| symptoms. The health care team will treat
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| | interventions they are to try at home.
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