RT Book, Section
A1 Seddon, Lesley
A1 James, Fiona
A1 Board, Ruth E.
A2 Velikova, Galina
A2 Fallowfield, Lesley
A2 Younger, Jane
A2 Board, Ruth E.
A2 Selby, Peter
SR Print(0)
ID 1152359757
T1 Psychological Therapy to Aid Tablet Taking in Cancer Treatment
T2 Problem Solving in Patient–Centred and Integrated Cancer Care
YR 2018
FD 2018
PB EBN Health
PP New York, NY
SN 9780995595408
LK hemonc.mhmedical.com/content.aspx?aid=1152359757
RD 2021/03/06
AB A  19-year-old  woman  presented  with  a  cough  and  was  found  to  have  a  large  mediastinal  mass.  Investigations  confirmed  Hodgkin's  lymphoma  (nodular  sclerosing  type,  stage  II  disease).  She  was  treated  with  hybrid  chemotherapy  and  mediastinal  radiotherapy,  leading  to  disease  remission.  She  re-presented  7  years  later  with  a  palpable  cervical  lymph  node.  Further  investigation  identified  widespread  relapse  of  her  lymphoma.  Holistic  needs  assessment  (HNA)  revealed  distress  and  psychological  concerns  around  swallowing.  She  was  treated  with  four  cycles  of  gemcitabine,  dacarbazine,  cyclophosphamide,  vincristine  and  prednisolone  chemotherapy  but  her  disease  progressed.  Further  lines  of  chemotherapy  including  vinblastine,  basiliximab,  and  etoposide,  methylprednisolone,  cytarabine  and  cisplatin  preceded  an  allogenic  stem  cell  transplant  from  her  sister.  Treatment  was  complicated  by  numerous  side  effects  including  peripheral  neuropathy,  premature  ovarian  failure  and  osteopenia.  She  also  developed  graft  versus  host  disease  of  the  mouth  and  skin.Since  her  relapse  she  complained  of  difficulties  swallowing  tablets  and  expressed  concerns  and  fears  about  tablet  taking.  No  organic  basis  for  her  dysphagia  was  found  and  she  was  referred  to  psycho-oncology  for  assessment  and  management  of  symptoms.  Assessment  confirmed  anxiety  and  dysfunctional  thinking  about  swallowing  tablets.  She  believed  she  would  choke  and  become  ill.  The  perceived  risk  of  asphyxiation  far  outweighed  the  consequences  of  non-compliance;  consequently,  adherence  to  medication  had  become  problematic  and  patchy.  She  was  struggling  with  adjustment  and  the  psychological  consequences  of  having  recurrent  disease  and  a  challenging  prognosis.  She  felt  out  of  control  and  overwhelmed  by  two  interconnected  threats  to  her  very  survival  and  was  feeling  increasingly  helpless.  Following  a  course  of  cognitive  behavioural  therapy  (CBT)  her  symptoms  improved  and  swallowing  of  her  supportive  medications  became  manageable.  As  her  disease  has  progressed  she  has  accessed  intermittent  support  from  the  psycho-oncology  team.What  psychological  therapy  options  were  considered  in  this  case?What  is  CBT  and  how  did  it  work  in  this  case?What  are  potential  barriers  to  effective  therapy?What  is  the  evidence  base  for  CBT?How  can  psychological  issues  be  identified  and  managed?