Category: Anxiety

Hello, I’m Norman Swan. Welcome to this programon maintaining wellbeing, dimple and tension in workers withprostate cancer, and their development partners. Prostate cancer is the most commoncancer in Australian boys apart from nonmelanotic skin cancer. One in nine will develop the illnessin their lifetime. Men with prostate cancerreport higher levels of depression than the general community, but the rate of depression and anxietyin their partners is even greater more than double the incidenceof the Australian parish. Psychological distress and depressionin humankinds with prostate cancer, and their partners, is often overlookedand underdiagnosed. There’s a fair fragment of evidencethat cancerassociated depression has its own problems, and that’s what we’ll explore. You’ll find useful resources available on the Rural Health EducationFoundation’s website: You’re can’t go there yetbecause you’ve got to meet our panel.Suzanne Chambers is director of researchof the Cancer Council Queensland and professor of psychooncologyat Griffith University. Welcome, Suzanne. Thank You, Norman. Suzanne is a member of theAustralian Cancer Network Working Party for the developmentof Clinical Practice Guidelines for the Managementof Advanced Prostate Cancer. As you’ll hear, that’s associated withsignificant psychological morbidity. Caroline Johnsonis a general practitioner and lecturerat the University of Melbourne. Welcome, Caroline. Thanks. Caroline is about to complete her PhD on monitoring depressionin general practice. Peter Strange is a nurse practitionerspecialising in mens health within the agricultural Bendigo area. Welcome, Peter. Good evening. NORMAN: You do portable clinics? We go to workplaces and areas where there aren’t physicians. What sort of things do you do? Health ratings for men. In particular, we look at preventative remedy, getting to the guysthat won’t come and see their doctors. NORMAN: You’re involved inthe Men’s Shed movement? Yeah. Anywhere we can get to menfor preventativetype health. NORMAN: Getting close to too much information. Colin Bartlettis a prostate cancer survivor, and also suffered depressionthrough his illness, as you’ll hear.He’s facilitator for the WestmeadHospital Prostate Cancer Support Group in Sydney, and is heavily involvedin the Prostate Cancer Foundation. Welcome, Colin. Good evening. Therefore welcomed you all. Colin, tell me your floor. I was asked to have a PSA testby my doctor, under protest, I was. Had it done. Four days later, he says, we have a problem I had the problem. Go to a urologist. I was given a DRE, and instantly told, there’s an irregularity.We’re going to have togo to another theatre. At that time, it didn’t reallycome home, but the next bit did. NORMAN: You didn’t realise you wereon a truck scooting towards the wall? No, I didn’t. I then went to have a biopsy done. It was after the biopsythat all countries of the world hurtled. That was when Trish was with me, my partner, and Andrew precisely told us straightaway, you have cancer.What are you going to do about it? Shock, repugnance. I anticipate she was more devastatedthan I was. The thinker just goes into freefall what am I going to do now? Do you retain the emotionattached to that? The feeling is one of mistrust why me? Why is this happening to me? A little bit of sect are entered into it, because I turning now to him and said, I’m going to make sure other lovers don’t fall into the same trapthat I’ve fallen into.That’s all I could say at that place. So you were offered a series of options? Yes, I was given three alternatives, exactly given them straight out a radical prostatectomy, radiation therapy or we could possibly go onto some therapy if it suited. It was just left at that, and I was to manufacture the choice. NORMAN: How did you construct the choice? Seeing as the urologistwasn’t much aid, I did get a piece of paper that indicated a prostate cancersupport group at Westmead Hospital. I observed the guy who was the facilitator, who still is, by the way. He gave me some informationabout selects. I went to see him, and we spoke it. We decided really “they dont have” optionbut a progressive prostatectomy because the Gleason score was high 7. The PSA was 20. It meantI actually had nowhere else to go. When did the depression hit? That, Norman, is an unknown factor. I don’t really know when it truly smacked, but it’s been an insidious thing that’sbeen growing and growing and developing. Possibly, it really came homeprobably three to four months after everything, I recalled, had colonized down. It hadn’t. So you had the operation.How did it leave you? I felt pretty good, actually.I wasn’t especially annoyed. I didn’t have any hurting or anything. I was still in this freefall what am I going to do now? I didn’t really knowwhat I was going to do.Didn’t know what to expect either. Were you feeling anxiety? I was anxious, of course I was, very anxious abouthow Trish was feeling. She was my main concern. NORMAN: How was it travelling between you? Then? Very good. We were pretty good. We’d suffered a few other questions whichhad brought us a bit closer together. So we were in a propitiou positionat that stagecoach, but it unwound later on. NORMAN: Unwound? I’m afraid I was the onewho was the problem because I virtually shut off. What you feel is pain, and it’s a mental pain. How do you run away from it, get away from it? I attained solace in getting on my bicycle and going off and doing three or fourhours’ go and coming home. NORMAN: The male thingof journeying off into the sunset? Virtually, yes. Into the sunrise, actually, at that time of day when I’m around.You sort of get yourselfinto your own little sphere, into your own little bubble. She wasn’t ableto make contact with you? We didn’t talk much about it , no. I had a lot of men come to talk to me. I had a lot of supportfrom the aid group itself. It more or less articulated her out on a limb. She really didn’t do muchin that course at all. How did it get better? I think it got better formerly we hadgot rid of the continence trouble. I suffered a postoperative hernia, and “were having” that specified. After that, things startedto get back into a normal operation but for one thing I had continencetroubles. I had incontinence. It wasn’t bad, but it was enoughto cause us some concern. And erectional purpose had also gone. Did anybody recognise the depression? No. That’s the unspeakable thing about it. I never talked to anyone, andI didn’t see what was happening to me.I didn’t know what was happening to me. How did the depressionshow itself in you? The dip demo probablyafter about three to four years. I began to get terribly edgy, extremely petulant, and being a bit picky with Trish. I look back at it, I’m ashamedof some of the things I told us to her, like, I don’t have to drive with you, do I? I was beginning to get very criticalabout her driving the car. I didn’t notice it.I was just picked up as a sulky old man who’d had a prostate operation. NORMAN: Were you sleeping? No , not very well at all. NORMAN: Had you lost interestin things around you? Yes, altogether. Had you thought of killing yourself? No, that didn’t come into it. There’s no selfharm in me. I’m very firm about that.There’s no selfharm.But you intent upnot get given for it? Quite a long time. In fact, it’s only aftersix years of going through this that I lastly was recognisedas having a problem. That was going to a Men’s Shed function and listening to somebodytalk about depression. His recommendation was then, go and talk to your GP. You do have a good one? Yes, I do.I’ve known him for 20 times. He said, he will be the best personto see. He knows a good deal about you. When I did go to Jim, he said, more orless, I’ve been waiting for you to come. NORMAN: But hadn’t asked? But hadn’t asked. In a nature, that’s a bit disappointing, but I won’t hold it against him. Certainly, we’re on the right track now.We have found the direction through. We’re having a good life. There’s been a spinoff. I’ve been ontomedication, and it’s quite a new floor. The medication, I started in September’ 09 and by December’ 09, I’m beginning to say, where’s this continence problem gone? NORMAN: Things have been fixed in one affect? It’s just gone.I’m the same as you would be, the same as any manwho has not had a prostatectomy.Which is quite surprising. Asking then a beyondblue personwhat had happened, she said straightaway, what drug are you on? It’s a serotonin type of medication. She said, are you thinking about it anymore? And I said , no.Really, I hadn’t really thought about it. She said, stress continence. It’s gone. Peter, you’re nod sagely there. This is obviously not an singular storyfor you. No. I’m very interested in your narration, peculiarly connecting withthe act of uncovering for early diagnosis of depressionwas at Men In Sheds.Well, it wasn’t early five, six years. True. The firstly diagnosis. It’s interesting that parish groupsand support groups and people you just have a chat tooften will pick up these things. It’s really important, a point to get across from the word go, that clinicians need to ask how people are travelling, if it’s as simple as that. That’s probably what you needed, Colin, for someone to situated their nose in and give him an opportunity to listen. You’ll consider menwith psychological issues, especially hollow and distres, a lot. Is it different when males have cancer, and is it differentwhen adults have prostate cancer? I think it is. Perhaps the more extreme the morbidityor the condition … Sometimes I study guys implant it moreso it’s even harder to get out.It does become more extreme. NORMAN: When you say more extreme, you signify what? The movement of the depression. The medical plight and how theyperceive it will determine that. That’s important.If we can help them through, give them education and explanation, perhaps we can lessen that. The waiting game waiting for research. Too, it encroaches with your senseof your own masculinity. Absolutely. Men will hasten onward. We might start, as medical professionals, saying, we’re having a PSA test.This may not mean anything. Some humankinds will automatically race aheadright to I’m going to have cancer, male erecticle dysfunction, wedlock problemsand all those things. As clinicians, we need to think aboutthat and cure that we are able to. It may not be unrealistic.PETER: I agree. Caroline, a familiar storyfrom your point of view as a general practitionerinterested in depression? It is indeed. One of the biggest ploys for GPsis getting this balance between the physicaland the psychological.If someone comes inwith a cancer diagnosis, we expect, probably rightly, that the most difficult thing on their mind is, is this going to kill me? So we focus on the physical. We often “re saying”, how are you touring? How’s it going? How are you coping? We think that’s usscreening for sadnes, but patients often think we’re saying, how are you coping with the cancer? You’re right, we have to bemore specific with questions. NORMAN: More systematic? That’s an interesting point. There aren’t countless experiment trialsthat show that by introducingsystematic screening … You might pick up more casesof hollow but whether you’ll get better outcomesis controversial unless you actually do something. Hard to get better outcomes unless youfind out somebody who’s got depression. In the late’ 90 s, there were lots of studies that showed that if “youre asking” beings, are you chilled, and they say yes, it doesn’t necessarily meananything will to get out of here. It’s important to emphasise thatif you ask the question, you need some kind of planof what to do next.Suzanne, how could it have been different? The first thing I would say is thatthe narration we heard is very typical to seeing how people often present whenthey’re distressed and have recession, for example, after cancer being withdrawn, annoyed, a strain on the relationship. It does get put down to beinga cranky old man, which is quite untrue. We know there’s a range of risk factorspredictive of someone more likely to suffer distress. What are they? Things like lower levels of education, being inadequate, having a previous psychiatric or autobiography of recession is important. Stage of disease and symptomatologycan be important as well. But the only thing, if you measureat diagnosis the level of distress, that’s the biggest predictorof subsequent distress. If someone had deterred a close gaze on yourlevels of distress from the beginning, they probably would have picked upthat they were high, and get in early. In essence, you had a prolonged periodof suffering that was unnecessary. Those are times you can’t get back. Yes. You’ve done well, and that’s great, but it’s not a good thing thatthat went on for so long.The other thing is, if you think about it, there are three main components to thinkabout with a cancerspecific distress. There’s the psychological aspect the distress the man exhibitswhether he’s depressed or agitated, having obtrusive concludes. Then there’s the social situation what’shis relationship like with his partner? Is that a supportive affair? Has it been there for a long time? Is it a well of resource for him? The third is, what’s happened with the cancer? How has the care wreaked? What’s the manifestation sketch like? When treating a cancerrelated distress, you’ve got to treat all those. Very important that you too considered side effects and symptomsof the cancer treatment.Otherwise, the interventiondoesn’t looking relevant to the man, who’s mainly marking I’ve gotcancer as his presenting problem. One of the greatest problemsthat we face within the support group is one of continence. Incontinence is a big problem. To a degree, a great deal of people don’tnotice or recognise it. We’re focusing on it at the moment to impart a little bit of awarenessto the people in the funding group to know that there is something thereto help them. A heap of them suffer greatlywith continence troubles. And it’s pretty depressing.COLIN: Very much. Which is your point. Exactly right. You can’t divorce those physical thingsfrom the psychological bang. When they do unmet encouraging caresurveys of men with prostate cancer, the big ones areunmet psychological needs with regards tofear of cancer appearance, and unmet sexuality needs.If I were going to pick something, I’d focus on those two sides for men who are surviving prostate cancer. Do you think you’ve got the equipmentto ask the questions, Caroline? For mental things? NORMAN: To explore this. Everybody has a different form. If you make it one of the purposes of your routinepractice to raise the issue … We know that whenyou have a serious illness, it is possible psychologically distressing. These are questions I’m going to ask, is it OK with you? So people knowyou’re not lope through a checklist. So afford us the write that you…It’s often useful for GPsto hear the script that professionals use. What are some of the questionsyou might feel tricky about? The screening toolsthat we use as psychologists are a little different to what worksin general practice. I’ll say what I would do, then I’ll defer to Caroline. We commonly usethe distress thermometer, a single entry. I’ll say, I’m going to ask youa question that musics a little strange to check that I understand whereyou’re at and I’m not missing anything.On a scale from 0 to 10, where 10 is really high-pitched distressand 0 is I’m fine … NORMAN: You “use the worddistress” ?’ I use the word ‘distress .’ .. where would you see yourself? They’ll give me a number. If it’s lessthan 4, I think they’re doing OK. If it’s over 4 or 5, there’s a good chancethey’ve got anxiety or dimple. If it’s over 7 or 8, I’m concerned by them. That cures guidebook how muchI will go indepth with such person or persons about their psychological condition. What I always do is cause a personset their agenda first with me by saying, tell me what’s been happening to you, why you’ve come to meand what you’d like help with. Then weave it into the conversation. NORMAN: That’s in referral situation, whereas a GP is in the first situation.I heard that technique precisely tonight, and I think it’s great. We do it all the time with hurting. We say, on a scale of 0 to 10, where would you rate this agony? It reaches perfect feel to do that. It is a nonlabelled wayof parent distress. NORMAN: And it’s a clairvoyant thing. Right. If we’re talking specific aboutdepression, I still make questions are good in the last two weeks or month, have youbeen feeling down most of the the time? Have you lost interest in pleasure? Researchers in New Zealand did a trialwhere they added the question would you like is contributing to that? No, yes or yes but not today.They found that extra questionwas a good way of picking up on people that might have been a false positive. If you ask people, would you like aid, and they say yes, it should ring a bellthat you should focus on them. Could something have been doneat the diagnostic place? For pattern, one of the very best predictors of whether or notyou’ll regain erectile function is how much erectile functionyou had before, regardless of your age. Could things have been donewith Colin earlier? Is there any evidence of preventability? There is evidence of preventability. What’s important is that at the outsetpeople understand this is going to bepsychologically tough. It substantiates them. If you start feelingdistressed, you’re not saying, I’m weak.It’s saying, this is a tough experience.Let me give you some tips-off about things to do to help yourself. Ideally, you work with the manand his partner. The best thing to do isget them working as a unit and preempt relationship publishes, which are not uncommonafter a diagnosis of prostate cancer. Research in South Australia showed that much as mortals don’t likeexpressing their distress, gals don’t like conveying it either’ cause they feel they have tobe the rock in this time of disturbance. Maidens are often the feelings spongein a relationship. They take responsibilityfor maintaining emotional poise, and they suck everything is up. So, while you’re getting cranky, she’s sucking it up, feeling worse. Often, men and women havedifferent communication structures about dealing with difficulties. If you can help them negotiate a wayto help them do that, that helps each person feel validated.It’s important that people knowtough times are ahead, and that they give a hint of, if you start feeling this wayand it goes on … It’s normal to feel distress, but if this goes on for some time , no stamps for mettle. Go back and see your GP or summon person, and be helped early. NORMAN: Peter? We may need to ask more than formerly. We may be asking someone like Colinhow he’s going, how he’s feeling, and at that stage of the process and this is stretched out over fiveor six years he may be doing well, so we need to keep asking himhow he’s roam and questioning those important questions.There will be periodswhen he goes up and down. How important do you think settingexpectations is at the beginning so people know the journey they’re on? We need to be very honest. We need to keep it very simplebecause men that are having accentuates won’t be ableto take in a lot of information. So we need to be very honest. We can’t prophesy what’s going to happen, but these are the possibilities. Colin, in retrospect, what do you thinkcould have been done for you at that diagnostic place, before anyonehad laid a hand or spear on you, that would have made a difference? One of the thingsthat would make a difference is having what we call a road maplaid down of what’s going to be, what the high expectations are, what’s going to happen.NORMAN: Physically and psychologically? Yes. The psychological onewould have been very important because I didn’t realisethat was going to happen. That’s been the most devastating proportion, is the mental persona. We’re sort of out of it, but it’s stilldevastating, the mental chip. In country towns, it is going tobe the GP who will carry the burden. That’s true. There are more openings nowfor GPs to get subscribe, but it is harder in the agricultural position because there are lesshealth professionals.It’s great that there arenurse practitioners now. Some practises have mentalhealth nursesthat can help, specially parties withmore serious psychiatric illness. There’s also dial support for GPsthrough GP Psych Support. But, eventually, the GP is often seeingboth partners in a relationship, so they often get the warning signsearlier. Knowing how to act on thatis the challenge.Suzanne, as the pilgrimage progresses? Things like hormone treatmentcan be pretty rough psychologically. That’s right. It’s importantto recognise it is a journey. Stress is typically very highat diagnosis, generally quite rapidly lessens, thencan spike when critical happens happen, for example, a cancer occurrence, where distress can be higherthan at initial diagnosis. If a man is diagnosed withrecurrent cancer, he’s at some extent going to be put ontohormone treatment.Hormone treatmentshave serious side effects such as mood disturbance, cognitivechanges, changes in muscle mass, central adiposity, osteoporosis. NORMAN: Libido disappearing. Libido remains, male erecticle dysfunction. There’s good work being done in WesternAustralia abusing highintensity exercise to help with that. There are things that can be donethat are complimentary rehabilitations. Serious exercising, physiology office, and there’s Medicare rebates for that exercise physiology under certain schemes. Again, for the GP, it’s being awarethat things change over time for men.Every age you insure themis an opportunity to check how things arewith the prostate cancer. Let’s go to our case studyand work through some of these issues. Don is a 52 yearold farmer. He comes to you, Caroline, with urinary symptoms. When you do a digital interrogation, it feels a little peculiar, and his PSA comes back at 7. You cite him for a biopsy because his brother was diagnosed with prostate cancer, which is why you did the PSA and DRE. He was widowed four years earlier, and got a bit chilled. His wife died of breast cancer after many years of illness. Luckily, he’s recently repartnered. Caroline, what’s your approaching going to be towards Don? He’s got the risk factors. He does. First of all, any time you do a test for cancer, you should try and discusswith the person or persons before you do the test what the possible sequels “wouldve been”, because you don’t want to read someoneand say, the test is abnormal, and them getting terribly distressedand panicking before they listen what it actually means.I try and tell people beforehandthe possible outcomes without going into detail. Then when the test comes back andthere is concern this could be cancer, taking into account his determining factor, past history. He’s also had knowledge of cancerthrough two brothers and his wife. That might reform his perceptionof what that is likely to represent. He has existing lore, but it may be helpful or unhelpful. You might want to knowwhat happened to his brother to see what making he’s got. Perfectly. It will be significant. The buzzer should be ringing straightaway when you’re presented withthat sort of history. Start asking questions about his brotherand how he feels and how much that’s feigned him. That’s going to drive him intothat provision, perhaps, of recession. Suzanne, is there anything you can doat this point to steelbelt him, apart from improvinghis mental substitutes? The things I’ve already mentionedare appropriate for this person. I suspect, close surveillance. Like Peter said, catch out what slide he has in his head about whatprostate cancer diagnosis intends. It may be he’s more focused onwhat happened to his wife she died a difficult demise, and that might happen to me.Or it could be focused onwhat happened to his brother. You don’t knowuntil you ask those questions. If he’s got position creeds about cancerthat are unhelpful or mistaken, you can try and correct those. Just remain a close racetrack on him. He’s in a new rapport, so he doesn’t have a 25 year history of coping together through adversity. That marry, I would anticipatethey would need backing and perhapssome liaison adviser. This is going to be a tough experience.It happens to you as a pair. Talk about things you can doto support each other through it. The fact that he’s gotthe history of depression, it rings buzzers thathe’s more at risk of recession again. You can use that to your advantage what was it like last meter? What were the symptoms you knowledge? What would you do if you did a screeningand detected he was chilled? I would askwhat worked for him last time.If he had antidepressantsand they were very effective and he had same manifestations this time, I’d have no hesitationthat he try it again. Suzanne, the evidence is that antidepressantsdon’t make a lot of difference at the slight to moderateend of the scale of assessments and that cognitive behavioural therapywill improve their resilience. The only thingthat improves your resilience in reducing recurrenceis psychotherapy. I don’t knowthat I is in favour of that. A combined coming is appropriateand separately accommodated. You can look at studies, then you look at people. I’m with Caroline what did he do that worked last age? I think that trying to help peopledevelop adaptive coping programmes if their predominant coping strategieshave been unhelpful is in relation to it as well. Maybe that’s partof construct their resilience. Coming back to Colin’s pointof information being important, what attest is there that informationhas an antidepressive gist? I don’t know of evidencethat report alone has only one antidepressive influence. It’s just a basic thing that you needinformation you understand so you can manufacture difficult decisionsand live with the consequences.It’s just basic good attention. The difficulty for peoplediagnosed with prostate cancer is , noone with cancer expects a selection. I don’t know how many timesI’ve had somebodies told me to me, what’s this business of, I’ve got achoice, and one is, I don’t do anything? Don comes back to the GP because he’shad the bad news from the urologist. The urologist says, there’s no rush, go and think about it. You can have a radical, you can have two types of radiation or we can watch and waitfor a couple of years and view what happens to your PSA heights. It’s only 7 at the moment. You’re not going to dieif we wait for a year or so. He goes home, he’s forlorn, furious, and he’s dragged in by his partnerto see you, Caroline.She says, he needs help to make a decision. Sit down, Don, and listen to the doctor. In his situation, “its hard”. As GPs, we draw on experiencefrom previous patients or narrations we’ve heard. We have to empower the patientto make a decision using information they’re given. One thing tested in general practiceis to use problemsolving therapy. NORMAN: How does that work? You work with the patient to generate a list of the problems. In this case it might be as simple aschoosing which regiman. You work with the patientto generate as many problems associated with that as is practicable. There’s still cognitive restructuringinvolved? No , no. It’s a very structured approach. You can download structuredproblemsolving worksheets off the internet if you’re so inclined. It’s not a difficult procedure to learn. It’s just steer the patientthrough that decisionmaking process, making as many solutionsas possible, then rolling them and looking atthe pros and cons of each. It is quite an effective therapy, but probably a hard case to start with. If you want to have a goat problemsolving therapy, you might not choose a distressed manwith prostate cancer as your first subject.Try it on yourselfor on a more simple case, then if it use, try it with person like this man. If there’s more than one clinicianinvolved, we need to get our narratives together. That can cause more confusionfor the patient if we’re giving different floors. We need to do thaton behalf of the patient, otherwise it becomes confusing. A nanny in Northern Queensland expects,’ Are there anyantidepressant prescriptions contraindicatedwith prostate cancer ?’ I’d start with the antidepressantsI’m used to using. I’d help ones that don’t interferewith urinary capacity. I don’t know if there’sa strong proof cornerstone for that. I’d start with SSRIsrather than tricyclics,’ lawsuit tricyclics have urine evidences. Obvious SSRIs, the sense I get from the panel of experts is, they’re pretty muchall in the same bunch. Some have slightly different advantages. They do have sexual side effects. That’s true, but that’s going to be aproblem with all of the antidepressants.You have to make a decisionof how severe the manifestations are. Again, if someone has had thesetreatments and they’ve worked, that’s a reliable indicatorthat they’ll study again, or are at least worth trying. The same harbour in Queensland questions ,’ Should all men on hormone medicine be automatically prescribedantidepressant remedy ?’ I wouldn’t do that.I can’t see any reason why you would. If they weren’t having those specificside effects, I don’t think you would. You’d do it based on the severityof their symptoms and their preference.It’s been awhile since we hada question from Western Australia. Too a nanny.’ Is there any informationon suicide rates in patientsdiagnosed with prostate cancer ?’ There was a article publicized recently, I’ve got a feeling it was European data, which presented an increasein the relative hazard of suicide in males with advanced prostate cancer. I’ve certainly had knowledge of men with advanced prostate cancercommitting suicide. It’s somethingyou certainly never forget. I don’t have accurate data on that. And I approximate, though, the main point is it’s more about anybody who’s got depressionneeds to be screened for suicidality.NORMAN: You’ve just got to ask the question? You’ve got to ask that question. NORMAN: Do you ask the question, Peter? PETER: I certainly do. It’s not the first issue, but if I think they’ve got mildto moderate feeling, I always ask whether there’s selfharm. Given that you’re seeing menin men’s places, how do you involve the partner? NORMAN: They’ve got to be involved. Sometimes men are now in becauseof the partner in the first place. So the partner may be involvedfrom the word go. NORMAN: You precisely don’t necessarilysee them right off. It can be. That’s issues and questions we too ask how are travelling, how is your partner tour? I often go into the relationship and askhow he sees the relationship is. If the discussion wants to go onfrom there, I volunteer whether it would be of benefitseeing them both together. That’s a really positive move, peculiarly if he agrees to that. Caroline, do we know to what extenttreating the man cures the woman’s feeling? I don’t think I could answer.I principally meet womenwho are worried about their partners. I find talking to them can help themdeal with their partner’s feeling. I can give them generic policies. The risk factors Suzanne spoke aboutfor men could apply to women more. If they’ve got a history of feeling, they could be at major hazard. That’s right. Making things betterin such relationships or a family situation moves things better for everyone, but whether you are eligible to automatically assumethat treating the man will stir the woman better, it dependson the severity of his dip and how it’s impactingon their problems. If the thing that’s worrying heris that he’s going to die or be impotent forever, treatinghis dimple might not help her.You have to have a conversationwith the individuals. If you merely attend one partnerand the three men views another doctor, it’s easier if the doctoris in the same practice. I’ve had that discussion of would it be OK if told his doctoryou came to see me? So he’s aware of your concerns. There’s issues of confidentiality. But if “youre telling”, these are things we could do to help, often they’re open to that. You have to respect people’s orders. NORMAN: Was your wife chilled? Yes. One thing we have learned, and willpass on as a testimony to other parties, is that if the manis suffering depression, look at your partner as well, or your carer, why it is dragged down as well.One changes the other. Did she receive treatment? Yes, she has. She was worse off then I was. NORMAN: Certainly? Yes. NORMAN: How was it changing her? Withdrawal, attracting away from things, not wanting to go anywhere , not driving her automobile, not wanting to go shopping. It was quite a thing, to drag her out of herself. She became very much a homebody, got into her plot. While you were off on your bikein the sunup, she was in the plot, pottering around. I was embed myself inprostate cancer work. NORMAN: You were living parallel lives? Basically, yes, Norman. It wasn’t very good, it was very poor. It’s the one thing to pass on to beings. I don’t think enough attention was paidon the problem that would come of this businessof depression. It wasn’t in our case. It’s only when it was too latethat it was noticed in me because of my crankiness, then suddenly she came down too. I say it was too late. It should havebeen picked up way before. NORMAN: Suzanne? SUZANNE: I made in accordance with all of that.Carers, it is very important to especially am concerned about. There’s desegregated makes on whether carershave more distress than do cases, but there’s enough that suggeststhat in many cases they do. In our experience in running trialsat Cancer Council Queensland into psychological interventionsfor parties with cancer, we find carers are relatively difficult, comparatively, to draft into tribulations because they thinkthey don’t really tally. I’m busy looking after my partnerwho’s unwell, and I don’t have cancer, so I don’t deserve that support. They forget themselves while tryingto support the person who has cancer.When you’re looking after someonewith cancer, you have to be as concernedabout their development partners as you do about that personwho has cancer. Don and his partner Glenda come backto see you, Caroline, a year later. He’s had a progressive. He’s got erectiledysfunction. He’s had it for a year. He’s got a bit of incontinence. He’s been dragged back by Glenda, ratherthan volunteering to come and see you. She tells you he doesn’t sleep, he’s not eating well, doesn’t want to get out and about. She’s pretty distressed, more, and tells the sort of storythat Colin tells.What are you going to do here? Certainly my relapseprevention strategy from the first part of this casedidn’t work so well. NORMAN: You don’t need to beat yourself up. I’ll told me to him, I “ve told you” ifthe indications came back, to talk to me. It’s great that you’re here now. Clearly, that sounds likehe has the indications of depression, but I would completea more thorough evaluation. NORMAN: You’d go into full state. Ask all the questions. There’s a list of symptomsyou have to have to qualify for a DSM diagnosisof depression, but in general practice, we tend to think more dimensionallythan categorically. If people have got distressat a sufficient level, we start talking aboutmore proactive treatment. In his suit, I’d come back to what’s worked before. If he has evidences of recession, medicines that have helped himin the past should help again, even though circumstanceshave changed. These therapies work for the symptomseven if you’ve got another diagnosis. But you have to be aware thatmedications have side effects, which you’d revisitif he’s had them in the past.Suzanne, this notion of stepped care.You talk about the pyramid. Certainly. We have developedin Queensland a tiered sit of care that’s been widely usedacross the country. The quintessence of thisis to acknowledge the fact that, while we’re talking tonight particularlyabout extreme recession or feeling, most people will do well over timewithout deeper psychological caution. At the bottom of the pyramidis where most people are. What they need is effectivecommunication from their clinicians, access to support groupsand cancer helplines Cancer Council Australiaruns those sorts of things to know there’s a Peter around ifthere is one, to have a caring GP. That’s what most people need. You’ve got a booklet, haven’t you? We produce various. There’s a beyondblue bookletwe’ve encouraged to, a general wellness volume, a sexuality after prostate cancertreatment booklet that’s on the Andrology Australiawebsite. There are lots of resources. beyondblue have a stack of themand cancer congress have them.There’s an excellent display of resources, Cancer Helpline is a national service. If you’ve got someonewho’s got mild to moderate distress, they’re further up the pyramid.They’re a smaller number. They need care with a deeperbut narrower focus. They might needa psychoeducational program. NORMAN: What do you meanby psychoeducational? Teaching parties indepth aboutwhat a diagnosis of cancer means psychologically, and how been faced with that.Stressmanagement abilities, copingskills training, things you can do easily in a group. Moving up, you might wantto do rapport or family rehabilitation. At the top of the pyramidare your vulnerable people who might be suicidal ordemonstrating high levels of distress. They might need a therapist, a mentalhealth care team. You don’t muck around withpeople in disturb. You get them straight to serious upkeep. If you’re in a country townand referral informants are restriction, what’s your view of the selfhelp localities? St Vincent’s Hospital in Sydneynow has internetbased therapy, where they will offer a therapistonline.You’re not just doing internet CBT, a psychologist willactually talk to you. There’s MoodGYMat the Australian National University. Swinburne has something. They seem to have good randomisedcontroltrial evidence that they labor. Would you cite someone with cancerto one? I think so, if it was a reputable oneand I knew about it. It’s an emerging province, and important for Australia because we havea decentralised population. Remoteaccess therapiesare important for us to get populationbased translationof mental caution , not just for cancer but in every orbit. There is randomisedcontrol evidence forthese rehabilitations being able to deliver through the internetand on the telephone. For a GP, it’s knowing what your arsenal is. Wherever I live, I know these things are available on the internet and the phone. This age group doesn’t necessarilyhave access to the internet. That’s an issue, but it also dependsupon the level of distress. We’re doing a ordeal on this now. We’re offering two types ofremoteaccess, telephonebased therapy. Our thoughts are that people who areover 4 on the distress thermometer but not up around 8will probably do well with negligible telephone intervention, where the more distressed peoplewill need the higher level.That study hasn’t been donein cancer before. Is there evidencethat response to therapy is different when cancer underlies the depression? I’m familiar withcancer psychooncology literature, where there’s good suggestion to supporta range of cognitivebased cares, problemsolving therapy. One of the most wonderful studies was onproblemsolving therapy, where they targeted peoplewho once had anxiety and recession. It’s also about health economics. You’ve got a limited numberof resources. Let’s get our indepth resourcesand throw those at beings in trouble. A much of the others will do finewith goodstandard care and access to selfmanagement fabrics. Because you feel disempowered, don’t you, Colin? COLIN: Yes, you do. You feel very disempowered. I feel sorry for the country people. They would be even more disempoweredthan we are because they have no accessto people like yourselves. They’re locked up. For them to come in to the city, it makes them a week.Who’s going to do that? There’s a lot of men we’ve heard ofwho have had repetition of their prostate cancerand it’s metastasised. Too late. If somebody had been in contact withthem regularly, probably their own GP, maybe that would not have happened. They don’t have timeto go for a PSA test. Let’s have a lookat our next case study, a film studyon a prostate cancer support group formed some years agoby David and Pam Sandoe. It’s based atthe Sydney Adventist Hospital in the Northern Suburbs of Sydney, and proposals a peculiar substantiate base to humen and their partners with prostate cancer. MAN: The the consequences of being diagnosedwith prostate cancer varies between individuals and couples. I opted for the revolutionary prostatectomy. Once I went over the original diagnosis, yes, I was anxious, but together as a duo, we’ve been able to handle it.There are other duos not so luckyas Pam and I. They’re the peoplewe’re trying to look after. Some guys are in tunnel vision for along time after going their diagnosis. They don’t want to speak about what canhappen in their therapy alternatives. It’s usually the wifethat has this huge learning curve, and knows more about the diseasethan the partner does. We need to know if there’s a situationwhere that maiden needs additional relief. She’s probably got anxietyand depression herself, rather than merely the malewith his recent diagnosis. It’s easy to talk to peoplethat ought to have similarly diagnosed. Through the brace group, we can match people upwith whatever they’re going through.I can think of one couplewho came to us in some despair because they weren’t communicatingwith one another. He didn’t talk about it at work, and when he came homehe didn’t talk about it. Somehow, they came to our backing groupand we generated them some facts. We opened them a link with medicalprofessionals that could help them. Now they’re a great couplethat assistant telephonecounsel parties going through a similar situation. beyondblue information about anxietyand dip, the women, you can see going through it.They’ll take the fact sheets. As Pam was suggesting, they’re the ones that will workthrough things in a realistic way. Mostly, they’re the state managersof their own families, we find. We get to the men through maidens. It’s amazing how many times, and we were exactly the same when we found out the prostate? What’s that? Where is it? What’s it time? It’s not like ladies, who know they’ve gotall the different sex percentages to them.Men contemplate as long astheir penis is functioning precisely and they’re having enormou copulation, that’s all there isto the anatomy of it. They need to speak to their partner and talk to other workers, if they’re brave enough, to find out howthey can best move forward. My erectile functionand urinary function are returning pretty well, I’d say to 90% to 100 %. It’s good to be able to express yourselfin front of people. As you see today, you can talk about anything at all. I experience coming. It’s companionship. My wife has enjoyed coming alongas well. I like to spread the word. I swim every morning, and I have circulars in my pocket. If I insure a new person in the dressing room, I say, would you like to read this? There’s so many insensitive peopleabout prostate cancer. The opinion I’d givemedical professionals giving information to their patientsabout mental health is that they’ve got to be mindfulof the distres and mood of depression that beings get in when they don’t, for instance, have full sexual reclamation. They’ve got to think beyondthe diagnosis and the therapy of the disease in its crudest anatomy, thinking more about get the person backto normal of life, or as regular as possible.Now more and more, beings are being aware of anxiety and depressionand how it changes the family. David and Pam Sandoeat the San in Sydney. It’s not for everybody though, is it, Colin? What, support groups? NORMAN: Yes. Probably not. A quantity of beings prefer to haveonetoone home treatment. That happens on a few opportunities. Generally, with a supporting radical, it’s the man and the woman who come in.You get the pair of them. The subject being draggedwith his ends skidding soil. Only about. It’s jocular, but yes. NORMAN: How long does it take on averagefor the lamp to go on? What, in getting something done? Realising that, I don’t need to resistcoming. This is not for wimps. It’s something that’s good for me. Some people, it’s usually a year before they truly get involvedwith a carry group. NORMAN: Actually? Yes, as long as that. A spate don’t come straightaway. Some do. They come beforehand. NORMAN: Which is what you did? Yes. A plenty of the guyswho are keen on themselves come before any procedure is done. That’s where they gettheir road map from. Peter, what are the benefits and limitsof support groups? The benefits are enormous. I’ve talked to a few support groups. The first thing I didis see how many collaborators there is indeed. There were 20 men and 20 womenat one in Bendigo.It was a terrific social eventas well as education. But I concur , not every guywill want to turn up to that. Which is not a problem, precisely a differentway of dealing with that subject. That’s a bloke, I repute. Men are like that. They can be withdrawn. Particularly if they’re chilled, theydon’t want to go out and be in public. We have to have our opening open to giveconsults and give them time to talk. Sometimes, I think they may benefit from talking to the guy on the bar stoolnext to them. It were not able to givegreat medical information, but they need somewhere to chit-chat. That can thrive through the clinicianif we give them more experience. Then maybe they will join thesupport group, even if it takes a year. NORMAN: How do you find a buoy groupin your domain, Colin? It’s reasonably active. We’ve got something like 70 couplesregistered, and we get a swimming attendance. That’s in Sydney. But if you’rein Kalgoorlie or the Northern Territory, is there a system of support groups? The system of support groups is done from the Prostate Cancer Foundationof Australia.They have written a listof where support groups are. Any evidence, Suzanne, that they run, beyond the anecdotal? We’ve done study ourselves. There are a lot of explanatory studiesthat are crosssectional, looking at people who goto support groups, how are they doing and what are the aspectsof support groups they recognize. They’ve been very positive studies. The important thing is that there area range of services available. Different things dres different parties. NORMAN: A menu. Which might be the Cancer Helpline, the cancer counselling service, the patronize groupor one of the volunteers from the group who’s available to talk on the phoneanonymously, your GP, your men’shealth practitioner.People need to know that some thingsmight not suit, but don’t give up. If it doesn’t seem likeit’s the right shape of support for you, try something else. In Bendigo, we range men’shealth nights.We have for nine years. We get 1,500 men out in Bendigo. Bendigo’s a 100,000 population. We’ll go out into the sticksand run these darkness, cities that have 200 or 300 parties, and you’ll get 100 turn up.At those, even though it may not bespecifically on prostate cancer, we will get chaps that comeand sneak in the back. We’ll talk about things likemental health and sex state, and those guys will absorbthat report. That’s incredible. So much for blokesnot wanting to come forward. Give them the right environment, they are able to. Particularly if you put on a barbecueand a drink, they’ll turn up, and you can talk frankly to them. Thank you all very much. What areyour takeaway senses? Colin? Takeaway message for people watching is to look at getting a proper road mapof where you’re going with some of these things we’vementioned tonight included in that, of course, the largest being depression.For clinicians to ask the questionsto the patients, then to give them timeand to listen to them. I made in accordance with that. To believethat you can make a difference by helping people with psychologicalproblems as well as physical ones. NORMAN: The prove locate is there.Suzanne? Cancer is a major life stress for boththe person with cancer and the carer. Good psychosocial and psychological careis central to good care. Thank you all very much, and thank you. I hope you’ve enjoy the programon maintaining wellbeing, dip and anxietyin beings with prostate cancer. Our thanks to beyondblue, the national depression initiative, and the Prostate Cancer Foundationof Australia for becoming the program possible. Our thanks to you for making timeto attend and contribute. If you’re interested in obtainingmore information, there are a number of resourcesavailable on the Rural Health Education Foundationwebsite: To cross-file for CPD details, completeand send in your evaluation forms.I’m Norman Swan. I’ll see you next time. Captions byCaptioning& Subtitling International Funded by the Australian GovernmentDepartment of Household, Housing, Community Servicesand Indigenous Affairs.

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