The Impact of Anxiety in Cancer Clients, Article Review Example

Abstract

In a recent article to be analyzed, the correlations between anxiety and cancer are addressed, with an emphasis on a general presentation of the forms anxiety may take.  The deficiencies of the article then lead to an expansion of the subject, as various treatment and approaches for lessening anxiety are discussed.  The methods employed vary, yet results consistently reveal that, as anxiety is very much a fixture within the cancer patient’s existence, so too do palliative measures, such as music and hypnotherapy, alleviate it.  Equally importantly, all of this study indicates the importance of the advance practice nurse.  Nursing is based upon an urgency to attend to the patient as an individual, rather than as an illness; this being the case, research on anxiety in cancer patients goes directly to the nurse’s purview, which is to ease distress in manners removed from the physician’s care.

Introduction

As is well established, no strict dichotomy exists between the health of the mid and body.  As illness tends to generate various types of emotional distress, so too may emotional imbalances promote poor health or exacerbate existing conditions.  Given the severity of cancer, then, it is only reasonable to anticipate higher degrees of this type of interaction, as most people greatly fear cancer, and as the disease itself may easily create feelings of despair and anxiety.  This latter element is the subject of the article to be reviewed, which in turn will enable expanded discourse regarding research and treatment potentials.  The arena is inherently complex and only recently explored but, as will be evident, the study and greater understanding of how anxiety impacts cancer patients clearly has vast implications for oncology nursing.  To be reviewed, and as expanding upon the central article, is how recent studies support non-pharmaceutical interventions of hypnotherapy, energy and music therapies, and the importance of senses of self-efficacy.  Ultimately, as cancer so drastically affects the individual’s entire state of being, nursing here is both constrained to comprehend the subject as fully as possible, and poised to have a significantly beneficial influence on how such patients deal with anxiety.

Article Summary

In “Stress, Fears, and Phobias: The Impact of Anxiety,” author Joyce Marrs presents a necessarily abridged assessment of anxiety as impacting on the population as a whole, and on oncology clients in particular.  Dramatically, she commences by citing several cases wherein cancer patients are severely hampered by forms of actual, physical distress, from nausea to sleeplessness, as they undergo treatment.  From here, Marrs turns to the thrust of the work, which is to emphasize both the omnipresence of anxiety and the lack of specific knowledge regarding its effects.  The breakdown is precise and comprehensive, with anxiety disorders of various kinds identified, ranging from agoraphobia to post-traumatic stress disorder.  Marrs then goes on to discuss the pathophysiology of such disorders, observing that, while environmental or social factors may certainly promote them, research indicates distinct biological causes as well, as in imbalances of biochemical neurotransmitters (2006,  p. 320).  Following a brief addressing of diagnostic methods, the author then discusses both pharmacologic and non-medicinal modes of treating anxiety.  Regarding the former, Marrs carefully documents currently accepted medications, including antidepressants, beta blockers, and anticonvulsants.  She notes, however, that psychological types of treatment, such as cognitive-behavioral therapy (CBT), are urged as assisting pharmaceutical efforts: “Control of long-term symptoms is 50%–75% greater with the use of CBT than with medication alone”  (Marrs, 2006,  p. 321).   In a very brief conclusion, Marrs returns to the subject of oncology, yet only as reinforcing the need for advance practice nursing applied to it as potentially meaningful mode of address.

In pragmatic terms, Marr’s article, while clearly well-researched and comprehensive, reveals to the reader little that is not already established, or even known widely outside of the medical community.  She defines the types of anxiety and moves in a linear manner to discuss diagnosis and existing treatment options, yet there is a conspicuous lack of emphasis regarding her initial point, which is that oncology apparently, and enormously, is linked to anxiety at high levels.  Interestingly, Marrs cites at the end of her article that the advance practice nurses who deal with such patients are in a “unique position” to enhance the experiences of treatment and care for them (2006,  p. 321), but she does not elaborate on this seemingly crucial point further.  This is regrettable, for everything Marrs relates most certainly goes to encouraging this vague assertion.  Quite simply, two circumstances exist which demand further investigation, and in a reciprocal manner:  anxiety is likely to be far more evident and impactful in the field of oncology, and nurses, attending to the entirety of the patient’s well-being in a way the physician cannot, may be the most instrumental agent in addressing anxiety in cancer clients.  How this may be pursued is reflected in recent research, and offered below for consideration.

Treatment Approaches and Implications for Nursing

If, as Marrs indicates, research is lacking in the relationship between anxiety and oncology, it is nonetheless increasingly undertaken, and in interesting ways which must impact on nursing.  At a palliative care unit in a hospice in Surrey, England, a study was conducted to gauge the value of hypnotherapy for terminally ill cancer patients. The focus group was selected, not unexpectedly, because the researchers identified that fear of death for the self is by no means the sole agent producing extreme anxiety in such patients; concerns for loved ones, as well as physical cause, may contribute, so the sampling relied upon the unfortunate extremity of these patients.  More precisely, it appears the study sought to assess hypnotherapy by applying it in the most complex and severe instances of oncology.  The 20 participants received four sessions of hypnotherapy, each reflecting a different strategy, and ranging from self-hypnosis to the visualizing of immune system enhancement.  The result indicated reduced degrees of anxiety, and in a manner specifically reflecting other such studies; namely, the improvements were noted as occurring after the second session, in which visualization is developed as a skill by the patient (Plaskota, Lucas, Pizzoferro, Saini, Evans, & Cook, 2012,  p. 73).  More exactly, in these sessions the patients were encouraged to view their illness, and other other issues, in a way external to themselves.  The study is, as acknowledged by the researchers, inherently limited in both size and scope.  The authors, nonetheless, reinforce the need to pursue hypnotherapy as a valuable resource in treating anxiety, based on these outcomes alone.

It may seem that such an intervention is inapplicable to oncology nursing, yet such a perception vastly underestimates both the nature of the study and the potentials – and pragmatic functions – of the advance practice nurse.  The anxiety in question is, as noted, intrinsically complex, and typically evolving from depression and/or states of extreme fear.  As hypnotherapy may provide a useful avenue in alleviating these causes, it is inevitable that the nurse be an active agent in the process, simply because the totality of the patient’s experience is within the nurse’s purview.  Then, further research indicates that therapeutic touch (TT) interventions, applied directly by nurses, accomplish the same, calming results.  TT is a modern interpretation of ancient healing techniques, in which human fields of energy as accepted as influencing, if not dictating, health, and external energy supplied by another augments the individual’s positive energy.  In a sense, this is a more physical variation on hypnotherapy, in that the treatment relies on the connections between perception and physicality, as well as between the emotional and the physical.  It is, moreover, validated by multiple and recent studies which reveal decreased anxiety levels when TT is administered by nurses.  Actual touching is rarely done; rather, the nurse maintains rhythmic movements of the hands near the patient’s skin, which is thought to eliminate energy congestion (Coakley, Barron, 2012, p. 59).

If such energy therapies were initially disregarded by the medical community as insubstantial, it must be remembered that hypnotherapy was long regarded as inapplicable to oncology, and it is increasingly accepted today that, as this most severe of diseases impacts the patient’s entirety, so too are seemingly extraneous modes of intervention effective.  More pertinently, qualitative and quantitative evidence indicates positive benefits from TT and other energy therapies (Coakley, Barron, 2012, p. 61).  The implications for nursing, then, are evident, particularly as these processes are removed from the responsibilities of a licensed physician.  What they reflect, in fact, is how vastly influential the nurse may be in alleviating anxiety, and consequently enhancing the life of the oncology patient.

Given the reflex of anxiety typically generated by the fear of chemotherapy, as well as by the comprehension of why the treatment is performed, further research has explored another type of approach removed from the pharmacological, and with strong implications for nursing.  It has been proposed that music therapy during chemotherapy will manifest significantly reduced anxiety levels, and to that end a study involving 123 cancer patients was conducted in 2009.   As the patients listened to music during the chemotherapy sessions, so too were their physical states monitored in order to reveal changes in stress and anxiety levels.  The results were positive:  “Music intervention during a 30-minute chemotherapy protocol possesses significant effects on reducing anxiety in those patients with prechemotherapy HSA”  (Lin, Hsieh, Hsu, Fetzer, & Hsu, 2010,  p. 996).   What is noteworthy here, aside from the obvious promotion of the use of music in these situations, is how the role of the nurse is reflected.  This type of therapy is ambient, or certainly outside of the physician’s province.  It appears to be a facet of care more belonging to the individual responsible for the general state of the patient’s well-being, and that individual is the nurse.  As the authors of the music therapy study conclude: “Skills for managing negative emotional responses and distressful symptoms are critical to the quality of life of a patient with cancer” (Lin et al 2010,  p. 989).  This, then, is a form of management significantly attached to the responsibilities of the advance practice nurse.

Lastly, the factor of self-efficacy is studied in its relation to how self-perceptions of innate capability reflect anxiety levels in cancer patients.  This approach addresses, and quite literally, the complex influences underlying anxiety in these situations, in that it focuses on the individual’s internal mechanisms for dealing with the trauma of the disease.  In a study of 99 cancer patients conducted in 2009, self-assessment measures were recorded to determine individual comprehensions of intensity of feeling, and through an instrument devised to ascertain anxiety likelihoods as indicated by these self-assessments.  The results, with some variations in regard to greater self-efficacy beliefs in men, tend to support the not unexpected reality that those with greater confidence in their own abilities, in general terms, are less prone to anxiety.  Moreover, the self-efficacy factor is not fixed, as it is suggested that: “Self-efficacy is increased when patients are taught to identify high-risk situations and cope with them effectively”  (Mystakidou, Tsilika, Parpa, Gogou, Theodorakis, & Vlahos, 2009, p. 209).  Clearly, anxiety, and specifically anxiety generated due to cancer, is an emotional response dependent upon multiple, and shifting, variables.  This in turn relates to an element further complicating the issue of anxiety, as confronted by both nurse and patient: response shift.  The term refers to the exponential variations in anxiety which occurs as the actual stages of disease develop, including early diagnosis.  Patients, simply, create differing perceptions regarding what quality of life means to them as they move through treatment and experience varying results, and these perceptions then trigger varying levels of anxiety (Hinz, Finck Barboza, Zenger, Singer, Schwalenbrrg, & Stolzenburg, 2011,  p. 601).  These factors, then, and in accord with research on specific therapies in place to ameliorate anxiety in cancer patients, profoundly underscore the critical role of the nurse.  As nursing addresses the entirety of the individual patient, it may be that no caregiver is better enabled to address the multifaceted issue of anxiety for the patient.

Conclusion

As demanding to medical science is the urgency to treat various cancers, so too is there today an increased and necessary emphasis given to how anxiety affects the lives of patients.  The emotions greatly influence physical states, certainly insofar as a greater sense of well-being must better enable a patient to combat all illness; anxiety, consequently, may be viewed as an ancillary and negative effect of disease.  With cancer, a variety of therapies are lately being explored, ranging from hypnotherapy, music and energy therapies,  and an approach based on comprehending the relationship between self-efficacy and anxiety.  The implications for the nurse are plain, for no one is more entrusted to attend to the cancer patient’s general state of well-being.  As research moves forward, in fact, it seems that this unique and essential relationship, and with specific regard to anxiety, should be further explored.  Cancer dramatically affects the individual’s total state of being; nursing, then, is both obligated to comprehend the subject as fully as possible, and most effectively poised to have a significantly beneficial influence on how cancer patients deal with anxiety.

References

Coakley, A. B., & Barron, A. (2012). “Energy Therapies in Oncology Nursing.” Seminars in Oncology Nursing, 28 (1),  55-63.

Hinz, A., Finck Barboza, C., Zenger, M., Singer, S.  Schwalenbrrg, T., & Stolzenburg, J.-U. (2011).  “Response Shift in the Assessment of Anxiety, Depression and Perceived Health in Urologic Cancer Patients: An Individual Perspective.”  European Journal of Cancer Care, 20, 601-609.

Lin, M.-F., Hsieh, Y.-J., Hsu, Y.-Y., Fetzer, S., & Hsu, M.-C. (2010).  “A Randomised-Controlled Trial of the Effect of Music Therapy and Verbal Relaxation on Chemotherapy-Induced Anxiety.”  Journal of Clinical Nursing, 20, 988-999.

Marrs, J. A.  (2006).  “Stress, Fears, and Phobias: The Impact of Anxiety.”  Clinical Journal of Oncology Nursing, 10 (3), 319-322.

Mystakidou, K., Tsilika, E., Parpa, E., Gogou, P.,Theodorakis, P., & Vlahos, L. (2010). “Self-  Efficacy Beliefs and Levels of Anxiety in Advanced Cancer Patients.” European Journal of Cancer Care, 19, 205-211.

Plaskota, M., Lucas, C., Pizzoferro, K., Saini, T., Evans, R., & Cook, K.  (2012).  “A Hypnotherapy Intervention for the Treatment of Anxiety in Patients with Cancer Receiving Palliative Care.”  International Journal of Palliative Nursing, 18 (2), 69-75.