PSYCHO-ONCOLOGY. CASE PRESENTATION

Abstract

Increased survival of oncology patients brings to attention new aspects of adverse effects due to antineoplastic treatment. Psychiatric disorders, cardiovascular disorders as well as the progressive incidence of multiple primary neoplasia are some of the most common side effects. Aim: Care of the oncology patient undergoes an important period of change, from the management of tumor disease to the multidisciplinary approach, centered on improving the quality of life. Method: We present the case of a 75-year-old patient, whose personal pathological history reveals the presence of a diagnosis of left testicular seminoma, in 1978, for which he received radiochemical therapy. An oncological patient under long-term medical supervision for several decades is diagnosed in November 2017 with urothelial carcinoma, infiltrative, invasive in his own muscle patch, pT2NxMx. Approximately 40 years later, the second neoplastic site, the malignant bladder tumor, appears. Facing this diagnosis, the patient becomes anxious, anticipates catastrophic consequences, isolates himself. The family and friends support is essential in these moments, the patient tries cognitive-behavioral psychotherapy, as well as various relaxation techniques, which have positive results for the patient attitude towards the disease. He admits, to complete staging, to follow the recommendations of the oncologist, perform proton emission tomography, which detects the presence of two lesions on the right lung. In January 2018, the surgical intervention is done by straight thoracotomy, atypical upper lobe resection and inferior lobectomy is performed. The histopathological and immunohistochemical results describe the presence of the third primary adenocarcinoma neoplasia. The initial emotional reaction is one of anger, denial, followed by demoralization, easy crying, sadness. The patient is examined by the psychiatrist, thus receiving the diagnosis of a severe depressive episode without psychotic symptoms. He follows an anxiolytic, antidepressant, sedative treatment but continues also the cognitive-behavioral therapy. The patient shows good compliance with psychopharmacological treatment and accepts adjuvant chemotherapy courses, which are well tolerated. Throughout the antineoplastic therapy, there was a close collaboration between the psychiatrist and the oncologist, to avoid drug interactions that could have led to interruption of the treatment. Under the oncology supervision, the patient receives another bad news, in September 2018, the fourth neoplastic localization, the prostatic adenocarcinoma pT2bN0M0, is discovered. In this case, in the presence of the combination of synchronous and methacrone tumors, the patient's psyche is deeply affected, continuing the psychopharmacological treatment. Conclusions: Psychiatric disorders are common among oncological patients, and they may suffer serious impairments in quality of life and treatment compliance, psycho-oncological collaboration being indispensable for the success of antineoplastic treatment.