In this lecture, we are going to be focusing on treatment options for patients with lung and esophageal cancer who have distress and or depression and anxiety. So let's talk about treatment options. When should patients with lung and esophageal cancers seek professional support? When symptoms interfere with the ability to function and when patients are unable to go to work, to have relationships, to come to their treatment, to engage. And hobbies to exercise, then it's important to seek professional support. When the symptoms are out of proportion to the actual threat. So sometimes patients need education they need to talk with their provider. Sometimes patients are going on the web, and receiving erroneous or non-factual information from the web. Sometimes patients join groups on the Internet which are not really helpful to them and actually just make them scared. So it's important for us to help patients get appropriate information and education about their particular type of cancer. And to help them, so that they're functioning and they don't perceive the correct in an inappropriate way. Patients should seek professional support when they are having suicidal thoughts or plans. And when they're behaviors, such as smoking, drinking or poor nutrition, are impacting on they're ways to be healthy. When family or friends express concerns about their loved one, it's important to seek professional help. Really any degree of emotional distress warrants an evaluation. When the the patient has very few supports or confidants, we need to help them build that up and build that in. In terms of psychosocial therapies for patients with lung or esophageal cancer, what do we mean when we say change or modify lifestyle? Well, exercise is an important component of being healthy. So, patients often have athletics or other things they enjoy before the cancer, we try to survey with them if that's possible to go back to, or if they need different activities. Some patients are very worried about getting back on the treadmill or walking or biking and so, we may need to have a trainer. Work with them or get them to the physical therapy or have them monitored by nurses use their other physical therapist so that it helps them readjust back to exercising. This is an important area for emotional health, and for depression and anxiety, as a matter of fact. We found that mind body interventions, such as the meditation, relaxation, yoga may be very helpful for patients, and improve their quality of life. We have expressive writing and journaling classes. Again, ways for various patients to express themselves. And art and music should be really integral as complementary therapies for patients with lung or esophageal or other kinds of cancer. There are a number of psychotherapies that are very helpful for patients. Cognitive behavioral therapy is one of them. Supportive expressive therapy, relaxation and guided imagery, group, family, and marital therapy as well. And in medication alone, but ideally combined with one of the above approaches such as cognitive, supportive, relaxational group or family therapies. When are Medications Appropriate? Well, to begin with one might want to use a distress thermometer or other screen for distress and then have certain cutoffs to determine when patients may be better evaluated by a mental health professional. So, medications might be discussed due to symptom severity, the duration of the symptoms and then the level of function. So question three, an antidepressant medication that is often used for patients with lung or esophageal cancer may include Thorazine, Quetiapine, Escitalopram or Clonazepam. And the answer is Escitalopram that was the only antidepressant medication on that list. The other medications were antipsychotics and one was an anxiolytic medication called Klonopin. The various Medication Classes that we may be able to prescribe to patients with distress and psychiatric conditions include antidepressants. Anxiolytics, antianxiety medications. Sedative/hypnotics. Those are medications for example, sleep. Mood stabilizers that might be used for bipolar disorder or recurrent depressions. Antipsychotics that may be used for patients with severe psychiatric conditions such as schizophrenia, schizoaffective disorders. And some phases of bipolar disorder, smoking cessation, and then sobriety maintenance are some of the major classes of types of drugs. In terms of antidepressants, there are two major types, but there are other types. One type is the selective serotonin reuptake inhibitors and you may have heard the term SSRIs. And in that class, would be Fluoxetine the brand name would be Prozac, Sertraline the brand name would be Zoloft, Escitalopram, the brand name would be Lexapro and paroxetine, the brand name would be Paxil. And on the other group, would be Serotonin norepinephrine reuptake inhibitors, the SNRIs. Though to be venlafaxine, brand name would be Effexor Desvenlafaxine, the brand name would be Pristiq. Duloxetine, the brand name would be Cymbalta. These medications would be used for different purposes. It might be related to what the patient's been on before for depression. It might be related to what other family members might have been on before and what has been useful. It might be related to the type of chemotherapy agents that the patients might be on for the long esophageal cancer and which medication would not interfere with the treatment for long esophageal cancer. What the side effects of the antidepressants might be, some of them are more enervating, some of them are more sedating, some of them help with appetite some might not. And so, we might take into effect these side effects and use those side effects when prescribing. Always working with the oncologist, the pharmacist, the radiation oncologist or the surgeon to try to determine with the patient what's the most efficacious medication there are other classes of antidepressants. The tricyclic antidepressants are probably the oldest antidepressants, and you might've heard of some of these names, Amitriptyline (Elavil) or Nortriptyline (Pamelor). We tend not to use that type very much anymore because of the side effects of tricyclics. There's something called the anticulminur side effect of the tricyclics, where it dries mucous membranes out. Sometimes it impacts on patients getting more constipated, and there's a great suicide potential and overdose with taking tricyclics so we tend to not use them. But there are some patients who are on them, have been on them for a long time. And sometimes, the side effect profile is good for that particular patient. There are also adjunct of antidepressants that we may add to one of the other antidepressants like the SSRIs or SRNIs that the patient's on. To try to increase the efficacy of the other antidepressants such as Buspirone or Buspar. Aripiprazole (Abilify) that's an antipsychotic, or Quetiapine (Seroquel) which is an antipsychotic. The other antidepressant medications that we use are Mirtazapine (Remeron) which is a very good drug, especially for people who are losing weight, it helps with appetite and it also helps people sleep. Bupropion, the other name for that is Wellbutruin, Zyban which is a good smoking cessation drug. Trazodone, which is branded as Desyrel and is a very good sleeping agent, it does cause orthostatic hypertension or priapism in men. And Viibryd which is a newer antidepressant. There are also anxiolytics and can be used to help patients with the anxieties. But some of the antidepressants also can be used as an anxiolytics and in general that's usually safer. Such as sertraline and zoloft is often very good when it's in a good therapeutic dose. It helps with anxiety, as well as depression. Some of the benzodiazepines we use for patients, we try to minimize these because of some of the side effects. So some of the benzodiazepines we use are Lorazepam (Ativan) Alprazolam, (Xanax) Diazepam (Valium) or Clonazepam (Klonopin). Ativan or Lorazepam is the shortest acting one and we tend to use this because often it's used as part of the chemotherapeutic agents. But these medications in general have significant side effects. It could effect coordination, gait, G-A-I-T it contributes to falls, F-A-L-L-S in the elderly. It impacts in a negative way with the concentration of memory could impact on driving and so, we try not to use this and if we do it is very, very, short periods of time. Complementary Therapies are very important for patients with long esophageal cancer and as we talked about before art therapy can be very significant and important for people. Especially for those who may not want to talk about, or have a conversation about their feelings, but may want to use their art to express themselves. Guided Imagery is very helpful for patients to help focus and think about and use. We make up audiotapes for patients to use, and they can use them when they're in stressful or difficult situations, or just to help relax. Massage Therapy is very helpful for some patients, meditation, music therapy, and yoga and sometimes patients use a variety of these in combination. In the next lecture, we're going to be talking about a very important factor for patients who have lung or esophageal cancer their families.
