In this lecture, we're going to be talking about families, an integral part of the care of patients with lung and esophageal cancer. Families are very critically important and we always say that cancer is a family illness, it's not just about the individual but everybody's affected. All patients families are complicated and complex patients are sometimes very embarrassed by their families or us finding out more about them, and we try to say that really everybody has a unique and special family. It's important for us to help patients and their families understand the kind of cancer, whether it's lung or esophageal or other cancer, and help educate the whole family. Some people don't understand the genetics, whether the cancer is catchy. Sometimes there are genetic factors and it's important for family members to be screened and then the impact of the genetic testing on other family members is very important. Families always start off with stressors. I don't know a family that doesn't have some stressors. Different strengths and values. And have different emotional problems, even before the cancer. So when we add the cancer, it's really important to figure out where the families are at, who's able to help, who's not able to help and to pull them in, and to find out maybe some other supports or resources to bring to bear for that patient and family. We want to know who's in the family, whether it's primary folks or extended family, and sometimes who live very far away are willing to come and help resell one another or be helpful in other ways not just for physical presence. And who might be helpful for the short or long term issues. It's a helpful for us to know what somebody all complex are. Can any of this be resolved? And what are the current tensions? Who's getting along with whom and can we do any contact family where to help with some of these issues. And so, family work, partner work, work with children, and parents are always so important, and we need to take time to understand families. So, question 4. An important issue for families might include, ability to communicate with the oncologist. Trying to enroll in a Ph.D program. Making sure to bring pizza and snacks for the oncology team. That would be nice. Or starting a new business. And the ability to communicate with the oncologist is really key, and we want to make sure that we provide a way for the patient to help us understand who is, in the family, important. And if it's approved by the patient for us to communicate with, we have a way at the University of Michigan for the patient to tell us who might be on an email or who we can communicate in terms of friends and family. And often that's very helpful for us to talk about in the very beginning, or through the course of care, then to have regular meetings with the patient, with the family. Other issues for family members that need to be sorted out include finances. How much is this going to cost? Are there ways to decrease costs? Sometimes patients want to know if going to the VA or other types of institutions might be easier for families, and so that's important. Important kinds of conversations, how's this going to impact on jobs, transportation, to and fro medical appointments, can friends be used for this, other kinds of transportation services. Who's going to take care of the household and children? Who's going to cook, clean and other matters that need to be on a practical basis, may be causing distress for the patient and family, and need to be talked about. Communicating with others, sometimes it's very fatiguing for family members or loved ones to have to send duplicative emails or telephone conversations saying the same thing, so is there a way to have communica- [INAUDIBLE] that is efficient effective and not duplicative and not stressful in taking a lot of time in perhaps making the patient or the family exhausted. How do other members of the family get rest or get their needs attended to, eat properly and healthy? And keep up with their own medical and dental and other appointments without feeling guilty or that they're taking time away from their loved one with lung or esophageal cancer. In conclusion what are some of the take home points from this lecture? Well It's very important to screen for distress on a regular basis but one has to do something about the screening and so one has to take it from the screening to then communicating and talking about the level of distress, finding out what's making the patient distress? It's not always psychological or emotional issues or having a psychiatric condition. Could be practical issues such as having transportation, financial issues, physical issues. And then one has to have a system in place to manage this level of distress. We at the University of Michigan comprehensive cancer center have an embedded site-long oncology programs. We have complimentary therapies embedded within the cancer center but other places have to determine how they can take that distress screening and then further evaluate the patient, the family, and then provide ongoing evaluation treatment and management. And then we need to communicate with the patients and families in an ongoing basis that distress is an incredibly important part of care especially in lung and esophageal cancers. So in terms of the post-lecture question. For patients with lung or esophageal cancer, distress is prevalent in about 5% of patients, not as important as other quality measures, a condition that may relate to depression, anxiety, adjustment and always attributable to past psychiatric history. And hopefully you know the answer to this. The answer is a condition that may relate to depression, anxiety and adjustment. But it could be related to something else such as transportation issues, financial issues, job issues, etc. So thank you very much. I appreciated the opportunity, to talk with you today. Thank you.
