{"id":3284,"date":"2024-12-09T07:18:09","date_gmt":"2024-12-09T07:18:09","guid":{"rendered":"https:\/\/practicalhealthpsychology.com\/?p=3284"},"modified":"2026-03-03T08:46:22","modified_gmt":"2026-03-03T08:46:22","slug":"what-if-it-comes-back-the-question-that-is-on-the-minds-of-those-who-experienced-cancer-treatment-and-their-loved-ones","status":"publish","type":"post","link":"https:\/\/practicalhealthpsychology.com\/fi\/2024\/12\/what-if-it-comes-back-the-question-that-is-on-the-minds-of-those-who-experienced-cancer-treatment-and-their-loved-ones\/","title":{"rendered":"“Mit\u00e4 jos se tulee takaisin?” T\u00e4m\u00e4 kysymys on sy\u00f6p\u00e4hoidot kokeneiden henkil\u00f6iden ja heid\u00e4n l\u00e4heistens\u00e4 mieliss\u00e4."},"content":{"rendered":"

Kirjoittanut: Gozde Ozakinci, Stirlingin yliopisto<\/p>\n

Sy\u00f6p\u00e4 yhdistet\u00e4\u00e4n usein pelottaviin tilastoihin, kuten esimerkiksi v\u00e4itteeseen “jokatoinen ihminen sairastuu el\u00e4m\u00e4ns\u00e4 aikana jonkinlaiseen sy\u00f6p\u00e4\u00e4n<\/a>“. Rohkaisevia kehitystulokset kuitenkin viittaavat siihen, ett\u00e4 sy\u00f6v\u00e4st\u00e4 selvi\u00e4misen todenn\u00e4k\u00f6isyys paranee<\/a>. Vuoden 2018 tilastojen mukaan maailmassa oli l\u00e4hes 44 miljoonaa ihmist\u00e4, jotka olivat selvinneet sy\u00f6p\u00e4diagnoosista ja -hoidosta<\/a>. T\u00e4m\u00e4 on ilahduttava uutinen kaikille sy\u00f6p\u00e4diagnoosin ja -hoidon kokeneille.<\/p>\n

Positiivinen kehitys selviytymistilastoissa tarkoittaa my\u00f6s sit\u00e4, ett\u00e4 yh\u00e4 useammat ihmiset el\u00e4v\u00e4t sy\u00f6p\u00e4hoitojen j\u00e4lkiseurausten kanssa. Yksi n\u00e4ist\u00e4 seurauksista on pelko sy\u00f6v\u00e4n uusiutumisesta. Kirjallisuudessa t\u00e4m\u00e4 m\u00e4\u00e4ritell\u00e4\u00e4n “peloksi, huoleksi tai ahdistukseksi, joka liittyy mahdollisuuteen, ett\u00e4 sy\u00f6p\u00e4 uusiutuu tai etenee”, ja se tunnistetaan laajalti yhdeksi merkitt\u00e4vimmist\u00e4 el\u00e4m\u00e4nlaatuun vaikuttavista ongelmista sy\u00f6p\u00e4diagnoosin saaneilla.<\/p>\n

<\/p>\n

Kuinka yleisi\u00e4 n\u00e4m\u00e4 pelot ovat?<\/strong><\/p>\n

T\u00e4h\u00e4n kysymykseen vastaaminen ei ole yksinkertaista, koska tutkimuksissa on k\u00e4ytetty erilaisia mittareita sy\u00f6v\u00e4n uusiutumisen pelon arviointiin. Systemaattinen katsaus 130 tutkimukseen<\/a> osoitti, ett\u00e4 eri sy\u00f6p\u00e4tyyppien ja arviointimenetelmien kohdalla keskim\u00e4\u00e4rin 49 % vastaajista raportoi kohtalaisia tai korkeita sy\u00f6v\u00e4n uusiutumisen pelkoja, ja keskim\u00e4\u00e4rin 7 % vastaajista raportoi eritt\u00e4in korkeita pelkoja. Uudempi meta-analyysi-tutkimus<\/a> raportoi, ett\u00e4 yksi viidest\u00e4 sy\u00f6p\u00e4selviytyj\u00e4st\u00e4 ja potilaasta koki voimakasta pelkoa sy\u00f6v\u00e4n uusiutumisesta, mik\u00e4 viittaa asiantuntevan psykologisen tuen tarpeeseen. Lis\u00e4ksi n\u00e4m\u00e4 tutkimukset osoittavat, ett\u00e4 pelot eiv\u00e4t h\u00e4vi\u00e4 ajan my\u00f6t\u00e4. Nuori ik\u00e4, naissukupuoli ja matala koulutustaso on yhdistetty korkeampiin uusiutumisen pelkoihin. T\u00e4rke\u00e4 n\u00e4ihin pelkoihin liittyv\u00e4 tekij\u00e4, on sellaisten fyysisten oireiden kokeminen, joita voidaan tulkita sy\u00f6v\u00e4n uusiutumisen merkkein\u00e4.<\/p>\n

Mik\u00e4 on pelkojen yhteys psykologiseen hyvinvointiin?<\/strong><\/p>\n

Sy\u00f6v\u00e4st\u00e4 selviytyneet tunnistavat sy\u00f6v\u00e4n uusiutumiseen tai etenemiseen liittyv\u00e4t pelot suurimmaksi tai yhdeksi viidest\u00e4 suurimmasta huolenaiheestaan<\/a>. N\u00e4iden pelkojen ei ainoastaan koeta olevan merkitt\u00e4v\u00e4 huolenaihe, vaan jopa 79 % raportoi, ett\u00e4 asiaan on hankala saada apua. Pelot sy\u00f6v\u00e4n uusiutumisesta on yhdistetty heikompaan el\u00e4m\u00e4nlaatuun, korkeampaan ahdistukseen, masennukseen ja stressiin<\/a>. On my\u00f6s n\u00e4ytt\u00f6\u00e4 siit\u00e4, ett\u00e4 korkeat pelot sy\u00f6v\u00e4n uusiutumisesta liittyv\u00e4t lis\u00e4\u00e4ntyneeseen terveydenhuollon k\u00e4ytt\u00f6\u00f6n.<\/a><\/p>\n

Vaikka suurin osa tutkimuksesta on tehty sy\u00f6v\u00e4st\u00e4 selviytyneiden parissa, tuore tutkimus<\/a> osoittaa, ett\u00e4 sy\u00f6v\u00e4n uusiutumisen pelot ovat ongelma my\u00f6s omaisille: 48 % raportoivat huolista, jotka viittaavat psykologisen tuen tarpeeseen. Toinen tutkimus<\/a> osoitti, ett\u00e4 omaisten pelot voivat olla yht\u00e4 korkeita tai jopa korkeampia kuin selviytyjien, ja n\u00e4m\u00e4 pelot olivat yhteydess\u00e4 omaisten ja sy\u00f6v\u00e4st\u00e4 selviytyjien heikompaan el\u00e4m\u00e4nlaatuun.<\/p>\n

Mitk\u00e4 ovat kliinisen tason sy\u00f6v\u00e4n uusiutumisen pelkojen piirteet?<\/strong><\/p>\n

On selv\u00e4\u00e4, ett\u00e4 sy\u00f6v\u00e4n uusiutumisen pelko ovat moniulotteinen ilmi\u00f6. Asiantuntijaryhm\u00e4n tutkimus<\/a> ehdotti seuraavia kliinisten pelkojen avainpiirteit\u00e4:<\/p>\n

    \n
  1. Liiallinen keskittyminen pelkoon.<\/li>\n
  2. Korkea huolestuneisuuden taso.<\/li>\n
  3. Pelkojen jatkuminen.<\/li>\n
  4. Kehon oireiden liiallinen tarkkailu.<\/li>\n<\/ol>\n

    Kuinka n\u00e4it\u00e4 pelkoja mitataan?<\/strong><\/p>\n

    Yksi varhaisista sy\u00f6v\u00e4n uusiutumisen pelkojen mittaamiseen keskittyvist\u00e4 tutkimuksista<\/a> tunnisti 20 mittaria, jonka j\u00e4lkeen toinen tutkimus<\/a> l\u00f6ysi kahdeksan lis\u00e4\u00e4. On pyritty luomaan kliininen raja-arvo niiden henkil\u00f6iden tunnistamiseksi, jotka tarvitsevat psykologista tukea. Fear of Cancer Recurrence Inventory<\/strong><\/a> on 42 kohtaa sis\u00e4lt\u00e4v\u00e4 mittari, joka mahdollistaa perusteellisen arvioinnin n\u00e4ist\u00e4 peloista. Siin\u00e4 on useita osamittareita, ja laajasti k\u00e4ytetty on 9-kohtainen Severity<\/em>-osamittari,<\/a> jossa raja-arvo on \u226522. Lyhyempi\u00e4 mittareita, kuten FCR4 ja FCR7<\/a>, on my\u00f6s k\u00e4ytetty lyhyempin\u00e4 mittareina tunnistamaan henkil\u00f6t, joilla pelon taso on keskim\u00e4\u00e4r\u00e4inen tai korkea. k\u00e4ytet\u00e4\u00e4n my\u00f6s. Lis\u00e4ksi on esitetty yhden kysymyksen mittaria<\/a> seulonnan helpottamiseksi.<\/p>\n

    Mitk\u00e4 ovat tehokkaat tavat tukea sy\u00f6p\u00e4potilaita n\u00e4iden pelkojen kanssa?<\/strong><\/p>\n

    Meta-analyysi psykologisista interventioista sy\u00f6v\u00e4n uusiutumisen pelkoihin liittyen<\/a> osoitti, ett\u00e4 interventiot voivat tuottaa pienen mutta kest\u00e4v\u00e4n vaikutuksen. Ne kognitiivis-behavioraaliset terapiat, jotka eiv\u00e4t keskittyneet pelk\u00e4st\u00e4\u00e4n sis\u00e4lt\u00f6\u00f6n vaan ennemminkin mielen prosesseihin kuten m\u00e4rehtimiseen (rumination) ja yksil\u00f6n sis\u00e4isten kokemusten k\u00e4sittelyyn, tuottivat suurempia vaikutuksia.<\/p>\n

    K\u00e4yt\u00e4nn\u00f6n suosituksia:<\/strong><\/p>\n

      \n
    1. Keskustelun k\u00e4ynnist\u00e4minen peloista<\/strong>: Potilaat eiv\u00e4t v\u00e4ltt\u00e4m\u00e4tt\u00e4 halua tuoda sy\u00f6v\u00e4n uusiutumiseen liittyvi\u00e4 pelkojaan esille terveydenhuollon edustajalle, koska eiv\u00e4t halua vaikuttaa ep\u00e4kiitollisilta<\/a>. Keskustelun aloittaminen voi kuitenkin auttaa ja tuoda tarvittavaa tukea. Pelkojen sanoittaminen voi olla eritt\u00e4in hy\u00f6dyllist\u00e4 sy\u00f6v\u00e4st\u00e4 selviytyneille.<\/li>\n
    2. Tiedon tarjoaminen sy\u00f6v\u00e4n merkeist\u00e4<\/strong>: Keskustelu siit\u00e4, mitk\u00e4 oireet voivat viitata sy\u00f6p\u00e4\u00e4n ja milloin kannattaa olla terveydenhuoltoon yhteydess\u00e4, voi auttaa h\u00e4lvent\u00e4m\u00e4\u00e4n v\u00e4\u00e4rink\u00e4sityksi\u00e4.<\/li>\n
    3. \u00c4l\u00e4 unohda omaisia<\/strong>: Vaikka sy\u00f6p\u00e4potilaisiin ja selviytyjiin keskittyminen on itsest\u00e4\u00e4n selv\u00e4\u00e4, tulee terveydenhuollon ammattilaisten muistaa, ett\u00e4 my\u00f6s omaiset kokevat pelkoja ja saattavat tarvita tukea.<\/li>\n
    4. Seulonta ei riit\u00e4<\/strong>: Pelkojen seulonta on hy\u00f6dyllist\u00e4. Pit\u00e4\u00e4 kuitenkin my\u00f6s varmistaa, ett\u00e4 \u00a0asianmukaista psykologista tukea on tarjolla potilaille ja omaisille.<\/li>\n
    5. Ahdistuksen merkkien tarkkailu<\/strong>: Varhaiset merkit ahdistuksesta ja muutokset ahdistuksen tasossa<\/a> voivat ennakoida sy\u00f6v\u00e4n uusiutumisen pelon lis\u00e4\u00e4ntymist\u00e4 ensimm\u00e4isen hoitovuoden aikana. Ahdistuksen merkkej\u00e4 on syyt\u00e4 seurata ja tukea tarjota varhaisessa vaiheessa.<\/li>\n<\/ol>\n

      [K\u00e4\u00e4nn\u00f6s: Eeva Kettunen]<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

      By Gozde Ozakinci, University of Stirling\u00a0 Cancer is very much associated with scary statistics. For instance, like the one \u20181 in 2 people will develop some form of cancer in their lifetime\u2019.\u00a0 But there are encouraging developments too that suggests […]<\/p>\n","protected":false},"author":9,"featured_media":3285,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"off","_et_pb_old_content":"By Gozde Ozakinci, University of Stirling\u00a0<\/span>\r\n\r\nCancer is very much associated with scary statistics. For instance, like the one \u2018<\/span>1 in 2 people will develop some form of cancer in their lifetime\u2019<\/span><\/a>.\u00a0 But there are encouraging developments too that suggests that <\/span>cancer survival rates are improving<\/span><\/a>.\u00a0 The last count in 2018 suggests that <\/span>there are nearly 44 million people who survived the cancer diagnosis and treatment in the world<\/span><\/a>. This is welcome news to those who have experienced cancer diagnosis and treatment.\u00a0<\/span>\r\n\r\nThe improvement in survival rates also means that more and more people live with the consequences of cancer treatment. One of these consequences is experiencing fears about cancer coming back. In the literature, it is defined as \u201c<\/span>fear, worry, or concern relating to the possibility that cancer will come back or progress<\/span><\/a>\u201d and recognised widely as one of the most significant issues that impact on the quality of life of those living after a cancer diagnosis.\u00a0<\/span>\r\n\r\nHow common are these fears?<\/b>\r\n\r\nAnswering this question is not straightforward as the studies have used different tools to measure fears of cancer recurrence. A <\/span>systematic review of 130 studies<\/span><\/a> showed that across different cancer sites and assessment strategies, 49% on average reported moderate to high degree of Fear of Cancer Reoccurrence (FCR), and 7% on average reported high degree. <\/span>A more recent meta-analysis<\/span><\/a> reported that one in 5 cancer survivors and patients experienced high levels of fears of cancer recurrence, indicating a need for specialised psychological support.\u00a0 Moreover, these reviews show that these fears do not go away over time. Being women, of younger age, and having less education have been associated with higher fears of cancer recurrence.\u00a0 One of the important factors that is associated with these fears is the experience of physical symptoms which can be interpreted as signs of cancer coming back.<\/span>\r\n\r\nWhat\u2019s the relationship of these fears with psychological wellbeing?<\/b>\r\n\r\nCancer survivors identify these fears as the major concern or one of <\/span>the top 5 greatest concerns<\/span><\/a>.\u00a0 Not only are these fears a major concern for them but <\/span>also up to 79% report that this is one of the most unmet needs<\/span><\/a>.\u00a0 <\/span>Fears about cancer recurrence have been found to be related to lower quality of life, higher anxiety, depression, and distress<\/span><\/a>. There is also indication that <\/span>higher fears of cancer recurrence are related to increased health care use<\/span><\/a>.\u00a0\u00a0<\/span>\r\n\r\nMoreover, although majority of the research has been conducted with cancer survivors, <\/span>a recent review<\/span><\/a> shows that fears about cancer recurrence is also a problem for caregivers, with 48% reporting levels that would indicate need for psychological support.\u00a0 <\/span>Another review<\/span><\/a> showed that caregivers\u2019 fears can be as high as the survivors\u2019 if not greater and the caregivers\u2019 fears were associated with poorer quality of life in caregivers and survivors.<\/span>\r\n\r\nWhat are the features of clinical levels of fears of cancer recurrence?<\/b>\r\n\r\nIt is clear that fears of cancer recurrence are a multidimensional phenomenon.\u00a0 An <\/span>expert consensus study<\/span><\/a> suggested the following as key features of \u2018clinical\u2019 fears of cancer recurrence: 1) high levels of preoccupation; 2) high levels of worry; 3) persistency; and 4) hypervigilance to bodily symptoms.\u00a0<\/span>\r\n\r\nHow do we measure these fears?<\/b>\r\n\r\nAn early review of fears of cancer recurrence measures<\/span><\/a> identified 20 scales and <\/span>another review<\/span><\/a> soon after found additional eight scales. There have been attempts for establishing a clinical cut-off score to identify those needing psychological support. <\/span>The Fear of Cancer Recurrence Inventory<\/span><\/a> is a 42-item measure that enables an in-depth assessment of these fears. It has several sub-scales and the <\/span>9-item Severity sub-scale<\/span><\/a> is widely used which has a cut-off to identify those who need psychological intervention (\u226522). Scales such as <\/span>FCR4 and FCR7<\/span><\/a> are also being used as shorter measures with suggested percentiles for identifying those with moderate and high fears. To facilitate screening of these fears, <\/span>1-item measure<\/span><\/a> has been put forward as well.<\/span>\r\n\r\nWhat are the effective ways of supporting cancer patients with these fears?<\/b>\r\n\r\nA meta-analysis of psychological interventions for fears of cancer recurrence<\/span><\/a> showed that they can have a small but robust effect at the end of intervention which be largely maintained at the follow-up.\u00a0 Cognitive Behavioural Therapies that were focused on processes of cognition such as rumination rather than the content and which aimed to change the way in which the individual relates to their inner experiences had larger effects.\u00a0<\/span>\r\n\r\nPractical recommendations:<\/b>\r\n

        \r\n \t
      1. Facilitate a conversation on fears:<\/b> Some patients may not want to approach their health care provider about their fears of cancer coming back <\/span>for fear of appearing ungrateful<\/span><\/a>. But starting these conversations can be very helpful for the patient to facilitate further support. Validating those fears can be immensely helpful to the cancer survivors.<\/span><\/li>\r\n \t
      2. Provide information on signs of cancer: <\/b>Talking through what might be signs of cancer that will warrant reaching out to their health care providers may provide opportunities for dispelling myths about cancer symptoms.\u00a0<\/span><\/li>\r\n \t
      3. Don\u2019t forget the caregivers:<\/b> While the focus on the cancer patient and survivor is necessary, healthcare professionals need to bear in mind that caregivers experience high levels of fear of cancer recurrence for their loved one and may need support too.<\/span><\/li>\r\n \t
      4. Screening is not enough:<\/b> Although screening for these fears is helpful, there is a need to ensure that there is appropriate psychological support that can be offered to the patients and caregivers.<\/span><\/li>\r\n \t
      5. Watch out for signs of anxiety:<\/b> Early signs of anxiety and changes in anxiety levels<\/span><\/a> are associated with later increases in fears of cancer recurrence in the first year of treatment. Monitor for signs of anxiety frequently and provide support to prevent further escalation of these fears.<\/span><\/li>\r\n<\/ol>","_et_gb_content_width":"","_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[64,15],"tags":[],"class_list":["post-3284","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cancer","category-fear"],"translation":{"provider":"WPGlobus","version":"3.0.5","language":"fi","enabled_languages":["en","id","my","bg","zh","hr","cz","da","de","es","fr","gr","he","it","ja","kr","lv","lt","hu","nl","no","pl","pt","ro","ru","sk","sr","fi","et","sv","tr","uk","hi","sw","ta"],"languages":{"en":{"title":true,"content":true,"excerpt":false},"id":{"title":false,"content":false,"excerpt":false},"my":{"title":false,"content":false,"excerpt":false},"bg":{"title":true,"content":true,"excerpt":false},"zh":{"title":false,"content":false,"excerpt":false},"hr":{"title":false,"content":false,"excerpt":false},"cz":{"title":false,"content":false,"excerpt":false},"da":{"title":false,"content":false,"excerpt":false},"de":{"title":false,"content":false,"excerpt":false},"es":{"title":false,"content":false,"excerpt":false},"fr":{"title":false,"content":false,"excerpt":false},"gr":{"title":false,"content":false,"excerpt":false},"he":{"title":true,"content":true,"excerpt":false},"it":{"title":true,"content":true,"excerpt":false},"ja":{"title":false,"content":false,"excerpt":false},"kr":{"title":false,"content":false,"excerpt":false},"lv":{"title":false,"content":false,"excerpt":false},"lt":{"title":false,"content":false,"excerpt":false},"hu":{"title":false,"content":false,"excerpt":false},"nl":{"title":false,"content":false,"excerpt":false},"no":{"title":false,"content":false,"excerpt":false},"pl":{"title":true,"content":true,"excerpt":false},"pt":{"title":false,"content":false,"excerpt":false},"ro":{"title":false,"content":false,"excerpt":false},"ru":{"title":true,"content":true,"excerpt":false},"sk":{"title":false,"content":false,"excerpt":false},"sr":{"title":false,"content":false,"excerpt":false},"fi":{"title":true,"content":true,"excerpt":false},"et":{"title":false,"content":false,"excerpt":false},"sv":{"title":false,"content":false,"excerpt":false},"tr":{"title":false,"content":false,"excerpt":false},"uk":{"title":true,"content":true,"excerpt":false},"hi":{"title":false,"content":false,"excerpt":false},"sw":{"title":false,"content":false,"excerpt":false},"ta":{"title":false,"content":false,"excerpt":false}}},"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t\n\t\n\t\n\t\n\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t