Análisis de las respuestas cognitivas relacionadas con el diagnóstico de cáncer en pacientes mexicanos / Cognitive response related to cancer diagnosis in Mexican patients

Resumen La evaluación subjetiva ha sido descripta como una variable mediadora para la respuesta emocional. Se presenta con diferentes contenidos y estilos. El estilo cognitivo se refiere a la manera en que se piensa sobre el estresor, por ejemplo: la rumiación (pensamientos intrusivos, repetitivos, que generan malestar emocional), la evitación (intentos por no pensar en el estresor) y el compromiso cognitivo (enfocados en búsqueda de sentido o solución). En base a esta respuesta emocional, se busca explorar y describir los pensamientos relacionados con el cáncer en un grupo de diez pacientes con la enfermedad. En un estudio cualitativo, se les pidió a diez pacientes con cáncer que indicaran los cinco pensamientos más frecuentes desde su diagnóstico. Se analizó el contenido mediante la técnica top down (teoría a contenido) y, a partir de los estilos de respuestas cognitivas, se clasificó el contenido de los pensamientos reportados por estilo de pensamiento (rumiación, compromiso cognitivo o evitación), por temporalidad (pasado, presente y futuro) y por valencia (positiva o negativa). Posteriormente, se hizo el análisis bottom up (contenido a teoría). Se hicieron tablas cruzadas para identificar los contenidos según el estilo de pensamiento, la temporalidad y la valencia. En los pensamientos con estilo rumiativo, el enfoque temporal se dirigía en su mayoría al futuro y al pasado, mientras que el compromiso cognitivo se enfocaba en el presente. Esta diferencia fue estadísticamente significativa mediante una prueba de chi cuadrado. Dentro de los temas relacionados con la incertidumbre, se refirieron a la muerte, al pronóstico de la enfermedad, a la respuesta de la familia y a las finanzas (en el futuro) y a las causas y culpa (en el pasado).

Abstract Cancer has been defined by the World Health Organization as "a disease caused by abnormal cells growing uncontrollably in the body, going beyond their usual boundaries, invading adjoining parts of the body and spreading to other organs". Being diagnosed with cancer has been described as an experience with diverse emotional reactions and difficulties in adaptation, having psychological consequences, being most common depression, anxiety and psychological distress; but also, some patients present positive consequences after having a cancer diagnosis, such as post traumatic growth, which includes positive changes presented after the disease experience. Subjective appraisal about cancer has been defined as a mediating variable for the emotional response presented after a stressor, such as cancer diagnosis, treatment, or important changes during disease process (initiating and finalizing treatment, presenting relapse or remission, as well as when having control studies). The subjective appraisal can be presented with different thought content and styles. Thought style is referred as the way thoughts about the stressor are presented, it has been classified as rumination (thoughts that are intrusive and repetitive that also increase psychological distress), cognitive engagement (thoughts associated with problem solving and meaning finding) or avoidance (aiming to stop thinking about stressor or feeling associated with it). Depending on the thought style presented at a stressor, could be the emotional response (anxiety, depression, distress, post-traumatic growth). The aim of the present study was to describe the thoughts (style, content, valence and temporality) related to cancer diagnosis in a group of ten oncologic patients. To identify if differences between thought style, valence and temporality were presented. The study design is qualitative from a phenomenological point of view. Ten oncologic (different cancer type, clinical stage and treatment) patients were asked to write the five more frequent thoughts since their cancer diagnosis. Each thought was classified by: thought style, valence, and temporality (top-down, classifying the thoughts according to theory). The same thoughts were also classified in semantic units (bottom-up, classifying the thoughts according to their own contents), generating concerns from the content. Cross tabs were made to identify contents and temporality for thought style and valence, which were analyzed by chi square to identify differences between thought style, temporality and valence. The most common thought style was cognitive engagement, followed by rumination (almost same frequency). On what respects to thought style and temporality, rumination was more focused on past (causes and attributions of cancer) and future (uncertainty about death and treatment effectiveness); meanwhile, cognitive engagement was focused on present (to enjoy present moment and focus on daily actions). Chi square was made to identify if this difference was significant, showing temporality was significantly different in cognitive engagement and rumination. The concerns identified in study participants were uncertainty about future and disease, family (communication and wellness of the family), finances (due to expensive treatments), causes and guilt about having cancer. Thoughts that were more centered in present, were more likely to be associated with cognitive engagement. Cognitive engagement has been described previously as an important variable associated with post traumatic growth. Thoughts centered in the past and present were more associated with rumination. Rumination has been associated with depression and post-traumatic stress disorder. Because of mediating role of thought style in disease adaptation, emotional response to the disease, and the relation of this adaptation with the perception of quality of life in cancer patients, the design of psychological interventions aiming on promoting cognitive engagement by problem solving skills, meaning finding, and focusing on present could be a research line derived from present studies results.

Comparación de las percepciones del cáncer entre pacientes oncológicos y personal de salud / Comparison of social representations about cancer between cancer patients and health professional

El cáncer es una de las principales causas de muerte en el mundo. Las percepciones sobre esta enfermedad impactan en la calidad de vida de los pacientes y del personal de salud. El objetivo de esta investigación fue conocer la percepción del cáncer en pacientes oncológicos y profesionales de la salud y compararlas entre sí. La investigación se realizó en un centro oncológico del estado de Querétaro, México, y se trató de un estudio cualitativo, en el que se utilizó la técnica "listados libres" de la antropología cognitiva. Constó de 10 pacientes con cáncer y 10 profesionales de la salud. El instrumento utilizado fue el de "listados libres". El análisis realizado fue perceptual cualitativo categorizando las palabras mencionadas en "listados libres" y un análisis de contenido temático. Se analizaron frecuencias y porcentajes de categorías y posteriormente se compararon entre personal y pacientes. En los resultados, se identificaron categorías de emociones displacenteras, afrontamiento, tratamientos y oportunidad en ambos grupos. Las diferencias identificadas fueron que los profesionales incluían emociones displacenteras en ellos mismos, elementos de relación médico paciente y aspectos administrativos-económicos. Se concluye que existen similitudes entre profesionales de salud y pacientes en la percepción del cáncer, sin embargo, hay diferencias que deben ser tomadas en cuenta, como que el personal de salud también presenta malestar emocional.

In Mexico and the world, cancer is one of the leading causes of death. Associations with this disease can have an impact on the quality of life of patients and health professionals practising oncology. As a result, it was considered relevant to study the social representations (SR) of cancer and to make a comparison between oncology patients and health professionals. Methods: The study was conducted in an oncology centre in the state of Querétaro, Mexico, and the sample consisted of 10 patients and 10 health professionals. Using qualitative perceptual analysis, it categorised the words mentioned in "free listings" and thematic analysis. Results: Categories of unpleasant emotions, coping, treatment and opportunity were identified in both groups. There were differences between SRs of cancer patients and health professionals; professionals included displeasing emotions in themselves (in addition to patients), elements of the doctor-patient relationship and administrative-economic aspects. Conclusions: There are some similarities between health professionals and cancer patients in terms of cancer perception; however, there are differences that should be considered. One of them is that health staff also present emotional discomfort (even if they are not the ones who have the disease), patients did not present the category "death". In contrast, health staff did, this as well as the administrative-economic category. These findings allow us to explore the perceptions of staff and patients to determine future lines of research.

Intervención cognitivo-conductual grupal para pérdida de peso y calidad de vida en pacientes candidatos a cirugía bariátrica / Cognitive behavioral group intervention for weight loss and quality of life in patients candidates for bariatric surgery / Intervenção cognitivo-condutual grupal para perda de peso e qualidade de vida em pacientes candidatos a cirurgia bariátrica

La obesidad es un problema de salud mundial asociado con el desarrollo de enfermedades crónico degenerativas. La cirugía bariátrica es el tratamiento que ha mostrado mayor efectividad para la obesidad severa; el paciente debe modificar su estilo de vida para mantener la pérdida de peso a largo plazo. Se ha visto que las intervenciones cognitivo conductuales han sido efectivas para lograr este cambio en el paciente. El presente estudio busca evaluar la efectividad de una intervención cognitivo conductual grupal en la pérdida de peso y calidad de vida antes de la cirugía. Se incluyeron nueve pacientes con obesidad mórbida candidatos a cirugía bariátrica sin comorbilidades psiquiátricas. Se realizó una evaluación inicial de calidad de vida que medía peso e IMC (Índice de Masa Corporal, por sus siglas en español). Los pacientes fueron sometidos a una intervención grupal con el objetivo de promover la pérdida de peso mediante técnicas cognitivo conductuales. El promedio de pérdida de peso fue de 5.7 kg en las cinco semanas que duró el tratamiento, mostrando significancia estadística de .001; a su vez, con la pérdida de peso disminuyó el IMC con una significancia estadística de .002. En cuanto a calidad de vida, hubo mejoría significativa en la percepción corporal y en la actitud al tratamiento.

Obesity is a global health problem associated with the development of chronic degenerative diseases. Bariatric surgery has proven to be the most effective treatment for severe obesity. Despite surgery, patients must change their lifestyle in order to maintain weight loss in the long term. It has been reported that cognitive behavioral interventions have been effective to promote a lifestyle change and weight loss in obese patients. The aim of this study was to assess the effectiveness of a cognitive behavioral group intervention on weight loss and quality of life before surgery. Participants were nine morbidly obese patients, without psychiatric comorbidities, candidates for bariatric surgery. An initial assessment of quality of life that measured weight and BMI (Body Mass Index, for its English acronym) was performed. Patients underwent a group intervention in order to promote weight loss through cognitive behavioral techniques. The average weight loss was 5.7 kg during the five weeks of treatment, showing statistical significance of .001. In turn, along with weight loss, there was a decrease in BMI, with a statistical significance of .002. Regarding quality of life, there was significant improvement in body perception and attitude toward treatment.

A obesidade é um problema de saúde mundial associado com o desenvolvimento de enfermidades crônico degenerativas. A cirurgia bariátrica é o tratamento que mostrou maior efetividade para a obesidade severa; o paciente deve modificar seu estilo de vida para manter a perda de peso a longo prazo. Observa-se que intervenções cognitivo conductuais têm sido efetivas para conseguir esta mudança no paciente. O presente estudo busca avaliar a efetividade de uma intervenção cognitivo conductual grupal na perda de peso e qualidade de vida antes da cirurgia. Incluíram-se nove pacientes com obesidade mórbida candidatos a cirurgia bariátrica sem co-morbilidades psiquiátricas. Realizou-se uma avaliação inicial de qualidade de vida que media peso e IMC (Índice de Massa Corporal). Os pacientes foram submetidos a uma intervenção grupal com o objetivo de promover a perda de peso mediante técnicas cognitivo conductuais. A média de peso perdido foi de 5.7 kg nas cinco semanas que o tratamento durou, mostrando significância estatística de .001; ao mesmo tempo a perda de peso fez com que o IMC diminuísse com uma significância estatística de .002. Com respeito à qualidade de vida, houve melhoria significativa na percepção corporal e na atitude com respeito ao tratamento.

El rol del psicólogo en el equipo Interdisciplinariasciplinario de cirugía bariátrica / The psychologist's role in a bariatric Interdisciplinariasciplinary team

La obesidad ha sido declarada por la OMS como una epidemia y es factor de riesgo para diversas enfermedades tanto físicas como psicológicas, por lo que supone una creciente carga económica para los sistemas de salud. Actualmente el tratamiento que mayor efectividad ha mostrado para tratar la obesidad severa es la cirugía bariátrica; sin embargo, a pesar de los cambios anatómicos realizados por la cirugía, no todos los pacientes se ven beneficiados por la misma. Se ha reportado que el 20% de estas cirugías fracasan y generalmente este fracaso es atribuido a causas psicológicas. El número de cirugías bariátricas realizadas en el mundo está aumentando exponencialmente y dentro de las guías norteamericanas se sugiere el tratamiento Interdisciplinariasciplinario, incluyendo en este el tratamiento psicológico. El trabajo que se informa busca describir el rol del psicólogo en un equipo Interdisciplinariasciplinario de cirugía bariátrica.

Obesity has been declared by the WHO as an epidemic. It has been described as a multicausal disease and that it's etiology is influenced by biological, psychological, environmental and other factors. It is a risk factor for many diseases not only physical (diabetes, hypertension, hypercholesterolemia, an so on) but also psychological (depression, anxiety, eating behavior disorders, etc.); reason for which it's supposed to be a raising charge for worldwide health systems. Among the approved treatments for overweight and obesity are included: nutritional (caloric restriction), increase physical activity and behavioral therapy. When talking about patients with severe obesity (BMI 40), the most effective treatment that has been proven is bariatric surgery, indicated for patients with a BMI 40 or 35 in case of presenting co morbidities. It has been described that surgical treatment for obesity promotes mayor weight loss, generates significant improvement of the co morbidities associated with the obese condition and helps to prolong life expectancy and to increase quality of life. Despite all of the advantages that this treatment has proven to offer, not all of the patients benefit from it, even with the anatomical changes made by the surgery, some of the patients don't get to loose a significant amount of weight; differences in the variations of weight after the surgery at short and long term have been reported. It has been reported that approximately 20% of bariatric surgeries fail due to poor weight loss and that this failure is generally attributed to psychological or behavioral causes. Nowadays the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines suggest that surgical treatment for obesity must be performed in a Interdisciplinariasciplinary approach that includes surgeon, nutritionist, internist, physical rehabilitator and a psychologist. According to the same guidelines, the psychologist's role in this team consists on initially evaluating surgery candidates in order to determine if there is existing psychopathology and their ability to implement the lifestyle changes needed before and after the procedure, to give psico educational interventions in order to prepare patients for these changes and to make an informed decision about this treatment. This preparation helps patients having realistic expectations about the surgery results, helps to decrease the uncertainty that generates anxiety. For this reason, psychologist´s work should be focused on motivation and adherence on lifestyle changes by psycho educational and cognitive behavioral specific interventions. In conclusion, the goal of the psychologist in the bariatric surgery team is to identify possible contraindications for the surgery and to identify possible post-surgical challenges as well as to give behavioral specific strategies in order to cope with those challenges. The prevalence of obesity is rising across the world and, in order to treat it, the increase in the number of bariatric surgeries performed. As ASMBS guidelines suggest a Interdisciplinariasciplinary approach where the psychologist plays a fundamental role in order to get a better prognosis after the surgery, it is important to increase the number of psychologists with the necessary skills to work with these patients, and with knowledge about obesity and bariatric surgery. The present research aims to describe the psychologist's role in a bariatric surgery Interdisciplinariasciplinary clinic and some of the strategies described for psychological obesity treatment suggested to be used before and after the surgery, in order to promote a lifestyle change.