Why Don’t We Talk About Cancer?

Cancer is associated with being a dreaded and life-limiting illness and is known to be the cause of death of millions each year. Cancer not only affects the physical health of the individual but also has a great mental impact that is difficult to handle for many people. Hence, it is very common for individuals to feel emotionally distressed after being diagnosed with cancer.

Most people diagnosed with cancer do not usually talk about it. There may be a variety of reasons for unwillingness to talk, ranging from discomfort about the issue to worry about becoming emotional. Whatever the reasons might be, experts highly encourage sharing of your feelings as it can enormously help you in coping with cancer in a much better way. About a third of patients with cancer experience significant distress (a multifactorial unpleasant emotional experience).

What about the patient’s dreams and plans?

The reality of death changes the course of anyone’s life.
A patient who is dying is a patient who is still alive!!

What Is Psycho-oncology?

Psycho-oncology is a super speciality of the professional field of psychology and deals with the physical, psychological, social, and behavioural aspects of cancer to improve the overall quality of life. Though it has been practiced in India for over a decade now, sadly, most people are not aware of it. Moreover, mental health has traditionally been a taboo topic for many, making it even more difficult for cancer patients to talk to a healthcare professional. It is thus extremely important for the cancer patients as well as families to understand that talking to a psycho-oncologist does not imply that the patient/caregiver is mentally unstable, but helps in coping with cancer more effectively.

This area deals with the psychological; the emotional reaction to this illness at all stages of disease for the patient, family, and the staff who have their own burden in taking care of the patient and to improve communication between the patient, caregivers and doctors.

Psychological Responses to Diagnosis:
Distress experienced by patients diagnosed with cancer include:

  • Adjustment disorders, Bereavement
  • Anxiety Disorder: Panic disorder, PTSD, OCD
  • Psychosis/ Mood disorders
  • Cognitive disorder
  • Delirium (Hypoactive, Hyperactive or Mixed)
  • Substance Use disorder
  • Personality Disorders
  • Depression/ Suicide
  • Hopelessness
  • Loss of Dignity
  • Demoralization
  • Depression/Anxiety/Panic
  • Loss of meaning/spiritual well-being
  • Desire for hastened death
  • Suicidal ideation

Survivors:
Living with Uncertainty

  • The course of the illness varies considerably
  • Secondary cancers
  • Fear of cancer recurrence
  • Broken families
  • Sexuality and Infertility
  • Body image, reminders
  • Disfigurement
  • Financial distress
  • Post Traumatic Stress disorder-PTSD
Medical progress, the improvement of general living conditions, and an increase in life expectancy have led to an increase in the general prevalence of oncologic disease. More importantly, more and more patients survive cancer or live with the disease for long periods of time. While the battle for survivorship is continuously being fought, improving patients’ quality of life has come to the fore. Psychosocial issues may modulate the course of the disease, but mainly have a deep impact on patients’ physical and mental wellbeing. Psycho-oncology has risen as a relatively new interdisciplinary field with the aim of addressing these issues and providing support for patients confronting numerous challenges throughout the different stages of the disease.

Targets of psycho-oncologic interventions

Physical Symptoms

  • Pain
  • Gatigue
  • Sexuality/ reproduction
  • Other (insomnia, cognitive disorder, sympto’s specifically related to cancer)

Emotional problems

  • Psychiatric comorbidities
  • Fear of progression
  • Other subthreshold psychological conditions

Assistance with practical/social problems

  • Return to work
  • Financial problems
  • Child care
  • Housing and other

Family problems/ support to caregivers

Spiritual aspects

  • Religious concerns
  • Meaning/ personal growth
  • Death/ bereavement

Improvement of general health condition

  • Lifestyle
  • Nutrition
  • Exercise
  • Stress management

Optimizing treatment

  • Adherence to treatment
  • Treatment decisions
  • Use of painkillers
  • Use of alternative medicine

Interventions available through psycho-oncology are:

Psychotherapy

01. Individual Therapy

  • Supportive; Psycho education
  • Cognitive Behaviorally Oriented
  • Meaning Centered Psychotherapy – Dignity therapy
  • Family Focused Grief Theapy

02. Group Therapy

  • Supportive
  • Cognitive Behaviour Therapy
  • Meaning Centered Psychotherapy

Psychotherapy at the End of Life

  • Meaning Centered Psychotherapy – Dignity therapy
  • Family Focused Grief Therapy
  • Group Therapy
  • Supportive
  • CBT
  • Meaning Centered

Helping the Helpers

Being in the helping role, constantly giving without expecting anything in return, would be exhausting for anyone and might be especially exhausting for the doctors and other healthcare providers

  • Help for medical professionals and staff must address environmental, interpersonal, and intra-psychic dimensions, especially in wards with prolonged illness and high mortality
  • Burnout

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