Tuesday 20 February 2018

Coping with cancer

Patricia Casey

The very word engulfs you with overwhelming terror. It fills every waking minute with uncertainty and your dreams with distressing images. There is no diagnosis quite so terrifying in medicine. When you hear the word "cancer" the first, most pressing and most important question is "Is this treatable"?

I know because I have had a deeply personal experience of hearing that word, when my little son, aged five, was diagnosed with an aggressive malignancy. I also heard it when a very close family member telephoned me as I sat in my out-patient clinic, in consultation with a patient, one Thursday morning in May 2013.

My son is now a happy 24-year-old; sadly the other dear person in my life passed away a short time ago.

We forget that cancer is not a single condition but consists of many varieties, some with better prognoses than others. Historically it was linked to a very premature death but this has changed significantly in recent years as screening has allowed early diagnosis, and treatments have improved. Still, these folk memories persist and once the word "cancer" is uttered, the most pertinent questions are about the chances of survival. And while the word itself strikes fear into people, talking about cancer in the doctor-patient discussions is helpful in reducing depression - because familiarity reduces distress and fear.

Most cancers are treatable and many do not recur, but some do so, even after being given the "all clear". This is such a positive and optimistic phrase that people put a lot of store in, but it is also one that makes no promises about the future. It simply means that the current cancer is in remission, but this in itself is reassuring and sustains people as they progress through treatment.

When receiving the news of a cancer diagnosis there is good evidence that most adults want certain people present and so they should be given the opportunity to bring somebody with them.

Most also report that receiving written information on the type of malignancy is valuable while video- or audio-tapes are not.

The more truthful the discussion the better the patient is able to adjust, although information should be given at a pace they find acceptable.

People also vary in the amount of information they want and this must be respected. Some seek as much as possible information when the diagnosis is received, while others choose to defer this until they have time to adjust to the news. Some opt for very limited information.

Discussions about treatment plans are viewed positively and should happen early and once treatment has begun there is a sense of relief because something is happening.

Because the future is uncertain, savouring every minute in the here-and-now becomes a sought-after aspiration since nothing can be planned beyond that day. As the side effects of treatment take command, it becomes impossible to even guarantee that routine appointments, such as a visit to the hairdresser, can be kept. So, focusing on the present, and treating oneself well, for example using body creams, candles and bath oils is helpful, as is having special times at home listening to music, watching movies, or whatever one hasn't time to do when in full health. These are also a healthy - albeit brief - distraction from the negative emotions.

The use of imagery, reinforced by music if necessary, can be of assistance in lifting mood and reducing anxiety. Guided imagery, in which a trained therapist assists the person, is sometimes used but individuals can practice this without professional help. Thinking of a beautiful place that you would want to be, or imagining your body being strong and your system fighting the cancer cells is an example of visualisation in operation.

Instead of focusing on the long term, dealing only in the short term is the least overwhelming option. And at each step in treatment the positive news we receive will carry us along to the next stage.

There is now good evidence that those who believe in a benevolent God rather than a vengeful one, or in none, remain more positive and are less overwhelmed by the diagnosis, so attending to the spiritual needs of cancer sufferers is important.

One of the myths is that being positive helps with the prognosis. There is no evidence to support this, although it does help with enduring the treatments and their side effects.

Families too find it very distressing when they see loved ones ill and in pain or distress. Keeping the lines of communication open is important, but they too may find talking about the future too difficult. Most cancer services now offer counselling to those having problems dealing with the diagnosis.

An exhaustive exploration of how to cope with a difficult diagnosis like cancer is not possible here in this column, but the website cancer.gov is a rich source of information on how to deal with different cancers, in different age groups and at different times in the treatment process.

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