Accepting the new normal

Psycho-oncology is emerging as integral to mitigating stress levels in cancer patients in hospital settings

Accepting the new normal

When someone is diagnosed with cancer, it throws innumerable challenges to the patient and to the family. Depending on the choices they make, it could be a life-changing experience for some, while the same may be a devastating ordeal for others. 

In either case, such situations exert an unexpected psychological burden on people. Ignoring this psychological distress is often a common mistake that many people make in their cancer treatment journey. 

Studies have established that 45% to 60% of patients are found to have severe psychological distress after a cancer diagnosis. In many cases, it is also found that ignoring this aspect of their suffering reduces their adherence to the treatment, and negatively impacts their functional level and health behaviour, ultimately affecting the overall treatment outcome. 

Considering the significant psychological impact and its influences on the treatment results, many modern cancer care facilities have started adopting a more holistic approach to cancer care by integrating psychological aspects into their treatment modalities. Along with paying attention to the physical aspects of the disease and its treatment, it is important to take care of the psychological and emotional concerns of the patient in order to bring a better quality of life and maximize treatment outcome. 

While oncologists look into the physical aspects of treatment, a psycho-oncologist (a specially trained psychologist for cancer care) helps patients and caregivers to handle these situations in an effective manner. Having said this, psychological support is a less explored area in oncology settings in India and many parts of the world. But the times are changing!

Emotional and socio-cultural challenges 

When most people encounter cancer, it naturally makes them distressed and they start developing negative thoughts associated with the disease. Feeling shocked, numb or being in denial is often seen as the common initial reaction towards the diagnosis.

In such circumstances, many face questions like ‘Why me?’, ‘Is it because of something wrong I may have done in the past?’ and so on. Such thoughts make them more vulnerable to irrational reasonings.

In some instances, the patients lose hope before even evaluating all their options for recovery. Such situations can be very tricky, especially when patients feel that they don’t have any control over themselves and the disease, seeing the situation as a crisis without a resolution. 

In most cases, it is often the false social and cultural associations of cancer that add more psychological distress. One needs to understand that when it is a race against time, the symptoms of distress are not things that one can ignore. The consequences of severe psychological distress can affect a patient’s decision making and adherence and the overall treatment efficacy and outcome. 

Not only the patient, but the caregivers taking care of their loved ones often feel worn out and confined. Many people feel they are ill-equipped to handle the situation, or that they do not have the resources to sail through such difficult times. At times, patients and caregivers are also reluctant to open up to their therapist about their emotional issues due to public/social stigma, self-stigma, and the fear of self-exposure. When people hide their emotions in such difficult times, it only adds fuel to the fire, impacting their overall quality of life during treatment. This situation can only be improved by creating awareness about emotional health in our society. 

Why psycho-oncology

Cancer diagnosis can rob a patient and his/her loved ones of a lifestyle that has been so familiar to them for years. Most of the patients and survivors often end up saying: “I don’t want this life; I want to feel normal again”. Here comes the importance of psycho-oncology services in modern cancer care. They help patients accept and embrace the new normal for good.

Psycho-oncology professionals use a holistic approach to understand each patient and their unique needs. They are armed with scientifically proven and goal-driven approaches to provide highly personalised and compassionate care to both patients and caregivers to maximise treatment results.

With the help of a psycho-oncologist, patients and their caregivers can manage their distress levels in various simple ways. They not only assist patients to build their confidence level, but also to identify some of the psychological symptoms early on. The following are some of the commonly used and effective practices used by psycho-oncologists to manage distress levels among cancer patients.

Psycho-pharmacotherapy: Delirium, sleep disorders, fatigue and other cognitive problems are highly prevalent in cancer settings and administering pharmacological interventions are an important component of the treatment. Doing so improves the overall well-being of the patient. Studies have shown that 25-30% of cancer patients experience depression or anxiety during treatment. If patients have these issues, they should be referred to a psychiatrist with the knowledge of the primary physician.

Individual counselling: This provides a window of opportunity to the patients in expressing their inner feelings that eventually help them to feel better and relaxed. Cognitive Behavioural Therapeutic (CBT) Interventions would modify specific emotional, behavioural and social problems that arise due to cancer diagnosis. CBT also enhances a sense of control despite the illness. Additionally, problem-solving approaches using COPE (Creativity, Optimism, Planning, and Expert Information) model is also found to be very effective.

Support group: This gives patients an opportunity to share their challenges, practical concerns, thoughts, and feelings with other people who are experiencing similar situations. They can also learn from each other. Sharing such experiences has been proven to create a sense of belonging and reduce loneliness and emotional distress.

Cancer education sessions: A lack of knowledge and understanding can cause serious distress among patients and caregivers. In cancer education sessions, oncologists and other health-care professionals (nurses, dietitians, psychologists, physiotherapists) make people understand the nuances of the disease and the treatment regimen and their side-effects, and provide them with advice and remedies. 

Mind-body techniques: Engaging patients in diversional therapies based on their likes and dislikes can help them be occupied and stay away from negative/irrational thoughts. Doing relaxation techniques such as deep breathing, passive relaxation, meditation, progressive muscle relaxation, guided imagery and visualization techniques are also found to be very effective.

Encourage and assist in choosing
the right exercises:
Being physically active is essential to bring down emotional distress. Patients can incorporate recommended mild exercise into their daily routine in keeping with their energy levels. 

The world has come a long way towards bringing better cancer treatment and quality of life through science and technology. Artificial Intelligence (AI) and big data have already become such game-changers in cancer research. Today people have easy access to free information, especially through social media and the new wave of social influencers — changing the landscape of healthcare. This is both a boon and a curse when it comes to life-limiting illnesses like cancer, because not all that you find on the internet is true. 

On the other hand, we have not seen a proportionate advancement in the emotional aspects of treatment. Still, it is encouraging to see how the psychological aspects of cancer are finally getting the right importance around the world. 

Patients and caregivers have started to recognize the impact of the emotional burden in the cancer journey. Many hospitals have already integrated psycho-oncology as part of their holistic cancer treatment to ensure maximum results to their patients. In coming years, we’ll see a great leap of advancement in the emotional aspects of cancer treatment around the world. Times are changing!  

The author is,psycho-oncologist and a tobacco cessation therapist at the Manipal Hospitals, New Delhi, India.

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