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Psychological counselling is important for cancer, long-term illnesses

Thursday, May 17, 2018
Photographs by Trupti Arekar

The recent case of Former Anti-Terrorism Squad (ATS) chief Himanshu Roy shooting himself is a wake-up call for the Indian medical fraternity. Roy who suffered from last stage cancer for the past two years was also undergoing heavy medication and severe treatment for bone cancer. Steffy Thevar talks to Dr Anup Aboti, an oncologist, on the importance of psychological help or medical counselling which can go a long way in treating long-term illnesses.

How stressful can cancer treatment be, in addition to the physical pain during cancer treatment?
First of all I would like to call and name all the cancer patients as 'Survivors' and not patients, because they are  true fighters, we cannot even imagine the immense stress and pain these survivors go through. It is a hell of a roller coaster ride but fighting cancer is the only option we human beings have.
Treating cancer is a big challenge these days. Yes, stress and pain play a vital role during comprehensive cancer treatment. In fact many patients respond slowly to the ongoing treatment or sometimes give up half way during treatment due to stress, improper pain management and altered imbalance of physical and clinical stability. Stress and pain management is a must for cancer survivors these days.

How painful is bone cancer treatment?
Most of the times it is unbearable. Bone cancer is one of the most painful and difficult to treat. As the whole skeletal system of a human body is comprised of multiple bones and joints, bones are the actual units for the physical working and functioning of a body. Certain types of cancer arising from bones start destroying the bones which are interwoven with each other and this results in severe physical pain, imbalance and sometimes disability. In some types of bone cancers we are only left with amputation (removal of limbs/legs/hands permanently) as an option.

What methods can we apply to help the patient cope mentally with treatment of cancer or any long-term ailments?
Cancer treatment is mostly decided depending on the stage the patient is in. If the survivor is in early stage, like Stage 1 or Stage 2, then the results may be 100 per cent curable, but unfortunately 80 per cent of cases are diagnosed and found out in later stages (Stage 3 and Stage 4) where multiple organs are already affected or the cancer is of aggressive nature. My personal opinion is not to emphasize treatments on survivors just going by the books. Every survivor's body is different and every survivor's response is different. So the treatment has to be customised and intelligently planned according to the survivor's physical and clinical condition, where counselling for mental strengthening of survivor and family members too, should be preferred.

How important is counseling when it comes to cancer treatment for the patient and the family?
Counselling plays the most important role in a cancer treatment protocol. I prefer to counsel my patients and their family members multiple times for hours with long discussion sessions and personal meetings during their treatment, explaining to them the clinical way of treatment, how to combat side-effects and complications of the disease and some ongoing treatments as well. Most importantly, concentrating on stress and pain management is the essence of counselling a cancer survivor. This helps to have a better result orientation and also helps to keep the patient away from depression and other negative surrounding effects.

Himamshu Roy's case comes as an example of the importance of tackling illness stress. However, in India counseling is still not given importance. Why so?
Yes, you are right. Counselling is still not given utmost importance in India, there may be multiple reasons for this. My personal opinion in this regard is: As compared to the increasing number of cancer patients, the number of cancer specialists are not in a proportionate ratio, hence the doctors are so busy that they can hardly spend five to ten minutes with a patient. I feel in such a small time span we cannot convince or comfort the patient with the complete knowledge of life threatening diseases such as cancer and also explain in detail about the pros and cons of the treatment. Also the surroundings of a cancer survivor is very important, work place, family support, thought process, feelings and sufferings of a cancer survivor, etc., these have to be given importance which directly help to counsel a survivor positively and makes recovery easier for the patients.

How should we start introducing counselling for cancer treatment, especially in a heavily populated country likes ours where the doctor patient ratio is so low?
In other developed countries counselling is a separate division/department at most of the cancer treatment centers. Here before and after each treatment sessions, the medical and counselling team spends time with the patient and the family. This helps to yield better results in the overall analysis. Research is also very important to help create treatment which is suitable to patients and have less side-effects and complications.

Which other countries in the world emphasize on counseling? What methods do they adopt?
Countries like USA, China, Japan, Australia and Germany emphasise a lot on counselling and make the patient feel strongly positive to fight this deadly disease. Personalised treatment plan, according to the survivor's personal, physical and clinical condition, special attention given to stress and pain management and multiple therapies are used to avoid side-effects and complications from conventional therapies.

What about the latest cancer treatment technologies, especially for stress management and pain.
Right now I am working for a super speciality cancer hospital in China, (Fuda Cancer Hospital, Guangzhou, China). Here we use latest ways of treatments like robotic surgeries, minimally invasive/stitch-less operations, latest interventional intra-arterial nano chemotherapy, targeted radiotherapy and combined immunotherapy. Our main target is to balance and combine these treatments because these treatments have minimal side-effects or complications, results are quicker, patients survival rate is good and we also believe and follow in counselling  each patient individually from the beginning. Medical experts have to be professional in dealing with already depressed or critically ill patients. The environment, while dealing with patients and result orientation has to be very positive here. In fact, many patients from India are going to other countries where such facilities are provided. However,  for the poor, they depend on charitable organisations where counselling is hardly provided.

Is work stress also related in the case of Roy?
Himanshu Roy was actually diagnosed with kidney tumour earlier which was treated well. Then after some years his cancer spread to multiple bones, brain and other soft tissues. This burden of extensively spreading disease is too harsh to handle for any individual. Work stress somehow plays a key role in some patients but in Roy's case it was more strong physically and mentally in the early days. Later, when the disease burden was increasing, maybe this creates a toll on any individual. I remember reading about one of Roy's old interview where he said that 'chemotherapy has limitations', so the overall treatment side-effects and increasing disease burden contributed to this stress, which he was able to manage for a certain period of time but later the disease still persisted.

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