The global community commemorated World Cancer Day on Sunday (Feb 4), with the slogan “Close the care gap”.
This is a call to unite our voices and commit to strengthening actions aimed at improving access to quality care, including screening, early detection, treatment and palliative care.
A “gap in care” is defined as the discrepancy between recommended best practices and the care that is actually provided or accessed.
This could include a high risk person who is overdue for a recommended screening like an annual mammogram or colonoscopy, but does not have access, or is not motivated, to seek such services.
Closing the care gap is also linked to detection and support in mental health, especially when it comes to palliative care.
Psychological effects of cancer
The diagnosis of cancer is a life-changing experience.
Depression and anxiety are the most common side effects.
The cancer patient’s whole life turns upside down, and it is crucial to identify those changes and provide needed help.
Persons experiencing cancer not only bear the physical pain of surgery, chemotherapy, radiation, bone marrow transplant and/or immunotherapy, but also undergo psychological trauma that can badly affect their physical and mental health.
Critically, cancer patients may consider themselves a burden to their family and friends, often resulting in self harm and suicidal thoughts.
Other psychological problems confronting cancer patients, such as body image concerns, financial crisis, increased marital stress, fear of being unemployed and being unable to fulfil their social roles, can also lead to pessimism and death wishes.
These factors slow down their recovery process and become a hurdle to obtaining the desired treatment outcomes.
A cancer diagnosis can also affect the emotional health of families, especially the caregivers.
More often than not, their roles at home, work and other environments are also affected.
With cancer incidence increasing over time worldwide, attention to the burden of psychiatric and psychosocial consequences of the disease is essential for both cancer and mental healthcare professionals.
Psychiatric disorders have been shown to affect at least 30-35% of cancer patients, although they differ in nature according to stage and type of cancer.
Cancer patients are often hesitant to talk about their mental health, so this also contributes to the gap in care.
Therefore, there is a need to break this barrier in order to understand the perceptions and behaviours of patients.
Evidence-based interventions aligned to the level of emotional disturbance could also depend on the religious and cultural beliefs of the patient and their acceptance about the prognosis, and even death.
From denial to acceptance
Dr Elisabeth Kubler-Ross was a Swiss-American psychiatrist who introduced the Five Stages of Grief model in her book On Death and Dying.
While this model was originally developed to describe the emotional stages that many people go through when facing their own impending death, it has also been applied to understanding the experiences of individuals with cancer.
These stages can also apply to the family members and loved ones of such patients.
Denial, which is the first stage, is often the initial reaction to a cancer diagnosis.
People may struggle to accept the reality of their situation and may deny that they have a potentially life-limiting illness.
It serves as a protective mechanism to help individuals cope with the shock of the diagnosis.
As denial begins to fade, individuals may start to feel anger, which is the second stage.
They may become frustrated and ask “Why me?”, or express anger at their healthcare providers, family members, or even at the situation itself.
This anger is a natural response to the sense of injustice and helplessness that can accompany a serious illness.
At the third stage of bargaining, individuals may attempt to make deals or bargains in an effort to change their fate.
They may pray, make promises or seek alternative treatments in the hope of extending their life or finding a cure.
This stage represents a desire for control and a way to cope with the impending loss.
As they progress into the fourth stage, which is depression, the reality of the illness becomes more apparent.
Individuals may experience deep sadness, hopelessness and a sense of grief.
They may withdraw from social activities and feel overwhelmed by the emotional and physical challenges they face.
At the final stage of acceptance, individuals come to terms with their diagnosis.
This does not necessarily mean that they are happy about it or have lost all hope, but that they have reached a level of understanding and acceptance of their situation.
They may focus on making the most of their remaining time, making amends and finding peace.
These stages are not a strict progression, and people may move back and forth between them.
The experience of facing a cancer diagnosis is highly individual as not everyone will face these stages with the same intensity.
Understanding these stages becomes important in planning the right psychological intervention.
Once the stages of denial and anger subside, acceptance of the condition can help in the treatment journey and overall prognosis.
Acceptance can also result in adherence to treatment to limit the spread of the cancer for a better prognosis (outcome).
On the other hand, if acceptance is not achieved, depression can jeopardise the motivation to be treated and this results in poor prognosis of the condition.
Support from others
Family and social support are considered essential for the psychological wellbeing of cancer patients.
However, the best moral and psychosocial support demands understanding individual and family-level perceptions at the time of cancer diagnosis and throughout the treatment journey.
The patient’s willpower and spirituality also play a vital role in cancer treatment.
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In addition, the success of therapies for the patient often depends not only on the patient’s and their family’s response to treatment, but also on positive patient-doctor communication.
It is important to be educated on the severity of the condition and symptoms that may emerge as a result of the cancer.
Even while on treatment, issues concerning recurrence must be explored.
A positive patient-doctor relationship also helps adaptation to illness, reduces treatment pain and provides hope to fight against the disease.
Such a relationship builds empathy with the patient and their family members, and helps in fostering mutual trust during the care process.
Everyone’s cancer journey is unique, and what works best for one person may not work for another.
It is essential to find a combination of mental health strategies, including psychological and pharmacological interventions that work for the patient, and to be open to adjusting them as needed throughout the cancer journey.
Working closely with the healthcare team to address both physical and emotional needs is crucial during this challenging time.
Additionally, there are psychosocial strategies that can play a significant role in coping with the stress, anxiety and emotional turmoil that often accompanies a cancer diagnosis.
Cancer patients should surround themselves with friends and family who are understanding and supportive.
Sharing their feelings and concerns with loved ones can provide emotional relief.
It is crucial to cultivate a positive mindset.
It is better for the patient to focus on their strengths, resilience and the things they can control, rather than dwelling on the negative aspects of their situation.
Establishing achievable short-term and long-term goals for oneself can give a sense of purpose and control during this challenging time.
For the large majority of Malaysians, their spiritual or religious beliefs can provide comfort and strength during their cancer journey.
Finally, cancer patients need to practice self-compassion.
Being kind to oneself and understanding that it is alright to have moments of fear, sadness or frustration makes the journey a less bumpy ride.
Prof Datuk Dr Andrew Mohanraj is a consultant psychiatrist, the Malaysian Mental Health Association president and Taylor’s University Impact Lab on Mental Health & Wellbeing director. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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