Supportive care addresses the psychosocial issues of cancer therapy, replacing negative feelings with hope.
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Some call supportive care the human dimension of treatment. Fifth dimension is the term trademarked by a cancer supportive care web site to indicate the role that supportive care takes alongside traditional modes of cancer treatment.
If you’ve ever been diagnosed with cancer or know someone who has, you are familiar with the powerful emotions experienced by virtually everyone involved–disbelief, denial, anger, guilt, hopelessness. Once treatment begins, the emotional trauma reaches a new level as the patient begins to battle pain as well as treatment side effects such as fatigue, nausea and loss of appetite.
Supportive care is designed to address all of these emotional, psychological and social issues, helping the patient replace negative feelings with positive ones such as hope. Whether through individual counseling or a self-help group, supportive therapy offers advice and reassurance, encourages release of painful emotions and strengthens the patient’s ability to function in every day activities. The overall goal is to strengthen, rather than challenge, the person’s defenses in the face of the immense challenges of cancer diagnosis and treatment.
In most cases, supportive care includes guiding patients to appropriate resources such as stress reduction classes, meditation, yoga, biofeedback, self hypnosis or massage therapy. It may involve helping the patient deal with self-image problems by obtaining a wig to cover up hair loss associated with chemotherapy. Many patients find that artistic expression can help them come to terms with their thoughts and feelings–writing daily journal entries or getting involved in pottery, weaving or photography.
Know Your Enemy
One major component of supportive care is education. After his diagnosis, Jason wanted every bit of information he could get about non-Hodgkin’s lymphoma, how the disease progresses, treatment options and what each involves. In discussions with his doctor, he used a tape recorder, then transcribed his notes. He read pamphlets and books and made frequent use of web sites and telephone help lines such as 1-800-4-CANCER (1-800-422-6237).
Learning about your illness helps give a sense of control that’s an important element of treatment. Good sources of information include the American Cancer Society (www.cancer.org), the National Cancer Institute (www.cancer.gov) and books such as Everyone’s Guide to Cancer Therapy, edited by Malin Dollinger, M.D., and Ernest H. Rosenbaum, M.D.
One recent survey found that 70 to 90 percent of cancer patients suffered from fatigue that affected their daily living habits–even to the point of making it difficult for them to socialize with family and friends. More than two thirds of respondents listed fatigue as the most common and the strongest side effect associated with treatment. Some patients characterized it as an overwhelming, whole-body tiredness that does not go away even after a good night’s sleep.
There are many causes. Constant emotional stress can be physically exhausting and interfere with normal sleeping and eating patterns.
More than two-thirds of respondents listed fatigue as the strongest and most common side effect of treatment.
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Some of the fatigue may have a direct physical source. The tumor may compete with normal cells for nutrients. Treatment, diagnostic tests or the disease itself can cause anemia, nausea, infection and fever. Regardless of what part of the body is being treated, radiation therapy frequently results in cumulative fatigue.
If your doctor forgets to ask about fatigue, bring up the subject yourself. Studies show that it can have a negative effect on quality of life and impede recovery. A blood transfusion, a medication or a change in diet may be all that’s needed.
Debilitating effects such as pain, fatigue and depression can cause problems for years. With good supportive care, they can be managed.
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In many cases, the fatigue can be traced to lack of physical activity or prolonged bed rest. A regular exercise program–such as brisk walking or biking–will restore some conditioning to the muscles and cardiovascular system. Exercise may also improve appetite and sleep and help quell other symptoms of depression.
Otherwise, cancer patients need to be realistic about what they are able to accomplish and include regular rest periods into their daily schedule.
Sometimes the initial support a patient receives begins to dissipate as time passes–even though the patient’s needs may become even greater after the trauma of surgery or chemotherapy. Patients are advised not to be shy about asking for help when demands become too great.
Whatever else is contributing to fatigue, depression may also be involved. As many as 42 percent of cancer patients report some level of depression. Major symptoms are sleeplessness, loss of appetite and a feeling of hopelessness–all of which can have a negative effect on treatment and overall health.
For a mild case of the blues, supportive self help measures may be enough, but in most cases depression requires treatment with medications and counseling.
While pain may be the most universally feared effect, it is by no means an inevitable consequence of cancer. An abdominal cancer may cause intense pain, but a lymphoma rarely does. Any growing cancer can, however, pinch or press nerves or cause painful obstructions in the intestines or urinary tract.
Surgery causes significant short- and long-term pain. Chemotherapy can be toxic to nerves and healthy tissue, and radiation can damage nerves and cause painful skin reactions.
For mild or moderate pain, doctors usually recommend over-the-counter or prescription medications, cold packs or heating pads, relaxation, exercise and activities that provide a distraction.
Many patients with advanced cancer have intense or excruciating pain that requires more potent medications. World Health Organization guidelines recommend a stepped approach to pain control with gradually more potent medications prescribed to match the intensity of pain.
Of Americans diagnosed with cancer this year, about 60 percent will still be alive five years from now. For them, as well for those with terminal cancer, quality of life is crucial. In addition to eradicating the tumor, doctors focus on alleviating debilitating effects like fatigue, depression and pain. Left untreated, these may cause problems for years. With good supportive care, they can be successfully managed.
REFERENCES:
“Effective Pain Control for Patients with Advanced Cancer,” American Family Physician, August, 1999.
Genevieve W. Ressel, “NIH Releases Statement on Manging Pain, Depression, and Fatigue in Cancer–Practice Guidelines,” American Family Physician, January 15, 2003.
Ernest H. Rosenbaum, Isadora Rosenbaum, Alexandra Andrews and David Spiegel, “Fifth Dimension Cancer Supportive Care, updated January 1, 2005.
Ernest H. Rosenbaum, Barbara F. Piper, Marilyn Dodd, Kathleen Dzubur, Michael Glover, Pat Kramer, RoseAnn Kurshner and Francine Manuel, “Fatigue Reduction and Management for the Primary Side-Effects of Cancer Therapy,” Cancer SupportiveCare.com.
National Cancer Institute, “Taking Time: Support for People with Cancer and the People Who Care about Them,” www.cancer.gov.
Tracy L. Skaer, “Cancer Pain Management,” American Journal of Pharmaceutical Education, Summer, 1998.
