Hearing of a diagnosis of cancer can devastating even if the cancer is very responsive to treatment or even if the cancer is at a very very early stage. I hear patients say that nothing is ever the same again.
Whenever a diagnosis of illness is life changing, patients often go through disbelief or denial. At this time, patients may request for a second opinion or additional tests in the hope that the diagnosis is incorrect. I allow the patients to go through this especially if I know that it will help them come to terms and move on. Requests for a second opinion should not be seen as an affront to the doctor because heeding the request will satisfy a very deep and important need of the patient. However, we must also know where to draw the line because some patients are paralyzed by this need and delay doing what needs to be done. Generally, if the patient has no symptoms from the disease, allowing 1-2 weeks delay will not do any harm nor have a negative effect on the treatment.
I’ve had patients who appreciated total honesty but I’ve also had patients turn very very angry on me for having told the truth. They would find little things to blame on me and there was even one relative who banned me from entering the patient’s room. Many patients get angry and often release this anger on their relatives, friends or caregivers. Meeting anger with anger or impatient or being defensive will do no good. It will only heighten the tension. Husband and wife, siblings, caregivers, friends may start fighting. Blaming, accusing and feeling of doing more than the others often ensue. Understanding, patience and persistence are direly needed during these times.
Depression and anxiety can affect half of the patients afflicted with cancer. Depression can present as a lack of focus, not wanting to go out and socialize, inability to sleep. Sometimes, simply encouraging patients will suffice but if the situation has gotten prolonged or has prevented the patient from discharging his functions properly, psychiatric consultation or counselling may be needed. Any emotion, if it is taking its toll on the patient, may need professional intervention and should be suggested to the patient or family regardless of the stage of disease.
Filipinos generally do not like being referred to psychiatrists. They think that being under the care of a psychiatrist means they are crazy. I’ve had patients never come back after I suggested for them to see a psychiatrist. That is one of the dangers of my profession. But to those who heeded, they are a testament that it is a risk worth taking. Seeking psychiatric help, if necessary, can mitigate many of the sufferings the patient and family are going through. It allows people to process and understand the situation and it makes adapting to the changes a little bit easier.