PROBLEMS OF CANCER PATIENT AND ITS MANAGEMENT What we learn from texts is treatment and what we do is management. How it defers? For example we have prescribed an evidence based medicine but the patient is economically poor.We have prescribed a medicine but patient is not willing to take because he wants to fast on religious ground.Many patient cannot take radiation because they cannot stay near machine.Many of them do not want surgery even after counseling when it is indicated because of myth that biopsy or surgery spreads cancer or they are afraid of surgery. Expectation and realities Expectation and realities are quite different in cancer services to cancer patients. They expect that they will be cured; they will have disease free life and will have excellent quality of life. They think that all these will be achieved at zero cost or minimum cost. They want the full benefit of surgery of best hand, but they do not want to pay best. They want to get treated in best institute with lowest cost. They want cutting age technology and state of art medicine at no down payment when they think about radiation therapy and PET (positron emission tomography) scans. Cancer patients want predictive oncology and a basket of marker study to pin down their diagnosis, treatment outcomes and to know their future without spending a penny. They navigate internet and read a lot. Some are evidence based while others are misleading blogs which confuses them as well as their physicians. They want to get the benefit of target therapy which only kills cancer, sparing normal tissue as they think that chemotherapy is old fashioned medicine. But target therapy is expensive. Science is progressing and new anti-cancer arms are added into the basket but they are costly and beyond the reach of poor patients. People are not agreed to participate in experiments but they want to enjoy the benefit of experiments. When multinational companies invest on research and development of new dimensions in science they want to enjoy the full return once the results come. Thus they make process and product patency and the cost of medicine is high. Competitor brands try to decode and crack the patency and bring the similar molecule at lower cost. Sometimes qualities are compromised in lower costs which patients do not want. Thus there is great divide between expectations and realities. Training of doctors Today patient wants hospitality more than treatment which they understand very little. Doctors, nurses and health care givers are not trained in hospitality. Moreover, they learn patient treatment skills, but they are doing patient management. Such management courses are not done in their curriculum. Nor they are trained to do so to meet the expectation of people. Crisis management, time management, communication skills, personality development are very important for health care givers in which many of them are not trained. Medical education system has to be refashioned and reframed to handle high expectation of people in upcoming era. Positive attitude There are doubts in people’s mind regarding cancer treatment outcomes, What is the use of treatment? In cancer treatment, patient will bleed their time, energy and money, but will they gain anything?. Timely treatment really makes difference, as cancer patients get benefits in terms of overall survival, disease free survival and quality of life with treatment. So, there is considerable difference, between treatments, versus no treatment. Patient spends money for above mentioned benefits. For example, a severe mitral stenosis with cardiac failure has a life span of 8 months and a pancreatic head of cancer patient will have the same life span. But the heart patient is not so afraid, and refuses treatment, as cancer patient. This attitude has to be changed. We need a positive attitude from negative attitude. Cancer patients can enjoy normal life, in comparison to CVA patients who cannot move or heart failure patients who are bed bound, or chair bound or respiratory distress patients, who suffer from air hunger. The treatment of cancer patients is not lifelong, in most of the times, unlike diabetes and hypertension patients, who are lifelong dependent on medicines. Most of the early stage cancer can be cured, and late stages diseases are controlled. The medical expenses for kidney transplant or cardiac transplant or heart bypass or pace maker are more than cancer treatment. The research shows, those who can cope with cancer, and are psychologically fit and, enjoy life, live more, both in terms of life span and quality of life than those who cannot. Biggest question that the patients ask to physicians is the question of survival. How long am I going to survive? In fact survival is the primary end point of many research studies .Sometimes we say 5years survival, ie, percentage of patients surviving after 5 years or median survival. Today many patients do not know that majority of cancer patients do not die from cancer and cancer is curable like Yuboraj sing’s seminoma. But all patients are afraid that they will die of cancer. Percentage of survival is increasing over the years from less than 40 percent in 1975 to more than 70 percent today considering all stages. The next question is disease free survival that is living with or without disease. We are treating with chemotherapy, radiotherapy, surgery, hormone therapy and more importantly with target therapy to kill the tumor cells minimizing side effects. With the increasing survival we are offering disease free survival to our patients. How the patients will live rest of his life? Quality of life is the next entity that doctors deal for cancer victims. Physical and mental sides are equally important. We offer a life which is close to normal life. Treatments are given in phases. Usually patients do not take lifelong treatment unlike hypertension or diabetes. Training of care givers is very important. Motivating for positive thinking will cure the disease. Doctors are God to patients and to patients’ parties. However, simple mistake in counseling can lead to suicide of patient. Patients expect good treatment, quality care, evidence based medicine at affordable cost. At this point patients suffer from lots of insecurities like financial, social, family etc. What will happen if I die? What will happen to my children or my husband or wife or mother of father? Often they ask about hereditary and genetic issues: prevention of cancer among kith and kins. Cancer is not only the problem to the patient, family, society, country, but also a problem to family doctor. Patients have physical problems as we observe from signs and symptoms .Such symptoms depends on primary organ of involvement to metastasis and stage of disease. But psychological issues are perhaps greatest problems to patients and family members. Breaking the bad news seems to be the death certificate to patients. Every biopsy report positive for malignancy is like a death certificate for patients and their relatives. Emotional intelligence is near zero at this stage. Anger, depression, denial, bargaining with god why I am, to acceptance is stages of psychological reactions. While some reactions might be missing others may overlap with all permutations and combinations. Any one may predominate. Collusion is hide and sick reaction to relatives where relatives hide the diagnosis and prognosis to patients. Relative often requests the doctors to do the same.” If you reveal the diagnosis to my father or mother or my patient the patient will die-now the doctors are in dilemma whether to tell the truth or lie to patient. Definitely this is a problem to doctors. On one hand according to western medicine every patient has right to know his diagnosis and prognosis, on the other hand the relatives push the doctors to lie especially in our country. Like psychiatric patients, every cancer patient is a stress to doctors. Patients and their relatives are stressed and they transfer some part of it to doctors who are their primary counselors. More we see patients more we are stressed. Doctors need to de-stress themselves.
Posted on: Sat, 15 Mar 2014 07:08:02 +0000
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