Preface
Cancer burden continues to grow day by day worldwide, with an increased number of newly diagnosed cases and deaths each year.
A significant proportion of such individuals at any stage of the disease trajectory suffer social, emotional, and psychological distress due to stigma related to cancer, diagnosis and treatment side-effects, survivorship issues etc. Therefore, psychological distress needs to be assessed on a regular basis to understand the reason and severity of the problem in order to help the individuals.
Distress is an unpleasant experience of a physical, mental, social, or spiritual nature. It can make it difficult for someone to cope with having cancer, its symptoms, treatment, both curative as well as side effects. This affects their survivorship and hence it impacts the entire family. Distress affect one across the range of experience. It varies from mild to severe, which includes sadness, fear, and helplessness with intensity.
Everyone with cancer has some level of distress at some point of time. Not only the patient but their caregivers too experience some level of distress during and after the course of illness, Moreover, distress extends along the continuum, ranging from common normal feelings of vulnerability, sadness, and fear to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual issues.
The 6th vital sign
Vital signs like body temperature, pulse or heart rate, blood pressure, and respiratory rate are four physical vital signs that are routinely measured to best described as a patient’s physical status. Pain is designated as the 5th vital sign as being very common symptom in cancer, and distress being highly prevalent in cancer, is designated as the 6th vital sign.
Forty percent of patients diagnosed with cancer experience significant level of distress. However fewer than 10% of patients are identified and referred for appropriate psychosocial support. Screening for distress is important for every patient at the appropriate time, and this needs to be managed by health professionals with the required expertise.
This becomes clinically significant when it interferes with the patients’ general functioning with their cancer treatment or with their progress in cancer care. It can be influenced by many factors such as type of cancer, stage of cancer, type of treatment, individual characteristics such as patients’ personality, available social support, financial conditions etc. Psychological distress is common as patient with cancer move beyond their diagnosis and into the intensive treatment. Distress is very common among cancer patients across diagnosis and across the disease trajectory. Psychological distress is common in cancer patients; however, it is often unrecognized and untreated.
Vulnerability to distress
Patients are vulnerable to distress at various stages of the disease trajectory, since they face the risk of substantial and permanent physical impairment, disability, and inability to perform routine activities. Investigation periods/ process and finding out diagnosis, getting treatment and facing its side effects are the stages when patient’ vulnerability is high. Stressor of the survivorship, as the constant fear of recurrence or relapse is always there. Getting back to the normalcy also becomes a challenge for many people surviving cancer.
Distressed patients tend to make extra visits to the physician and hospitals. Often, they seem to have trouble making decisions about treatment and adhering to the treatment. Patients also become dissatisfied with their physicians and medical care when in distress.
Role of the psycho-oncologist
Early diagnosis and Psycho-oncology services help the patients in theenhancement of treatment satisfaction and helps them cope with the accompanying emotions. It also helps in improving patients – physician communication, respect, and trust. Additionally Psycho oncology services are also helpful in improving patients’ adherence to the treatment regimen and survivorship issues.
Summary
Psycho oncology is a specialty which is concerned with the understanding and treating the social, psychological, emotional, spiritual, quality of life and other functional aspects of cancer from prevention to palliation and survivorship. Hence it focuses on improving the mental health of individuals who are diagnosed with cancer and their caregivers. Cancer affects not only to an individual, but it affects the entire family. Hence it becomes imperative to care for the caregivers as well. Patients admitted in the hospital for cancer directed treatment are regularly seen by psycho-oncologist. Therefore, regular screening of distress helps understanding the severity and specific area due to which psychological issues and concerns arise and helps to plan the better intervention for the same.
Author: Keshav Sharma
Psycho oncologist & Lead counselling services
Bagchi Karunashraya Palliative Care Center
Bhubaneswar, Odisha, India