Wed, 17 May 2000

Breaking bad news and psychosocial disorders in cancer patient

By Kok Lee Peng

SINGAPORE: Despite the advances in oncological treatment, the diagnosis of cancer invariably fills a patient with dread and fear.

There is really no good way to tell patients they have cancer, but a doctor has to be sensitive to the needs of his patients and be aware of their personalities and styles of coping

Patients who prefer to know the worst may still not be able to take the news well, and the diagnosis and prognosis should be put to them in as positive a light as possible.

Other patients may try to evade the whole issue altogether, and may send signals that they do not want to know anything. The doctor should spend as much time as possible when breaking the news, and should be alert to cues.

Sometimes the patient may not be ready to know the worst, but after another session or two may be more willing to accept the truth and participate in treatment decisions. Difficulties may arise in elderly patients with protective children who may wish to spare their parents the pain of knowledge.

If treatment involves chemotherapy or radiotherapy, it is not easy to hide what the patient has or to prevent them from talking to other patients.

The doctor then has to help the relatives confront their own fears and from an understanding of his patient, tell them what is best for the patient.

Psychological disorders in cancer patients range from adjustment reactions when first told the diagnosis, to coming to terms with their own mortality if the prognosis is poor. The disorders may be reactive in nature or organic, like delirium.

Reaction to pain is also a major issue cancer patients need help with, especially if they fear being overwhelmed by its constant presence.

Responses of family members vary -- some relatives may be very concerned and caring, while others may not be willing to look after an ailing parent, and may reject the patient outright, or have unfounded fears of being contaminated.

This state of affair could be due to a poor relationship between patients and their children, or it could be that the family is too caught up with the business of living to be bothered.

Cancer, in some, is a prolonged illness, and career burnout could occur, especially if the patient is depressed, incapacitated and requires a great deal of financial support.

The writer is a consultant psychiatrist at Gleneagles Hospital in Singapore.