Counseling Patients with Cancer

Artwork (c)2006, www.psychotherapy.net

Dr Koh gave a run-down of statistical and informational update on curable and incurable cancers. The graphic presentation was a little difficult to stomach. Although it was brief, the impression it created has since stayed on in the mind. His ultimate message to us all was, ‘Early detection saves lives!’ The tumor size, symptom control and quality of life will determine the outcome of treatment. Some common screenings that normal and healthy people can go for are mammogram, Hepatitis B Screening, Pap Smear, Fecal Occult blood test.

It is well documented that counseling and psychotherapy can improve quality of life for cancer patients. Cancer and cancer treatments can affect a person’s:
 body image and appearance
 energy levels
 physical, social, and mental functioning
 intimate relationships and sexuality.
The goal of counseling and psychotherapy is to help patients make the functional, emotional, and spiritual adjustments necessary to maintain their quality of life.

A wide variety of psychological interventions are available to the cancer patient, including:
σ educational cancer-related counseling
σ individual supportive psychotherapy
σ cognitive behavioral therapy
σ group therapy and/or cancer support groups.
In my counseling with cancer or terminally ill patients, good communication skill is very important. Patients often have filtered information. It is important that I identify and acknowledge their emotions, find out what they already know and what they want to know. When giving information, I will need to check that the language used is right, i.e., word used must have the same meaning to both.
I wished Dr Koh would elaborate on how Cognitive behavioral therapy (CBT) could help the cancer patient. But I guess as a medical doctor he focused on how the counselors could attend to the patients in an all-rounded manner. I went on line to search for related article to understand how CBT can be used on cancer patients. (http://www.cancerline.com/cancerlinehcp/9898_21550_0_0_0.aspx? Extracted on 25 June, 2007)

CBT was initially developed by Aaron T. Beck, MD to treat depression and has been validated as an effective psychotherapy for patients with cancer. CBT is based on the assumption that depression and anxiety arise from negative internal dialogue, or “self-talk.” By replacing negative dialogue with positive self-talk, patients feel and act more positively, even in the face of life-threatening illness.

Central to CBT is the theory that the individual has control over his or her thoughts and has the power to modify feelings and behavior. The cognitive behavioral therapist helps the patient to take specific steps to do this.

1. Actively identify negative thoughts as they occur.
2. Document the negative thought.
3. Correlate it with related events.
4. Identify the type of faulty thinking.
5. Replace the negative thought with more a realistic—and positive—interpretation of events.

Studies have shown that CBT helps to quickly alleviate stress, depression and anxiety in patients with cancer. CBT reduced the prevalence of moderate depression in women diagnosed with stage 0–II breast cancer. Women with early stage breast cancer who underwent CBT experienced less anxiety and disruption of family relationships.

From the same website, I learnt Relaxation Techniques that have been proven helpful in bringing down the anxiety level of patients. Relaxation has been defined as a “state of consciousness characterized by feelings of peace, and release from tension, anxiety and fear.”

In the 1970’s Herbert Benson, MD began recommending a simple form of meditation to his patients to elicit the “relaxation response.” This response moderates sympathetic arousal and produces marked health benefits, resulting in:

 decreased heart rate and blood pressure
 lowered lipid levels
 decreased levels of circulating stress hormones
 improved immune functioning

There are a number of techniques that patients can use to induce relaxation, but they possess underlying common factors. Some of the most common methods are:

guided imagery or visualization
progressive muscle relaxation
meditation

Studies do not show benefits of one relaxation technique over another.

Research does show that relaxation is an effective adjunctive therapy to help cancer patients:

 self-regulate feelings of distress
 reduce cancer-related and neuropathic pain
 improve mood disorders
 lessen fatigue

There is also evidence that relaxation improves post-surgical outcomes, such as length of stay and recovery time.

"To talk sometimes, to listen often, to understand always.
To cure sometimes, to relieve often, to comfort always.” - Pierre Ambrose