Whole person care treats human being, not only disease
October is Breast Cancer Awareness month and, as a breast cancer specialist, there is much to celebrate. Survival has increased to 90 per cent from about 75 per cent in the late 1970s and innovative approaches have decreased the morbidity (side effects, both short- and long-term) of breast surgery.
However, there is still room for significant improvement. As the medical armamentarium has blossomed, our ability to treat the human being behind the illness has fallen by the wayside.
The symbol of whole person care is the caduceus, the intertwining of the white snake that represents curing (Hippocratic) and the black snake that represents healing (Asklepian).
In the treatment of breast cancer, healing refers to the provision of such services as psycho-oncology, dietetics, exercise, physiotherapy and therapeutic massage. Interestingly, none of these is covered by the government and patients must pay out-ofpocket unless they have private insurance. Why are these services important? It has been shown that moderate exercise three times a week (eg: brisk walking) improves survival an amount equal to that achieved by adjuvant chemotherapy. It is amazing that we spend millions on chemotherapy, yet something as simple as a supervised exercise regimen with a personal trainer cannot be provided. In addition, women who gain weight after they are diagnosed also have a poorer prognosis, yet access to an oncology-trained dietitian is limited in Quebec.
Although cured of their disease, many women suffer psychologically, as their body image becomes distorted, their sexual function is altered, their spouses or boyfriends leave them and their performance at work is affected by “chemobrain,” an inability to concentrate for long periods.
So why don’t we pay attention to these factors? Because the health-care system is built to treat illness or injuries, and does it very well. Unfortunately, the maintenance of health and the rehabilitation to health is neglected. That is where programs in whole person care come in. My colleague Tom Hutchison, a nephrologist in his past life and at present one of McGill’s leaders in whole person care, has written a wonderful little book titled Whole Person Care: Transforming Healthcare (2017, Springer) that is well worth a read. In fact McGill’s program in whole person care was launched in the late 1990s by Dr. Balfour Mount, a legend in the field of palliative care and a recent inductee into the Canadian Medical Hall of Fame.
But why are we lagging behind in the day-today provision of whole person care?
The reason is simple: governments have not taken notice. Whole person care must be ingrained in our health-care system; it should not be considered a luxury, but a necessity, akin to chemo- or radiotherapy.