World Cancer Day 2017
International cancer research indicates that incidence of severe post-traumatic stress disorder ranges from 3% to 4% in earlystage patients recently diagnosed to 35% in patients evaluated after treatment.
When the incidence of less severe symptoms is measured, rates range from 20% in patients with early cancer to 80% in those with recurrent cancer.
Thus on World Cancer Day (celebrated every year on 4th February) whilst supporting all efforts aimed to raise awareness of cancer and to encourage prevention, early detection, and effective treatment to significantly reduce illness and death caused by cancer and to reduce stigma and misinformation, it is also necessary to address the person as a whole and look at the impact of cancer on mental wellbeing.
For a number of years, investigators have reported significant stress or trauma-related symptoms in survivors of cancer. Being diagnosed with a life-threatening illness is clearly an example of a traumatic event.
International cancer care standards are increasingly advocating that people with histories of cancer are evaluated and considered at risk for acute stress, post-traumatic stress and related symptoms. Although less well-researched, considerable stress or trauma-related symptoms can be seen in family members and close friends. Cancer-related stress also causes burnout among staff caring for patients.
Cancer has therefore a significant impact on mental health and wellbeing.
Slightly over 2000 persons from under 5 years to over 85 years were diagnosed with cancer in Malta in 2014, in the same year close to 900 Maltese citizens lost their battle with cancer. As Commissioner for the promotion of the rights of persons suffering from mental ill-health, and evaluating the facts given above - over 2000 families a year are facing cancer - the first recommendation must necessarily focus on patients and families.
Patients living with cancer need support, help, care and attention to make adjustments in their lives to cope with the disease and changes in treatment. Living with cancer causes different levels of distress and anxiety at different points in time. Patients are encouraged to maintain open, regular and honest communication with their loved ones.
Patients and families are encouraged to discuss their feelings and what they are going through with caring staff including social workers, psychologists etc., irrespective of whether they feel good or bad.
Seeking such dialogue automatically widens the patient’s support system. Dealing with cancer and cancer care becomes a new way of living to which patients adapt. Thus a holistic approach which promotes the patient’s physical and psychological wellbeing should be sought.
The second recommendation concerns caring staff. Dealing with emotionally challenging situations is an everyday occurrence for those working in cancer care. Reflective practice is a key ingredient of
self-care, ongoing learning and personal development. Staff need time and help to reflect on the emotional impact of patient care on their personal wellbeing and emotions and on their ability to provide compassionate care for patients. Caring for staff emotional health and physical needs makes them more effective caregivers, which ultimately benefits the patient.
The third recommendation addresses policy makers. Psychosocial oncology care needs to feature prominently in the upcoming new cancer plan for Malta.
Quality cancer care today integrates the psychosocial domain into routine cancer care. There are clear guidelines that distress should be regularly measured as the 6th vital sign after temperature, blood pressure, pulse, respiratory rate and pain.
Existing service initiatives and support groups need to be strengthened. Outreach services must focus on those who find it difficult to seek help. Evidencebased programmes of psychosocial care need to be integrated into multidisciplinary cancer care plans.
Health care professionals need to be provided with training in psychosocial care and with individual help and support for their own mental health and wellbeing.