Heal­ing, care and the fes­tive sea­son at the Sir An­thony Mamo On­col­ogy Cen­tre

The Malta Independent on Sunday - - FRONT PAGE -

What is a pa­tient’s first point of con­tact with the On­col­ogy Cen­tre?

I think that be­fore then, the di­ag­no­sis process is im­por­tant be­cause there is a lot of anx­i­ety for the pa­tient at that point.

Even though most doc­tors re­as­sure their pa­tients, I think the pa­tient al­ready has some sort of an idea about what is go­ing on. There will al­ready have been a wait be­tween, for ex­am­ple, hav­ing a biopsy taken or a PET scan and be­ing given the re­sult of the pro­ce­dure.

This is al­ready a very dif­fi­cult time for the pa­tient, and I’m say­ing this be­cause I think the big­gest prob­lem in all this is what the pa­tient feels and how dif­fi­cult it is for him or her to process what they are be­ing told.

Break­ing bad news is prob­a­bly one of the most dif­fi­cult stages in the jour­ney, and we try to give it as much time as pos­si­ble. Gen­er­ally speak­ing, the on­col­o­gists don’t give the di­ag­noses them­selves, so when a pa­tient comes to the On­col­ogy Cen­tre he or she will al­ready have had the di­ag­no­sis.

When they come here, some peo­ple are al­ready to­tally clued in, and then you have the peo­ple who are com­pletely un­aware. Usu­ally, that is the first point of con­tact with this depart­ment.

The pa­tient then comes to the point of what ther­apy – ra­dio­ther­apy or chemo­ther­apy – has been de­cided. Both modal­i­ties of ther­apy have their own group of nurses who are spe­cialised in their par­tic­u­lar field.

We try to ar­range for the pa­tients to meet the nurses be­fore they come to chemo­ther­apy; there is a group of peo­ple in a group called ‘Aurora’ who will meet them and ex­plain to them what chemo­ther­apy they are go­ing to have, what the side ef­fects will be, how long it will take and what they have to avoid.

We try to ar­range for that date be­fore the pa­tient be­gins the chemo­ther­apy, and we try to do the same with ra­dio­ther­apy.

There is al­ways a gap be­tween the new case ap­point­ment and the pro­ce­dure.

Do the doc­tors and nurses get spe­cialised train­ing?

The doc­tors are trained in their spe­cial­ties; for ex­am­ple, my spe­cialty is hae­ma­tol­ogy. We cur­rently have nine doc­tors – four haema­tol­o­gists and five on­col­o­gists – but it’s not enough.

For our pop­u­la­tion, the Royal Col­lege for Ra­dio­ther­apy is­sues a guide­line that each on­col­o­gist should see around 200 new cases a year. With five peo­ple and 2,000 cases the maths doesn’t work out!

With the nurses it’s slightly dif­fer­ent. They ac­quire a lot of their ex­per­tise while they’re work­ing in the area. You need a par­tic­u­lar set of skills here, as the pa­tients need a dif­fer­ent kind of care.

If you speak to pa­tients they will tell you that their ex­pe­ri­ence here is dif­fer­ent to the ex­pe­ri­ence in Mater Dei, also be­cause in Mater Dei you meet the pa­tient for max­i­mum of a week and then you don’t see him or her again.

Here we see the pa­tient ev­ery week for as long as they need to come, so the re­la­tion­ship is dif­fer­ent.

I would like to see more spe­cial­i­sa­tion in the nurses; more op­por­tu­ni­ties – which a num­ber of them have taken on in the form of Mas­ter’s De­gree, but this is some­thing that is done on an in­di­vid­ual ba­sis.

Does the fam­ily play a role in this area?

The fam­ily has a cen­tral role in all of this: it is lit­er­ally part and par­cel of what we do here.

The psy­cho­log­i­cal sup­port that they give, and the lift­ing of the mood – it makes the pa­tient able to face the treat­ment in a bet­ter frame of mind.

If a pa­tient comes to Aurora for in­for­ma­tion re­gard­ing chemo­ther­apy or ra­dio­ther­apy, the rel­a­tives are in­vited to come as well. We try to in­clude the rel­a­tives as much as pos­si­ble – even in the pal­lia­tive part.

Tell me about train­ing for pal­lia­tive care.

While you’re talk­ing to the per­son you feel what is go­ing on, and you mod­ify the mes­sage ac­cord­ing to what that per­son is feel­ing.

There are skills that one can learn as well: how to get the mes­sage across, what lan­guage to use, what en­vi­ron­ment to use...

Pal­lia­tive care is prob­a­bly the least re­sourced in terms of med­i­cal man­power.

We have a ward with 16 beds and we only deal with pal­lia­tive cases in on­col­ogy.

Pal­li­a­tion should be opened up with other in­tractable con­di­tions such as res­pi­ra­tory and re­nal con­di­tions.

At present, we are only of­fer­ing these ser­vices in the hos­pi­tal and there is a huge need for them in the com­mu­nity. We should be pro­vid­ing peo­ple with the free­dom to re­ceive pal­li­a­tion in your home, sur­rounded by your fam­ily.

Do you find that some in­di­vid­u­als choose not to un­dergo treat­ment?

Yes, but not very of­ten. You tend to find peo­ple who are more dis­cern­ing – specif­i­cally with re­gard to sur­vival rates and side ef­fects. When you give them the av­er­age length of time, you quote the av­er­age, but in re­al­ity its a range: for ex­am­ple 15 days to five years, but the me­dian is six months.

It’s a very dif­fi­cult de­ci­sion, even if you pro­vide all the in­for­ma­tion you can by quot­ing the lat­est lit­er­a­ture.

In Malta, peo­ple tend to trust med­i­cal staff more than other places – they leave med­i­cal de­ci­sions up to the doc­tor more of­ten.

Are peo­ple en­cour­aged to cel­e­brate in the fes­tive sea­son?

There is a suc­cess­ful at­tempt to dec­o­rate the area; the staff them­selves feel a lit­tle bit lighter as do many oth­ers.

A lot of peo­ple – such as the Pres­i­dent – also come to visit and a few peo­ple come to sing car­ols as well.

On Christ­mas Day the Cen­tre is a bit more ac­tive as food is brought in, along with other things. And we also try to send as many peo­ple as pos­si­ble home for the day – that is the ef­fort that is, I think, some­what low-key. It hap­pens ev­ery Christ­mas: it just hap­pens.

I think it’s harder on the fam­i­lies, al­though they do tend to try to bring their rel­a­tives home at Christ­mas if they are par­tic­u­larly un­well.

Break­ing bad news is prob­a­bly one of the most dif­fi­cult stages in the jour­ney, and we try to give it as much time as pos­si­ble. Gen­er­ally speak­ing, the on­col­o­gists don’t give the di­ag­noses them­selves, so when a pa­tient comes to the On­col­ogy Cen­tre he or she will al­ready have had the di­ag­no­sis.

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