Psycho-oncology concentrates on the psychological and psychiatric aspects of cancer. The help of psycho-oncologists is directed to cancer patients, their families and clinicians.
Currently, novel psychotherapy modalities, which are used by the psycho-oncologist in their work, like mindfulness-based stress-reduction programs, meaning-centered psychotherapy, and cognitive-existential, supportive-expressive, group therapies are dynamically being developed and studied in cancer patients, thereby expanding the possibilities of obtaining effective psychological methods in this specific population group (Breitbart, Alici 2009).
The main causes of intense stress in cancer patients are the fear of deteriorating functioning, death, changing of life plans, changes in body image, loss of self-esteem, significant changes in daily routine, financial problems, waiting for the results of diagnostic tests, misunderstanding of medical terms, waiting-times for treatment, ineffectiveness of treatment, and unresolved emotional trauma from before the onset of illness (Rebegea et al. 2019). Physical pain can also be a contributing factor to depression. Research shows that depression occurred in 33% of those experiencing high levels of pain, compared with 13% in those with low levels of pain (Smith 2015). People accustomed to maladaptive coping strategies, with a past history of major depressive disorder and poor contact with doctors, are notably predisposed to the development of depression (Okamura et al. 2005). The factors that protect against depression include strong emotional support from loved ones and optimism (Smith 2015).
Sadness, helplessness and stress is a normal response to a cancer diagnosis, but strong, negative and long-term negative well-being beyond a patient’s adaptive abilities may result in major depressive disorder.
Many cancer patients struggle with depression. The somatic symptoms of depression are similar to those manifested by cancer or the side effects of treating it. For example, very common symptoms like fatigue and loss of appetite are overlapping. Therefore, they may be overlooked by clinicians, which leads to a reduction in the detection of depression (Smith 2015). Unfortunately, in most cases in patients with cancer, depression remains undiagnosed and untreated, with a negative impact on quality of life and disease progression (Rebegea et al. 2019). Depression can be a pain worsening factor that leads to a deterioration in quality of life. According to some researchers, depression results in higher rates of mortality in cancer. This may be due to the supposed tendency of depressed patients to be less proactive in obtaining health care (Colleoni et al. 2000, Pinquart and Duberstein 2012). Fortunately, many cancer clinics already offer psycho-oncological services to which vulnerable patients can be referred.
When we talk about cancer, we talk about medicine, health, suffering, pain, fear and hope for a cure. However, it is impossible not to mention the topic of death. The subject of death raises fears – after all, is there anything we fear more?
For a terminally ill and suffering person, the period of dying can last weeks or even months. After coming to terms with dying, there may be a long wait for death. A difficult, but extremely liberating challenge for the patient, may be reducing the focus on himself and his illness and suffering, as well as realising that his words and behaviour at this stage can significantly support his relatives, who will stay and experience his suffering.
Viktor Frankl (1984) Austrian neurologist, psychiatrist, Holocaust survivor and founder of Logotherapy found meaning in his suffering. He claims that once you find a meaning in what you are going through, then it is no longer suffering. “In some ways suffering ceases to be suffering at the moment it finds a meaning.”
Sometimes religious rituals we grew up with can, with ease, give hope and meaning. Dying and bereavement may be a possibility to spiritual growth (Chase 2012). The psychotherapist helps the patient to understand and accept their mortality, rather than looking at it with fear.
Kübler-Ross (1969), while working with patients, observed five stages of grief: Denial, Anger, Bargaining, Depression and Acceptance. The last stage is about accepting the reality and recognising that this new reality is the permanent reality. In this stage, emotions may begin to stabilise. The guiding principle is “I can’t fight it; I may as well prepare for it.” Instead of denying feelings, the patient listens to his needs; he moves, he changes, he grows, he evolves into a new reality. He may start to reach out to others. According to Byock (1996), relationships need to be replenished in the face of impending death. He distinguishes five meaningful sentences that the patient and their loved ones should say to each other: ‘forgive me’, ‘I forgive you’, ‘thank you’, ‘I love you’ and ‘goodbye’. This saying goodbye, which can take a long time, is intensely painful, but remarkable in keeping spirits up (Chase 2012).
“We may not have answers for the existential questions of life and death any more than the person dying. We may not be able to assuage all feelings of regret or fears of the unknown. But it is not our solutions that matter. The role of the clinical team is to stand by the patient, steadfastly providing meticulous physical care and psychosocial support, while people strive to discover their own answers.” – Byock, I. R. (1996)
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