Cancer's other impacts
Cancer is one of the biggest causes of deaths around the world today.
While scientists and researchers continue with their analyses of the causes and treatments, it is important to take a look at the oft-ignored aspects of the disease – the psychological impact of cancer on patients as well as caregivers.
Psychologist and psychotherapist Dr Nishat Shams, who works at the Ministry of Health and volunteers at the Oman Cancer Association (OCA) says that the first and most common emotion of patients is denial. “Next is uncertainty. This would be before the doctor confirms the diagnosis. The third stage is depression, which goes on till the diagnosis is confirmed. The next stage is anger – they may have been completely healthy, or been fervently religious.”
This stands true for both, women and men; where men mostly react rationally, and women are more emotional, says Dr Nishat.
Uncertainties bring anxiety, as the immediate thought is of death. Acceptance comes late, which depends upon the coping skills of the patient – through family support or spiritual comfort. “This cycle is called grief period in terms of psychology and mental health,” says Dr Nishat. “This is a universal cycle of reaction regardless of the type of cancer.”
The stress levels for the caregiver are pretty much the same, she points out. “Research shows that the stress level of the caregiver rises equally even after confirmed diagnosis. The caregiver might not go through the same cycle of emotions as the patient, but s/he goes through depression and severely high levels of stress.”
A study, ‘The Impact of Living with Leukemia on Parents’, supervised by Dr Zakia Allamki, Professor of Child Health at the Sultan Qaboos University, aimed to elicit the psychological distress of parents of children diagnosed with leukemia.
This study demonstrated that most of the studied parents were depressed (29.41 per cent) and anxious (41.18 per cent).
Findings illustrated that parents’ psychological status varied with the different variables like social support, time of diagnosis and education level. Those educated and with social support
reacted positively. This study also emphasised on the necessity of psychosocial intervention in parents of children with cancer.
“Sometimes, there are cases where a patient’s immediate reaction after hearing the confirmed diagnosis is refusal of treatment. The reasons could be that the disease is too advanced, or the fear of pain, or being financially ill-equipped, or even the feeling of guilt of not wanting to burden the family. This is where the role of the healthcare team becomes crucial,” says Dr Nishat.
Being positive helps
“Since there is a misconception that cancer means sure death, which is due to lack of knowledge. The onus lies on the healthcare team to educate the extent of the cancer, and let those affected know, how and when it can be treated.”
So is it a myth or fact that mental strength is essential to battle cancer? Dr Nishat clears the air, “According to research, when you are mentally strong, positive, and happy, you respond better to medication and chemotherapy, thereby speeding up the recovery process. Response to chemotherapy is delayed among those who are extremely stressed, as their immunity goes down. It is important for the patient to be mentally strong as it also helps the caregiver.”
Talking to children
Dr Zakia advises that children should be given accurate, age-appropriate information about cancer.
“If you don’t talk to them about cancer, they may invent their own explanations, which can be even more frightening than the facts. Explain the treatment plan and how it may affect their lives. Prepare them for any physical changes during treatment (hair loss, extreme tiredness, or weight loss).
“Reassure them and let them know that their needs will continue to be taken care of. Answer their questions calmly and as accurately as possible.”
Outlook on Oman
Dr Nishat, who is conducting a research on breast cancer in Oman, asserts that the psychological need has to be addressed in the sultanate. Cancer is still considered a huge stigma in the country, she says. Also, people are wary of seeking psychological help because misconceptions about mental health are still prevalent.
Dr Zakia notes, “Oman faces a significant challenge to keep its citizens from travelling abroad to seek what is believed, better treatment options and outcome. In such cases, safety is a risk due to poor or no follow-up care.”
Oman has achieved a dramatic transformation in cancer care in a remarkably short time.
OCA arranges seminars and holds a yearly cancer awareness walk. “While diagnosis and treatment modalities are improving we need to work more on education and awareness for early signs as well as screening and early detection,” says Dr Zakia.