Distress In Cancer

Quotes from Dr. Adil Akhtar

National Comprehensive Cancer Network (NCCN) defines distress as multifactorial unpleasant experience of psychological, social, spiritual and physical nature that may interfere with the ability to cope effectively with cancer, its physical symptoms and its treatment.

The biggest barriers to getting distress support and treatment is under recognition and the stigma associated with mental health issues in the society, therefore we have to be very careful in looking for early signs of distress, making a prompt diagnosis and providing the support in a timely fashion.

Oncologists become the primary doctors when someone is going through cancer treatment. In a way, we become the quarterback of the patient’s care. It is very important to create a team to provide not only cancer treatment but also to provide physical, mental and emotional support to the patient. Patient and their family must be included in the team, along with the doctors, nurses, pharmacists, social workers, pain specialists, mental health and spiritual care specialists. Patients should be the central focus of the team and the treatment be holistic in nature taking care of the whole person and not only the cancer. We need to make sure that patients are making the decisions about their care.

At the time of diagnosis, patients are anxious and scared, so I make sure the disease process is explained to them in detail along with their families. I encourage them to ask all the questions about the disease, prognosis and the goals of treatment. I also encourage the patients to express their feelings about the diagnosis. I show them compassion and assure them that we will take care of them through their cancer journey. I also give my cell phone number to all my patients so that they have the comfort of knowing that I am only a phone call away at all times. Being available to the patients is probably the biggest support an oncologist can give their patients.

When the treatment starts, I make sure that I see my patients frequently so that we can discuss any symptoms they are having. Common symptoms can be fatigue, nausea, vomiting, mouth sores and diarrhea. I listen to the complaints and then work with the patients to design treatment plans.

I look carefully for signs of emotional and mental distress. There is a distress management tool which we use routinely to identify patients at high risk of distress. We have social workers, mental health and spiritual care specialists in our team. If we identify someone at high risk or with signs of distress, we refer them promptly to the specialists. I also encourage the patients to talk to other patients who have gone through similar treatments. We also have support groups for different cancer types where patients can join a group discussion

Giving the news about a life threating illness to a patient for the first time can be difficult but a detailed, well thought out discussion by a compassionate doctor can help make it easier on the patient.

Steps that I take when giving the news to a patient that has been diagnosed with cancer:

Before anything, I review the case thoroughly so that I have a good plan of treatment to discuss with the patient. I am also ready for any questions that could possibly be asked.

I always chose a quiet and comfortable space to sit down with the patient and his/her family/friends.

I always make sure that all phones or beepers are turned off; that could be a distraction during discussion.

I always ask if there is anyone that patient wants to have attend the meeting. Friends, family and anyone that the patient want to be there are welcome.

When entering the room, I always give full attention in a compassionate manner to the patient and their loved ones. I make direct eye contact. Also, anything I have to do to make my patient feel comfortable.

I start the meeting by asking the patient their understanding of their problems, and the work up done so far to make the diagnosis.

I then start my discussion by giving the details of testing done so far, if I can show x-rays or scan I do that with the patient’s permission

And continuing the discussion, I tell the diagnosis gently, but very clearly without using any scientific terms so that they understand the disease and diagnosis well.

I always speak clearly and precisely. I am never vague.

With patient’s permission, I hold their hands to comfort them while I do the discussion.

Once I am finished, I pause to make sure the patient and family have time to grasp what I just told them, and then ask the patient and the family members if they understand the diagnosis, and if they have any questions.

I make sure that all the questions that were brought up by the patient during the discussion, have been answered completely and in detail

When all the questions are answered, I start the discussion of what is the plan for treatment. This reassures them that there is a treatment and help available. I also tell them that I am a part of their team, and will help them through the treatment.

I will always give some time at the end of the discussion for the patient and loved ones to ask any other questions they need answered. I give them my cell phone number in case they have any questions later on.
When I leave the room, I make sure that our staff is available to comfort them and answer any question which may come up.
The patients will most likely have strong emotions toward being given the news so always reassure them with words that will boost their confidence.