Treatment and its further implications

Having briefly reviewed the treatment options available when dealing with a cancer illness, it is by no means uncommon for another, less frequently articulated but nevertheless, key question to be lurking and requiring an ‘airing’; i.e. “Can it be treated? Of the majority of patients who may be reading and following these blogs, I would hazard a guess that this aspect of their cancer journey actually began quite a few postings back in this series. Perhaps it began with the unexpected discovery of something which upon first awareness, appeared to be innocent enough, e.g. a swelling or lump or an inflamed or (in some other way) changed area somewhere on the body. For others it might possibly have stemmed from a routine screening procedure, e.g. cervical, breast, colorectal etc. Perhaps you received a letter through the post indicating that a prompt appointment with, or return visit to, your GP was now urgently required. For yet others, the change may have been more gradual and insidious, as in bodily functioning perhaps, such as increasing and intensifying bouts of indigestion around meal times; or shortness of breath, chronic fatigue or weight loss.  Whatever it was or is, that ‘muscle’ deep within became suddenly tensed, as much of the pattern of life thereafter – waking and sleeping – began to move in a wholly unfavourable direction.

The next step may well have required a further visit to the Screening Centre or GP who, depending on his/her findings, advised and set in motion other courses of action.  Even if, as one invariably hopes, it all turned out to be a false alarm with the news reassuringly good, we doubtless will have been – at least for a few days – somewhat edgy’ and on-the-alert, with continuing moments of uncertainty, doubt and anxiety. Where symptoms have disappeared, or have been otherwise satisfactorily resolved, it will have become much easier to accept assurances offered and, doubtless with much relief, to have returned to the normal round of daily living.

Some people – and you may be among them – may not have been so fortunate. Following initial clinical examination and tests on blood, urine, possibly sputum etc., they have been referred to an oncology specialist at consultant level. Also involved may be a consultant surgeon – breast, colorectal, orthopaedic etc. Where this is/has been the case, there may well follow/have followed a period of further anxiety commonly associated with the period of waiting for an appointment. Thereafter, the consultant has or will, in all probability, carried/carry out a further routine physical examination, accompanied by relevant questions about recent history etc., all of which may well also include the need for biopsy. Cancer, of whatever type, is a disease of the cells of the body and a biopsy is an examination of a small sample of cells from the affected site.  These may be obtained surgically or from blood or sputum coughed into a container for microscopic examination.  Also at this time further tests of blood and/or organs, where necessary, such as the kidneys and liver (and perhaps even chest x-ray), may also need to be carried out. Once again, it is important to stress that many people who are so referred for a specialist opinion in this way do, at the end (of what admittedly is likely to be a difficult and stressful interlude) receive a welcome “all clear”.

Where cancer is diagnosed, one or more possible options may be recommended. This/these may entail surgery or some other form of procedure/treatment such as chemotherapy, radiotherapy or hormonal treatment and even combinations of them.  It is, of course, beyond the scope and competency of these letters to discuss such highly skilled and increasingly sophisticated treatment approaches in any kind of technical detail.  However, there are well known and documented psychologic, emotional and behavioural implications of all of these treatments, which certainly do lie within the remit of these postings and consequently at the heart of my inclination to write to you in the first place.

Moreover, we – that is all of us who work (or have worked) intensively with cancer patients in professional health-care occupations – need clearly to recognise and ever remind ourselves of a now well established and documented fact; namely that the management and overall care of cancer patients demands a multidisciplinary approach. This involvement of people from several disciplines and specialties – surgeons, physicians in the form of oncologists, radiotherapists, haematologists etc., also psychologists, physiotherapists, occupational therapists, chaplains, social workers, dieticians – can at first be quite daunting to patients· and this aspect of need and treatment/support, I hope to discuss in some detail in future postings.

  • · Such a complement of healthcare staff is more likely to be confined to Oncology Centres of Excellence and Teaching centres. (Even so, they are most unlikely to all be needed or to all turn up at once!)
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