Friday, August 31st, 2018 will be the last day of my postdoctoral fellowship at the Psycho-Oncology Center of the Sainte-Justine Hospital. Wednesday, September 3rd, 2008 was the beginning of my doctoral studies and my thesis focused on breast cancer and one of my clinical internships was at the Psychosocial Oncology Program of the Jewish General Hospital. Since it has been close to 10 years that I have been involved in cancer research and clinical work, I thought I would share some of what I have learned thus far.
The first thing that comes to mind is how resilient people are throughout their cancer trajectory (diagnosis – treatment – survivorship or end of life). Indeed, it requires great strength to be able to cope with a life-threatening diagnosis and adapt to lifestyle changes that can have permanent consequences. A study reviewed 57 published articles and found several personal attributes and characteristics related to resiliency throughout different cancer phases such as optimism, hope, realistic expectations, social support, spirituality and supportive provider communication, etc (Molina et el., 2014). In sum, it is of utmost importance to promote resiliency to meet the psychosocial needs of patients whether they are undergoing treatment, their treatment is completed or whether they are in palliative care. In fact, several cognitive behavioral and existential interventions have been elaborated to foster resiliency to improve quality of life and enable psychological well-being or posttraumatic growth (Loprinzi et al., 2011; Lee, Robin Cohen, Edgar, Laizner, & Gagnon, 2006).
Forces beyond your control can take away everything you possess except one thing, your freedom to choose how you will respond to the situation. ― Viktor E. Frankl
The second thing that comes to mind is the word distress. I have read, heard and witnessed that word countless times throughout my cancer experience. Distress is the 6th vital sign in a cancer population and it is estimated that 33% of the cancer population suffer from significant distress (Howell et Olsen, 2011). Also, it has been associated with worsened health-related quality of life, lesser treatment adherence and lower satisfaction with care (Howell et Olsen, 2011). Although it is recommended to screen for psychological distress along the cancer continuum, it has been reported that patient’s distress often goes unnoticed and the patients are not referred to psychosocial services available (Cohen, 2013; Johnsen et al., 2013; Mitchell, 2015). Also, patients considered as “survivors” report distress as several struggle to find a new sense of normalcy or cope with adverse long-term effects.
Considering that approximately 1 in 2 Canadians will receive a cancer diagnosis in their lifetime and that the survival rate after 5 years is estimated to be 60% (Canadian Cancer Statistics, 2017), it becomes apparent how assessing psychological distress and promoting resiliency is imperative to enable psychological well-being and improve quality of life throughout the cancer trajectory. There are several resources available: several hospitals have a psychosocial oncology department offering several services (psychologist, social worker, spiritual aid, musicotherapy/artherapy, mindulfness/yoga interventions). The Canadian Cancer Society also has a community service locator which is a directory of different services available for patients or caregivers. Lastly, I have suggested several books to patients who have completed their treatment and are seeking support and struggling to find their “new normal”. Please see below for the list of resources and books.
Dans cette tranche de vie, il n’y aura eu ni duel, ni vainqueur, ni vaincu. Juste un magistral coup de poing, des descentes aux enfers sans demi-mesure et ce bain d’humanité
― Françoise Stanton, extrait d’un témoignage tiré du livre Tu n’es pas seule
The last point I would like to make is that although my focus has been on the “patient”, I would be remiss not to mention the family and friends of said patient as their cancer experience matters as well. They too show great strength and can experience distress which can go unnoticed, and they too can benefit from some of the above-mentioned resources. Finally, what I learned thus far is how much I want to keep learning, broaden my cancer experience and share my knowledge.
Ministère de la santé et des services sociaux. La détresse des personnes atteintes de cancer : un incontournable dans les soins. Édition: La Direction des communications du ministère de la Santé et des Services sociaux. http://publications.msss.gouv.qc.ca/msss/fichiers/2017/17-902-11W.pdf.
Molina Y, Yi JC, Martinez-Gutierrez J, et al. Resilience Among Patients Across the Cancer Continuum: Diverse Perspectives. Clin J Oncol Nurs. 2014; 18:93-101.
Loprinzi CE, Prasad K, Schroeder DR, Sood A. Stress Management and Resilience Training (SMART) program to decrease stress and enhance resilience among breast cancer survivors: A pilot randomized clinical trial. Clin Breast Cancer. 2011; 11:364–368.
Lee V, Robin Cohen S, Edgar L, Laizner AM, Gagnon AJ. Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Soc Sci Med. 2006; 62:3133–3145.
Howell D, Olsen K. Distress- the 6th vital sign. Curr Oncol. 2011;18:208-210. Cohen, M. The Association of Cancer Patients’ Emotional suppression and their Self-rating of Psychological Distress on Short Screening Tools. Int J Behav Med. 2013: 39;29-35.
Johnsen, A.T., Petersen, M.A., Pedersen, L., Houmann, L.J., & Groenvold, M. (2013). Do Advanced Cancer Patients in Denmark Receive the Help they Need? A Nationally Representative Survey of the Need Related to 12 Frequent Symptoms/Problems. Psychooncology. 2013; 22:1724-30.
Mitchell, A.J. (2015). Screening and Assessment for Distress. Oxford University Press: New York.