ESGO 2013
Emotional and physical effects of cancer in life after treatment
Prof Annette Hasenburg - Universitätsklinikum Freiburg, Germany
Psycho-oncology or life after cancer, doctors of course are keen to get cures for cancer, they’re keen to bring their patients through the acute stages of cancer to a future but you’re concerned with what happens afterwards and you’ve been to a symposium this afternoon, today here in Liverpool, you’ve chaired it, what did you find out about life after cancer? What are the big issues?
To treat cancer is not enough, we have to focus on helping our patients to live a full, productive and meaningful life after cancer so we have to support them regarding many issues. That can be psycho-oncological problems – many of our patients suffer from anxiety and depression; it can be partnership problems, sexual problems; patients may have lymphedema or they’re suffering from fatigue and today we had experts in the session to show us how you cope with those issues, like how to motivate our patients to perform physical activity, to improve the fatigue syndrome, to improve lymphedema, to improve depression and anxiety.
Now there are breakdowns of relationships and, in fact, one of the most difficult areas for doctors and nurses to talk about is sex lives. What sorts of things actually go wrong?
The major problem is that patients don’t talk to each other; partners don’t talk to each other. The woman is thinking, ‘I have a scar, I’m not attractive any more,’ and she doesn’t want to have contact with her husband. And her husband thinks, ‘Oh, she doesn’t want to see me any more,’ so he doesn’t talk to her. So it’s just like a circle. It’s very important that they start to talk to each other and tell them that they love each other, that they want to be together, that they are looking for intimacy.
Right, so there are ways that psychologists can help them to overcome these difficulties, is that what you’re saying?
Yes, there are many ways to do this. They can be evaluated in face-to-face discussions and they can encourage women to let husbands know their problems, their feelings and they can encourage husbands to support their women and to talk to them and to look for nice things they can do together like going to a restaurant, having sports together, talking to each other and to have sex.
So learning how to fall back in love or to refresh your love is very important.
Exactly.
And that’s not a domain that doctors are very comfortable talking about, is it?
It’s difficult for the doctors so we have special training workshops – how to talk to patients about these issues because we don’t want to talk about it, patients are afraid to talk about it but we have to come together. And we doctors are the first ones to learn how to talk about those delicate issues to support our patients in living a really full and meaningful life and to feel love and romance and to be supported.
Is this something, though, that the cancer doctor should pass on to someone else to do because this is difficult, or is it something the cancer doctor needs to take on board as part of the overall package of treatment?
I think it should be a package of treatment from the gynaecological oncologist but, of course, if it’s very difficult and you have special problems you can refer to a psycho-oncologist or to a sexologist. So there are many that could help and support you in your work.
I’m sure there are lots of wonderful things that can be done, but reassurance and building confidence is important, isn’t it, in the relationship?
Exactly. It’s not only the sexual intimacy, like you said, it’s important that men and women rely on each other, they talk to each other and they communicate and they look at the good sides of life together.
Now there are a few antidotes to post-cancer treatment blues and things like coping with lymphedema, things like physical activity. First of all lymphedema, you were talking about that in the session today, weren’t you?
Yes. We had an expert from the German Földi clinic, it’s a clinic specialised for patients with severe lymphological problems. She showed us many measures, how to bandage and how to support patients with lymphedema, how they can change their lifestyle, how they can support to get in a better condition and to reduce the lymphedema.
And I know a lot of patients get the idea into their heads that physical activity is good, you’ve got evidence that it really is?
It is, we know from many studies, more than a hundred studies, especially for breast and colon cancer, that you can reduce recurrence by approximately 50% and you can reduce fatigue which is the main problem troubling cancer patients. So it’s very easy, not costly and it can be done by everybody, even by pretty sick patients and by old patients adapted to their personal condition.
So how much scope do you think, overall, is there for improving quality of life of patients after cancer?
I don’t know a percentage but I would say a lot.
And why would you urge doctors to be more involved in this?
Because we are treating a human being, we are not treating cancer, we are treating somebody who is a wife, mother, a daughter, and we want to see her in a good relationship and to live a really fulfilled life in every aspect. Not only to survive but to survive in a good manner.
So if you just treat the illness you might win the battle but lose the war?
Exactly. We might lose the patient.
Through feeling hopeless? So what sort of message would you like to leave doctors with after this very fascinating session that you’ve just been talking about?
Talk to your patients, let the patients talk with their partner. Support communication and try to look at the downsides of cancer and the downsides of the side effects of our therapy. We have not only to treat cancer we have to treat everything around.
And if patients don’t have a partner?
But they have friends, they have family and maybe they have patient support groups. There are a lot of things you can do.
And things to make it easier for them to feel good about themselves?
Exactly. And every cancer centre is offering special groups, for example, you could join.
Is this cancer specific, these psychological toxicities of being treated or the disease?
There are many severe diseases and they need psychological support but cancer is the disease patients are afraid of most.
Any cancer?
Any cancer. So if you hear cancer you think about dying so this is a special aspect and we need psycho-oncologists to overcome this problem of depression and anxiety and fear of recurrence. Even five years or more after diagnosis patients are suffering from the fear of recurrence.
And what part in all of this should prescribing drugs take, do you think, to improve mental outlook?
This is something special for psychiatrists who have to treat depression and other severe diseases. This should not be only done by psycho-oncologists.
But you do see a mix between psychology and the use of psycho-active drugs?
Yes, I do.
Annette, thank you very much, fascinating.
Pleasure.