Psycho-oncology in our country is still in its infancy stages here. We are yet to have an independent identity as far as psycho-oncology is concerned, as an independent speciality is concerned, we are yet to have that kind of an identity, one. So having psycho-oncology as an independent track as a part of ICC gave us a very strong platform to showcase psycho-oncology as a speciality, one. Two, both in terms of academic specialities as well as professional specialities and, three, it helped us in formulating our own Psycho-oncology Association of India, for the very first time in the country an independent body which looks after in terms of licensing, regulating our work, regulating our contributions and of course helping promoting psycho-oncology, both academically as well as professionally in the country.
What are some of the issues that psycho-oncology faces in India?
As far as psycho-oncology in India is concerned there is still a lot of stigma, stigma attached to both in terms of psychology and stigma and the taboo that comes along with cancer as well. So psycho-oncology also is encompassed with a lot of stigma, one. Two, there is still a lot of lack of awareness regarding the aspects of psycho-oncology. It’s the sensitisation towards the contributions that can be made by a psycho-oncologist in terms of enhancing the quality of life of cancer patients is still not well understood in the country. So as far as our segment of psycho-oncology in ICC was concerned it focussed on these little issues in terms of what is psycho-oncology in terms of getting different perspectives from the oncologist, getting perspectives from the psycho-oncologist and getting a perspective from the psychiatrist and integrating those views in terms of various aspects as to how one can integrate psycho-oncological care into regular oncology care or into regular cancer care, that was one. Second, we also spoke about the promotion of distress management as a lot of our oncology colleagues here and a lot of our senior doctors here, they follow NCCN guidelines and distress management is one of the important key chapters as far as the NCCN guidelines are concerned. So the distress as the sixth vital sign is still not accepted in our country. That’s again because of lack of awareness. Though there are guidelines available, though there are full proven guidelines available, but we are still not following them except for a couple of centres, maybe in the south and maybe one in Calcutta. In Delhi, in the other parts of north India and in the centre we do not see anyone following the NCCN guidelines on distress management. So, yes, it was a lot to talk about, how distress can be endorsed as a sixth vital sign apart from the other five key vital signs which are used in cancer care.
We had Dr David Kissane who is the secretary of the International Psycho-Oncology Society. He is from Monash and also he has worked with Memorial-Sloan so he’s a psycho-oncologist, one of the top pioneers in the world. We had him as our chief guest as well as one of the key speakers who not only highlighted various issues as to how in India we can improvise on psycho-oncology as well as also helped us in enhancing our own skills by conducting a workshop for us, an exclusive workshop on couples therapy for us, which was on day two which was yesterday, for us.
Can you explain how a psycho-oncologist would contribute to a patient’s care?
Specific examples would be when it comes to psychological interventions in cancer care it primarily focusses on… we do not have any evidence to tell you or to show whether it can have an impact on survival or not, maybe one or two studies here and there, very scarce studies here and there. However, when it comes to enhancing quality of life, certainly, definitely. So, for example, if there’s a new child who has been diagnosed with blood cancer and of course the minute the oncologist will break the news to the parents the parents would obviously go in distress, they would obviously get shocked, they would obviously feel very depressed and upset about it. So the target, when the psycho-oncologist is put into the picture here, the target of the psycho-oncologist becomes in helping the parents accept, one, the harsh reality of their child, one; two, in helping the parents cope in a healthy way. There are some who do not, all of us as individual beings, there are some who would surrender to a specific situation who would succumb to a problem and there would be others who would adopt more of a problem-focussed coping. A problem-focussed coping happens to be more healthy as compared to which is more emotion-focussed, as compared to, which is when the person tries to succumb to a problem. So the psycho-oncologist’s role would be to help the parents in coping in a healthy way, second. Third, in terms of even guiding, at times, in terms of how they can help that child when there is an interruption in their child’s play activities, academic activities, so we help in that. Fourth, there was this interesting case discussed as a part of our psycho-oncology conference also of a young girl whereby after taking chemo she had developed some cognitive problems. Cognitive problems would mean related to the brain, thought processes, learning difficulties, and how the psycho-oncologist would sit down and conduct regular sessions in terms of cognitive re-training and cognitive re-structuring, would focus on that and that brought about her abilities and academic performances, she improved in school as and when she went ahead.
That’s one example to quote; a second could also be we play an important role when it comes to end of life care concerns. There are a whole lot of issues during when a patient is declared as end of life care, that is again when the family therapy comes into the picture and the psycho-oncologist plays an important role, one. Two, even a lot of times when the patients also want to discuss a whole advanced directive when they know that they have been diagnosed with an advanced stage of disease and they are approaching the ultimate reality and the harsh reality. So we help the patients in advancing directives also. That’s another way. Fourth would be helping them to deal with their own emotions. It’s not only playing an important role with the patients or the family members, we as psycho-oncologists can also contribute a lot to the nursing in terms of sensitising them towards how they should communicate, one, with patients, with cancer patients and their families; two, how they should handle their own emotions. In the West you would also see psycho-oncologists helping the oncologist in overcoming their distress phases, in helping handle their transference and counter-transference feelings when they are unable to handle their own emotions when they get so engrossed and involved with their own patients, so they help in that as well.
We’re not only looking at the emotional component of it, we look at the behavioural component also and, of course, things like lifestyle modification when it comes to… Lifestyle modification is an important aspect when it comes to cancer prevention; psycho-oncologists play an important role there. When it comes to psycho-education, so there’s a lot of education material which doctors and nurses need to prepare, psycho-oncologists contribute to that as well. The psycho-oncologists help with support groups as well. So there’s a whole series of things which you can think of and it is not purely emotions or just the thought processes, it’s the behavioural component, it’s the thought processes, it’s the emotional component also which we take into the picture. And it’s very much need-centric, all therapy sessions, all sessions that we conduct with patients or their families are very, very need-centred so it depends on the need of the patient as to what kind of a session they are looking for, in terms of what kind of help they are looking for.
A lot of times what we also come across is marital discord, just because a particular spouse has been diagnosed with cancer and is undergoing certain emotional problems or physical problems. So, as a result of that, that can bring about a lot of marital discord between the two partners, between the spouses. So it can bring about a lot of disturbances in family relationships. So this is where psycho-oncologists would play a role in helping patients overcome these disruptions in their life.
