Receiving the diagnosis of any serious illness is a disturbing event that will eventually occur in the lives of almost all of us. Once called the “emperor of all maladies,” cancer has been associated with particular fear and stigma. It is perhaps fitting then that the global emergence of psychosocial and palliative care came most prominently from the field of oncology.
We are fortunate that recent technological advances have allowed more sophisticated approaches to early detection and treatment. Nevertheless, for those who are diagnosed with cancer or other major medical conditions, the future can seem terrifying.
This fear about the future may be responsible for the increased risk of suicide that tragically occurs in the first week after the diagnosis of cancer. Depression or demoralization may also emerge later, particularly when there is pain or other physical symptoms. Whole-person care means treating these symptoms as vigorously as the disease itself.
The routine assessment of physical and emotional distress in clinics has now become a standard of medical care. The reporting of these symptoms allows for their early treatment and facilitates sensitive and important conversations between patients and their health care providers. Such communication improves medical care and the satisfaction with care of patients and families being treated for cancer or other medical conditions.
Supportive care is the responsibility of all health care providers who interact with patients. However, specialized psychosocial and palliative care services are also available in many medical treatment settings.
A term that originally referred to end-of-life care, palliative care is now understood to refer to psychological, physical and spiritual care for patients and families at any stage of a serious or life-threatening illness. Psychosocial and palliative care services are provided by nurses, social workers, psychologists, psychiatrists, palliative care physicians, spiritual care providers and other health professionals.
Supportive care services include education about the disease and treatment, psychological support and, sometimes, medication to manage symptoms of anxiety and depression, control of pain and other physical symptoms, as well as planning for all eventualities. It also includes support for spouses and caregivers, who can be even more distressed than the patients themselves. Such care helps to preserve the physical and emotional well-being of patients and their family members at all stages of the disease. It also helps to ensure that the treatment process stays aligned with the goals and values of patients and their family members.
Medical clinics can be busy places in which the health care team is under time pressure. Patients can help optimize clinic visits by thinking before the appointment about the questions that they want to ask and about the information that they need in order to make a treatment decision.
It is also important for patients to communicate to their health care team about pain and other physical symptoms, emotional distress, and family and social problems that may compromise the treatment process. Inquiring about the psychosocial and palliative care services that are available may also help them to obtain timely support and symptom control, and to better manage the treatment process.
Navigating the course of cancer or other serious medical conditions is a team effort involving family, friends and usually multiple health care providers. Considering supportive care as one of the components helps to ensure that we treat patients and families as well as we treat diseases. In future columns on this topic, readers will learn from diverse health professionals about the range of psychosocial and palliative services that may be available to patients with cancer or other medical conditions.
Dr. Gary Rodin, head of psychosocial oncology and palliative care at Princess Margaret Cancer Centre, University Health Network (UHN), is a professor in the department of psychiatry at the University of Toronto (U of T) and also academic director of the Kensington Hospice. In June, Dr. Rodin was appointed first director of the new the Global Institute for Psychosocial, Palliative and End-of-Life Care.