Monday, December 24, 2012

Why not Psycho-oncology?

1. Many people think working in cancer setting is not easy and it requires lot of courage to see the grief of the patients everyday. I can agree this statement to some extent only.

I see myself as a tender hearted person and I was afraid to work with special children and psychiatric patients thinking that there would so much burn out and things like that.

The truth is “I was also afraid to work in a cancer setting but my intuition said there is something for me in the field of Psycho-oncology”. So I joined with courage and I am sure that I am doing a good job here.

Cancer is no more a deadly disease. We have got wonderful treatment modalities to save the lives and also preserve their quality of life. I have treated more than 100 patients till now. Only 2 patients have died, all others are doing good. I am happy that I have contributed something when were in so much grief. Most of my job was ‘alleviating the stigma attached to the word cancer’.

2. Many people have fixed their mind to study Clinical Psychology and did not want to apply for M.Phil Psycho-oncology.

I understand that people who have fixed their mind to Clinical Psychology want to work in a hospital setting. Psycho-oncology also makes you work in a hospital setting. Only one difference is ‘In Clinical Psychology, you would work with Psychiatric Patients and In Psycho-oncology, you would work with normal people who have become neurotic because of the trauma’

3. Many other people say they want to work in the field of Counseling Psychology.

Psycho-oncology provides a wide platform to give counseling to the patients and especially family members starting from adolescent children to the geriatric population. We do almost all sorts of counseling like family counseling, marital therapy, adolescent counseling but the only difference is ‘it is centered upon cancer and its treatment’

4. Few more people say they want to work in Neuro-Psychology.
Here is also a great opportunity for those who want to do something on Neuro-Psychology. We are doing many researches in the concept called Chemo-brain. We want to know whether cancer treatment affects the neuro-psychology of the patients.

5. Finally some more people say they want to work with children.

We have got hundreds of children affected with various types of blood cancers and most of them have to be in the hospital at least for a year. We need people who have got some exposure to art and play therapy to make them ease with the treatment.

In conclusion, Psycho-oncology has so much scope and you will find your skills irrespective of your specialization readily helping people here. We also work on Tobacco Cessation otherwise called Nicotine De-addiction, in which we do lot of awareness programmes in schools, colleges and community. Thus if you are interested to work with community and have good skills in Training, Psycho-oncology is a very apt field.

Kindly disseminate the real scenario of Psycho-oncology and remove the stigma so that people can make use of the opportunity mentioned above.

You can read the following articles to know more about the field.
Why Cancer Care Needs Psychologists?
Is Cancer Synonymous to Death?

Sunday, December 18, 2011

Challenges in identifying ‘Depression’ in Cancer Patients

Depression is the common cold in psychiatry. No body can escape from depression. At one point or other in everybody’s life time, depression occurs. The reason behind depression varies from individual to individual. One such reason is cancer. Important issues in the life of any person with cancer may
include the following:

  • Fear of death.
  •  Interruption of life plans.
  • Changes in body image and self-esteem.
  • Changes in social role and lifestyle.
  •  Money and legal concerns.
Everyone who is diagnosed with cancer will react to these issues in different ways and may not experience serious depression.

Why Depression is not given due importance in Cancer Care?
Even though observable symptoms of depression such as crying spells, social withdrawn and sad mood are present in many cancer patients, only few are recognized by the oncologists and referred for further assessment and treatment. There are many difficulties present that obstruct the patients getting appropriate treatment for depression and they will be discussed under the following headings.

ü      Related to Oncologists
Most of the oncologists think depressive symptoms are normal when facing a very serious illness like cancer. It is generally seen as sickness behavior. Except the symptoms of depressed mood, guilt/worthless and suicidal ideation, all the other symptoms of depression are similar to sickness behavior.

Since the number of oncologists is very less in India comparing with the actual requirement, they are burdened with so many patients. Their work is being shared by nurses. Nurses are usually given adequate training to understand and use the technical language of cancer but nurses are not trained to understand the psychological issues of cancer patients.

Most of the oncologists are not aware of the symptoms of psychological issues such as depression, anxiety and stress. Even if they are aware of the symptoms, they tend to ignore even they are presented to them since they have no expertise to address them.

Fatigue is a well known mental health issue in cancer. One of the symptoms of clinical depression is fatigue. With the increased awareness among cancer care professionals, depression is overlooked as fatigue. However many oncologists fail to refer to treat fatigue.

In deciding the treatment plan, the family members are given more importance rather than the patients. So the interactions between the patients and the oncologists are very less. Thus oncologists fail to recognize the patients’ mental health issues. Since the patients are not completely informed about the diagnosis and prognosis, the fear of unknown catches the patients and it may lead to depression.

The source of significant weight loss/gain and Insomnia/Hypersomnia are very difficult to find in case of cancer. There are various possibilities such as site and stage of cancer, side effects of treatment and psychological issues.

ü      Related to Patients
For cancer patients and their family members, the priority is cancer treatment. They give less importance to mental health. They themselves think the sad mood is normal irrespective of its intensity. Moreover most of the oncologists also think it is normal to undergo distress during the time of diagnosis and treatment.

The taboo to meet mental health professional is another significant challenge. People lack awareness about the mental health.

ü      Related to Psychologists
The next challenge is ‘lack of trained human resources in Psycho-oncology’. If the distress or depression is identified, it has to be addressed properly. Most of the cancer centers do not have psycho-oncology unit. Even if Psycho-oncology unit is present, the training and expertise of the unit have to be viewed seriously.

A research world wide done in the field of Psycho-oncology says the incidence of depression is 15-25% on an average. The widely used tool in hospital setting to diagnose depression is HADS. However the 7 items of HADS which measure depression are not adequately correlated with the symptoms of depression as given in DSM IV TR. Feelings of worthlessness or excessive and inappropriate guilt, significant weight loss or gain, Insomnia or hypersomnia are neglected.

In oncology setting, all the symptoms of depression may not be observable. The stage, site and type of cancer influence the behaviors of the patients. Thus it is better to develop new parameters according to the stage, site and type of the cancer. So that depression in cancer will not be left unrecognized.

ü      Related to System/Practices
The cancer treatment is packed with many procedures. Inserting Psychological tests may be regarded as a burden for the patient. There is no clear cut idea where to bring in the psychological tests whether at the time of screening or disclosing diagnosis or during the course of treatment. Even though NCCN guidelines state patients have to be screened for distress in the first visit itself, Indian oncology set up lack facilities to do it.

Sustained efforts to educate medical professionals involved in cancer care such as oncologists and nurses on identifying depression and techniques to intervene will be of great help to the cancer patients who undergo depression. Patients should also be given awareness about the psychological services available for them. Psycho-oncologists have to have strong research base to convince the oncology setting to take up depression as a serious issue since depression has the potential to affect the treatment outcome. New set of criteria to recognize depression according to site, type and stage of cancer has to be developed.

Saturday, November 26, 2011

Why Cancer Care needs Psychologists? – A brief note

Medical community has recognized that quality of life is as important as quantity of life. At present, psychological concerns are given increased importance in cancer care if it is compared with the past. Psycho-oncologists have the obligation to increase the human touch in cancer care from the screening to rehabilitation for the patients who are successfully treated and palliative care for patients who go through the end-of-life process.

The work of Psycho-oncologists starts from prevention aspects such as tobacco cessation and change in life style. There are many myths related to cancer. One of them is ‘cancer is synonymous to death and the treatment is very distressing’. Thus to alleviate the myths about cancer and cancer care is another responsibility of Psycho-oncologists.

All patients experience some level of distress associated with diagnosis and treatment of cancer at all stages of disease. However very fewer patients are referred for psycho-social care due to under recognition of patient’s psychological needs by primary oncology team and lack of human resources. Thus to reveal the diagnosis and prognosis for ‘difficult’ patients is one of the key responsibilities for psycho-oncologists.

Cancer affects not only the patients and also the family members to a large extent. The burden of care givers is very huge. So burn-out, stress, depression and anxiety are also very common in care givers. To deal with the distress, grief of the patients and family members is again a responsibility of Psych-oncologists.

In the past two decades, dramatic advances in early detection and treatment options have increased the over all survival rates in patients of all ages with cancer. At the same time, these improved treatment options are also associated with substantial long term side effects: fatigue, pain, anxiety and depression. Some patients develop phobias of needles, hospital and blood or conditioned nausea/vomiting related to chemotherapy. Cognitive impairment associated with chemotherapy (often referred as ‘chemobrain’) has also been described in patients with advanced cancer especially CNS Cancers and brain metastases. When it comes to treatment through oral medications, depression and anxiety are the risk factors for non-compliance. It is a responsibility of Psych-oncologist to make the patients comply with the treatment process and treat the mental health issues.

Last but not the least, the health professionals involved in cancer care go through lot of difficulties to deal with the disease and patients. Job satisfaction of health professionals to work is a key factor to maintain the quality of cancer care. Psycho-oncologists take care of their mental health and preserve their quality of life.

Friday, November 25, 2011

Cancer is synonymous to death???

Many people think that cancer often leads to death and it is a killer disease. It IS a big myth. There are many survivors of cancer. Almost all the cancers are curable if they are treated in the early stage. So what we need is ‘AWARENESS’.

There are many more myths available when you talk of cancer and using tobacco.

1.       I will not get cancer.
Cancer is a disease of cells. When the cells divide in the process of metabolism, due to some unknown factor(s) the DNA programming of cells loses the control over the division of cells. And so cells keep growing uncontrollably.

So whoever has cells (all of us) is capable of developing cancer.

2.       Only tobacco usage can cause cancer.
 “The exact cause for cancer is still unknown. Even though some carcinogens (cancer causing agents) are found, the mechanism how DNA programming of cells is changed by carcinogens could not e found in spite of medical advancement.

For tobacco to cause cancer, it takes so many years. Tobacco is a very slow killer. A person who was using tobacco in his young age can develop cancer in his old age also. So, NOT getting into the habit is what the best solution.

3.       Tobacco is less harmful than alcohol, marijuana and other addictive drugs.
Just because using tobacco is culturally accepted, it does not mean it is less harmful. Nicotine is the most addictive substance in the world. That’s why quitting tobacco usage/smoking is very much difficult when compared to other addictions. Using tobacco leads to so many complications for both physical and as well as psychological health.

4.       Branded/Menthol cigarettes are not harmful.
All Branded/Menthol cigarettes also have almost the same amount of nicotine and other carcinogens (that lead to cancer).

5.       Gutka/Pan masala will not lead to cancer unlike cigarette or beedi.
In India, almost 70% of tobacco usage is in the form of smokeless tobacco i.e. Gutka/Pan masala and Snuff powder (Brand Names: Hans, Pan Parag, Manick Chand and etc). The consumption of smokeless/chewing tobacco has been increasing every year. There is a high correlation for smokeless tobacco to cancer when compared to smoking tobacco. The gutka/pan masala damages the cells in the mouth where they are placed and change the biological functioning of cells that lead to cancer.

6.       Foreign country treatment can cure cancer.
Almost India has got all the advanced treatment methods to treat cancer. If the cancer is in advanced stage, objective of the treatment would be ‘pronging life’ and never cure. Many of the treatment methods for advanced cancers in foreign countries are still experimental and not proven enough to cure the disease.

7.       Alternate medicines have certain cure for cancer even if it is advanced
No alternate medicine has proven scientifically to cure cancer in advanced stage.

8.       People with cancer must remain confined in a hospital bed.
Not necessarily. It is based on the site and stage of cancer. 

Tuesday, May 11, 2010

To Nagarathaar Community from a Psychologist

The content is moved to Google Docs. Please Click Here to view!

Saturday, December 26, 2009

Re-searching Myself!

Research=Re + Search; ‘Keep Searching for facts/truth’ has become the essential part of any field nowadays. With the advent of Internet Revolution and Satellite Technology, one has to equip to compete with global standards. All the global standards are the outcome of carefully done researches. Especially as a student of Behavioral Science, the arena is much wider for the Research.

To a significant extent, my values, beliefs, attitude and understanding of myself have changed after studying Research Methodology and doing Researches as a part of curricula. Research Methodology provides pathway to objective and proof based beliefs and values. It triggers the curiosity to explore the real cause(s) of any behavior or event.

The one who has done research in a highly effective manner is given Ph.D. He is honored and believed to be a great man in a particular field because he should have done everything scientifically following the Research Methodology and is able to respond the quarries raised with proof based answers. It is believed that he would have studied everything related to his field and is considered and consulted as an expert in the field.

There is a Tamil Proverb-“Kannal Kaanpathum Poi, Kaadhal Ketpathum Poi, Theera Visarippathae Mei” meaning whatever we see, hear may be illusory but scientific enquiry makes us to find the facts. There is a Thirukkural (written by Thiruvalluar)-“EpporuL Yaar-yaar Vaay Kaetpinum ApporuL MeiporuL Kaanbathu Arivu” meaning whatever we hear from others must be examined and that’s the sign of possessing analytical sense. Do we all thus
posses the so called ‘Analytical Sense’?! L

I would tell you, don’t believe in God until you really (scientifically!?) find He is there, because the belief in God sometimes makes you irrational. According to Albert Ellis, a famous Psychotherapist (Founder of Rational Emotive Behavior Therapy-REBT) says, “Believing in God is also irrational in addition to many others”
You may tell me, “Everything cannot be found by Science such as existence of God” Yes, of course, I agree. But please accept that Science is in the process of finding facts to a great extent and all of us tasting the fruits of science in the form of Technology.

The life without knowing the facts have been leading to superstitions. Until recent times, we kept Leprosy as a harmful disease which was believed to be a curse and now it is found that Leprosy can be cured with proper medications! It is the outcome of Research. Paradigm shifts take place as an effect of Researches all over the world.

Generally speaking, we keep judging everything with our previous experience and no knowledge update takes place. Updating knowledge through various resources would enhance the Perceiving ability instead of judging.
Thus in whatever we see, hear, smell, understand and do, they have to be correlated with the scientific facts that are found from recent researches. I know it is not that easy but can be done step by step.

Let’s come out and explore the world with no preconceived notions and as it is!!

Thursday, May 28, 2009

British India and Indian India

We see many injustices and unfair things happening everywhere in our country. If you compare British India and this Indian India, more or less it is the same situation. The superiors of this state and many other people exploit us and manage the agitations by many ways; they are ready to do anything for the sake of their livelihood and maintain their social and monitory status.

The full stop can be put only by attracting people for support against those dangerous persons through various strategies. The strategy used by Gandhi at that time is Non-Violence. It was powerful due the reason that they followed the Path of Truth in which most of the lay men believe and the British did not expect non-violence to be the reaction for violence and so they respected it. It is applicable for Indian India also.

The best non-violence strategy that we have in this Indian India is MEDIA through which we can make anything happen. That’s why people who want to exploit us have taken Media in their hands, but I reckon it is not possible all the time to hide the truth. So using media in an effective way is the need of the hour more importantly. It must be continuous because lay men will forget the issues if some distraction takes place.

People who stand for truth and justice have to be both firm and effective in bringing the issues to the public who are least bothered about them. The freedom fighters were firm when the mere existence of Indians became a question in British India. So only-when the mere existence becomes a question, the sufferers join together. If the exploiter is such a person who knows the psychology of the sufferers or who has a psychologist with him will never make people to get into the question of existence, they will both exploit and do something good to retain power on lay men.

Bringing the issues to the public is the only way to eradicate exploitation through media, because everyone is afraid of public in one matter or another. If and only if the followers of truth know the psychology of both lay men and exploiters, can use the media effectively to communicate their ideologies to the public and stop people not to become their hand toys, it is possible to hoard the truth.

Then agitation from lay men will be initiated with the immediate cause of emotions but once it is started, intelligence should play the role to eradicate exploitation further for which the people of justice must have studied or known a lot about dealing people.

I write this after seeing a film Aayutham Seivom, Strike in Madras School of Social Work, Strike in Madurai American College and the status of Vellore Vallalar Middle School.

For many of us, the God has given us a lot of chances to understand this real world without affecting our routine life. I believe, everyone is born for a noble cause. Let us continue our covert observations and understand the things better. Let us wait for the right time to take serious efforts in our journey towards Truth and God.