About one-quarter of cancer patients experience disabling psychological problems. Now a new unit in St James's Hospital is specialising in identifying and treating them. Dr Muiris Houston, Medical Correspondent, reports
One in three people in the Republic will develop cancer at some stage in their lives. Have you ever thought what it must be like, after a series of medical investigations, to be told that "the news isn't good"?
Whether the word cancer is articulated or not, it remains a fearful diagnosis.
Less than 50 years ago, cancer was equated with death. This led to a feeling that it was cruel to tell patients they had the disease.
Even now, a conspiracy of silence can seem attractive to the doctors and relatives of some cancer patients.
For most people, however, cancer has moved on.
While there is no doubt that it is a major life stress, the culture is now one of telling patients by breaking the bad news in a skilful and gentle way.
According to Dr Sonya Collier, principal clinical psychologist with the psychological medicine and psycho-oncology service at St James's Hospital, about one-quarter of cancer patients experience disabling psychological problems.
"Studies have shown that anxiety and depression not only negatively affect the patient's quality of life but they also reduce compliance with cancer treatments," she says.
Psychological distress may cause fatigue, sleeplessness, low self-esteem, body image concerns as well as sexual and relationship difficulties. Some women, for example, who have had mastectomies may assume that their partner has lost interest in them sexually because of what they perceive as disfigurement after surgery.
When a sensitive partner waits for his wife or girlfriend to indicate that she is ready for intimate contact, this can seem, against a background of lowered self-esteem, like rejection.
The Psychological Medicine Service at St James's Hospital has set up one of the first multidisciplinary regional psycho-oncology services in the Republic.
It follows the finding in a Department of Health report that although psychological problems in cancer patients were common, they were often left undiagnosed and untreated.
Led by Dr Anne Marie O'Dwyer, consultant psychiatrist, and by Dr Collier, the aim is to build on initiatives already undertaken at St James's Hospital and to develop a psycho-oncology service throughout the South Western Area Health Board.
Based on a stratified model of care (see graphic), it ranges from the provision of patient information leaflets and lectures for those with mild distress to structured psychological and psychiatric interventions.
People with anxiety and depression secondary to a cancer diagnosis respond extremely well to a psychological intervention called cognitive behavioural therapy (CBT).
Medication also plays a useful role at the severe end of the spectrum.
"One of our key aims is to destigmatise psychological distress in cancer patients," Dr O'Dwyer says.
"There is a fear for many of a second stigma, on top of having cancer."
Eventually, highly trained clinical nurse specialists will work in both the wards and the out-patients department of St James's and all doctors and nurses working in cancer care will be trained in basic psychological techniques.
Preliminary research into the activity of the service suggests women are more open to using the psycho-oncology service. Some 98 of 130 oncology patients seen were women. And out of 33 who benefited from cognitive therapy, only three were men.
The normalisation of the emotional aspect of cancer and its integration into mainstream cancer care is a significant step forward.
The developments at St James's Hospital are being replicated elsewhere in our health system and are set to completely change the experience of the cancer patient from the moment of diagnosis onwards.