Holistic cancer patient management provides total care to the whole person, looking into ways of helping the person with cancer in coping with the disease, its treatment, the overall effects on the person, and to rebuild life after treatment completion.

The total care for the whole person includes the medical and nursing care that focus on providing the treatment to the diseased part of the body, psychosocial care for the psychological and practical needs that helps the individual to deal with daily living and go through treatment successfully; rehabilitative care to guide the person regain strength and self confidence to continue living and embrace life.

In the holistic approach, individuals are not only provided with information on the disease and treatment, they are also given assistance in identifying their physical, emotional and social needs together with information about the cancer support provider to meet those needs.

Patients are encouraged to participate actively in their overall management which will help them feel they are in control and not feeling helpless. Not everyone will need these special assistance but asking for support when required shows that one understands what one feels and needs.

These services and cares, provided by a team of interdisciplinary professionals, not only help the individuals to meet their needs but also their families to better understand and extend suport to their loved ones during their trying times.

Counseling

Cancer counseling lead by trained professionals such as oncologist, clinical psychologist, social workers, medical counselor can guide patients to talk about their feelings and worries and how it has affected them (and families). The counselor will listen, ask questions and guide them in finding solutions to their problems

Individuals may seek counseling for different reasons and at different stages of cancer management. Early sessions help the person to accept the disease; to lessen fear and confusion caused by the disease; to realize the importance of treatment, to understand the treatment side effects and ways to overcome them. After treatment completion some may require counseling to deal with body changes and learn to live a normal life.

Counseling not only helps persons with cancer in sorting out their feelings but also in enabling them to approach problems with their own strength, it allows families to have a better understanding of behavioural changes, relieve family tension and improve relationships, enabling them to provide better emotional support to the patients.

The individuals (and families) must understand that it is alright to ask for help; that it is not a sign of weakness and should not be embarassed because it can help them feel and cope better.

Diet

A balanced diet for any healthy person must contain carbohydrates, fiber, protein, fats, water, vitamins and minerals. However, for patients undergoing cancer treatment, they need extra 20% nutrition to help the body build new tissues, provide energy, fight against infections, repair damages and to speed up healing processes.

There are a number of reasons why cancer patients find difficulties in maintaining proper food intake such as:-

• The disease can cause changes to the body and render it unable to absorb nutrients.
• Emotional distress can makes the person not want to eat.
• Loss interest in food because of symptoms such as pain, fatigue.
• Side effects of treatment such as nausea, diarrhea and altered taste further reduce food intake.

If one experiences eating problems, talk to the oncologist, oncology nurse, radiation therapist and/ or dietitian and let them address and attend to the cause(s) that restrict the patient from getting a proper diet.

Good nutritional support at this stage is vital so that patients will feel better and can tolerate treatment side effects better. The dietitian teaches the person how to make dietary adjustments based on the treatment and expected side effects to improve nourishment. Individualized advice will be given on the types of food and suggestions of ways to prepare them to increase their appetite. Sometimes nutritional supplement may be recommended.

If a patient’s condition does not improve and he/ she continues to lose weight, feeding tube may have to be inserted temporarily through the nose or stomach to maintain proper nutrient and body weight.

Social Work Service

Social work services are essential to individuals who are on cancer treatment with fatigue and radiation sickness, people with physical dysfunction, patients who have been discharged from hospital stay and those that have little or no family support.

Social workers provide information and assistance in helping people (and families) to deal with day to day practical problems. They coordinate and connect people to various organizations which provide services that patients need to make daily life management easier. They also provide temporary relieve for the carer caring the patients at home, allowing them to take a break.

Social workers play vital roles in:

• explaining treatment procedures, instructions and schedules.
• talking to individuals and help them identify psychological and practical needs.
• helping individuals to arrange transportation for hospital visits and daily treatment.
• locating helpers to pay bills, to do grocery shopping, to prepare food, to do domestic cleaning and washing, to help with child care etc.
• assisting individuals to fill forms for disability benefits, health insurance and/ or financial aids.
• helping individuals to look for medical aids such as wheelchair, walking frame.
• collecting medication and medical supplies such as dressing materials, colostomy bags.
• looking up for suitable support groups.
  

Rehabilitation

Cancer and its treatment can cause some temporary loss of body functions or disfigurement, resulting in psychosocial changes. These patients will require assistance in function or image restoration to regain self confidence and to continue daily activities without total dependence on other people.

Cancer rehabilitation in restoring physical, mental, social and vocational functions maybe a long process. Here are some rehabilitation examples:-

For physical rehabilitation

• Speech therapist helps to restore function and improve communication for speech impairment or improve function in swallowing difficulties;
• Occupational therapist trains and helps in relearning motor function to perform daily activities and personal care; evaluate home environment and provide recommendations for suitable modification as well as advice on where to get adaptive devices;
• Physical therapist assists in muscle strengthening to prevent weakness, stiffness and movement limitation;
• Rehabilitation laboratory technician helps to provide support aids and devices such as prostheses;
• Oncology nurse assists in caring and education on bladder and bowel management, colostomy care;
• Dietitian aids in evaluating nutritional status, providing advice on dietary supplements and alternative food;
• Oral and dental healthcare provider helps to restore oral and dental hygiene;
• Image counselor assists in rebuilding confidence with advice on adjustment to body changes and self image such as skin changes, hair loss;
• Psychosexual counselor counsels patients (and families) on intimacy issues and to cope with sexuality changes;
• Vocational counselor helps in evaluating patient’s disabilities and to recommend retraining to continue previous employment with special equipment or advice for new vocational training;

For psychosocial rehabilitation

• Clinical psychologist assists in psychological distress assessment and treatment for patients and also family members;
• Social worker helps in counseling, coordinating home-care and domestic services, getting medical supplies and devices;
• Recreation therapist helps to strengthen personal skills, to reduce depression and anxiety through exercise, relaxation, art and music;
  

Cancer Support Groups

Cancer support groups are the meeting and interaction of people who have the same interest in the disease. They comprise of medical professionals, cancer survivors who had undergone treatment, individuals and family members of those who are currently having the treatment. They provide a venue for people to talk about their life with cancer and how they overcome challenges, with others having the same disease or similar conditions.

These meetings are either arranged by hospitals or non-government organizations or associations within a hospital compound or in the community centers. The intention is to help patients to reduce stress and to learn new coping skills. Social workers can help to look for reliable suport groups that provide validated information and education.

This sharing of feelings and experiences can produce a sense of belonging for individuals that are on treatment as they feel that someone understands what they are experiencing and that they are not alone. It will form a support system for those look for emotional comfort, providing sympathetic understanding and create a healthy social network that can improve life quality.

References

1. Committee on Psychosocial Services to Cancer Patients/ Families in a Community Setting, Nancy E.Adler and Ann E. K. Page, Editors.(2008). Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. National Academies Press.
2. Dollinger, M. MD, Rosenbaum, E.H.MD & Cable G.(1991). Everyone’s Guide to Cancer Therapy.Somerville House Books Limited.
3. Graphic designs by Aisyah bt Zulkifli.
4. Guidelines on Cancer Services: Improving Supportive and Paliative Care for Adults with cancer. The Manual. National Institute for Clinical Excellence. NHS 2004
5. cancer.org/treatment/emotional-side-effects/coping-with-cancer-in-everyday-life
6. emedicine.medscape.com/cancer-and-rehabilitation/320261-overview accessed 13/6/2013