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As an oncologist, I am frequently asked by people I newly meet as to why I chose this specialty of medicine. Inevitably in this field, one is constantly reminded of the fragility of life. In my early years, the revolutionary advancements in cancer diagnosis and treatment were the main attraction to pursue this field. However, years later, it is the invaluable life lessons which patients teach me daily that continues to fuel passion in this field. Being diagnosed with a potentially terminal illness at any point of one’s life is indeed life changing. It is a fact that life is unlikely to be perceived the same way even if one is lucky enough to be diagnosed with curable disease. Going through the different emotional states of cancer diagnosis – from anger, denial, bargaining to acceptance eventually – is human norm. Only when one is in acceptance of the disease can one move forward to manage and cope with the illness physically and emotionally. The courage and strength seen among cancer patients, families and caregivers is often hard to believe. Dealing with children with cancer and witnessing the distress parents go through remains as challenging as ever. The good news is that advancements in cancer diagnosis and treatment have led to an encouraging increase in the number of long term survivors. In the context of cancers with good screening tests like breast and cervical cancers, it is a fact that early detection translates to better outcomes. Even among patients with incurable disease, newer drugs and therapies have enabled better survival which is often coupled with an improved quality of life. In its true essence, surviving cancer incorporates the full spectrum of issues related to the physical, psychological, social and spiritual wellbeing of the patient, family and caregivers. Having a good understanding of the disease process, therapeutic options and side effects related to treatment would greatly facilitate decision making. The intent of treatment needs to be well established as to whether it offers potential cure, control of disease, or symptom improvement. It is important to clearly discuss and understand the disease and treatment course with your oncologist. A frequent misconception is that intense or expensive therapies guarantee cure. Physical wellbeing A balanced diet, adequate physical activity and good sleep make a huge difference in wellbeing. Supplemental nutrition may be required to maintain energy balance, and ideally should be prescribed by trained personnel. For instance, patients with swallowing difficulty would need nutritional support often for a prolonged duration. Should one be keen on alternative cancer therapies, be sure to discuss this with your oncologist. The efficacy of alternative therapies which lack scientific evidence needs to be examined closely. Alternative therapies could also cause unexpected drug interactions with cancer therapy that may alter outcomes or cause unexpected side effects. Cancer patients may require curative surgeries such as limb amputation, breasts, testes or voice box removals. This is not only mutilating but also leads to loss of function of the removed organ. The availability of a wide range of prosthesis and implants coupled with effective rehabilitation have enabled many patients to restore cosmesis and satisfactory function of the lost organ. With the increasing number of young people being diagnosed with cancer, addressing disease and treatment-related infertility issues are of increasing importance. Fertility preserving options which are done prior to curative cancer treatment such as egg, embryo or ovarian tissue freezing and sperm banking have enabled successful pregnancies following completion of cancer treatment. Engaging with palliative care teams has immense benefits not only to the patient, but also to the family and caregivers who are often equally affected on this journey. Many of my patients have shared their utmost happiness and satisfaction with the service provided by hospice teams available in our country. Home visits by medical personnel enable end of life care to be carried out in the comfort of home. This reduces hospital visits, costs and offer holistic cancer care. Psychological wellbeing Cancer diagnosis often sparks an opportunity for self-transformation. It motivates many to meet goals of personal importance such as pursuing a dream of climbing a mountain, travelling to a faraway island, completing a half written book or reconciling with an estranged family member. The satisfaction gained through these experiences enriches life and contributes towards being at peace as a whole. Frequently experienced symptoms such as fatigue, sleep disturbances, chest pains and palpitations are often manifestations of underlying anxiety, fear or depression. Getting in touch with support groups or talking to others who share similar experiences is often therapeutic. Self-enrichment practices such as prayer, meditation, exercise and practising mindfulness are examples of coping mechanisms. Financial planning A cancer diagnosis inevitably leads to serious financial consequences. Treatment-related expenses often coupled with loss of income from discontinuation of work can deplete savings. Good financial planning is key to having sustainable care. Exploring health insurance coverage and benefits, as well as privileges of government servants and pensioners, helps in making informed decisions on treatment-related expenses. For patients from the lower socio-economic groups, besides welfare aid in public hospitals, the Government has initiated several nationwide programmes such as PEKA B40 and MySalam. Implementing a coordinated and holistic cancer survivorship plan will require additional health care resources and commitment from providers. As we move towards being a developed nation, may these aspects of care gain the attention it duly deserves at a national level. Dr Vaishnavi Jeyasingam is a clinical oncologist at Subang Jaya Medical Centre. |
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