The role of counselling and support for an end-stage cancer patient

Dr Suversha Khanna

Counselling and support are essential pillars of healing a patient at any stage of a chronic condition. Though these may sound manageable, it requires a great deal of dedication and undivided commitment to care for the person suffering.

Especially, if an elderly patient knows about his end-stage diagnosis of cancer, this leaves them disheartened. Such patients need more emotional, psychological, and social support. When they know that their condition can no longer be controlled there seems to be no hope for the next step and people often become stressed and anxious. At this point, the caregiver or family members need to ensure that all their needs and wishes are fulfilled.

Even with improvements in accessibility and availability of good cancer treatment facilities in metros, 60 per cent of cancer patients report to the hospitals in the late stages, when they are incurable. The only way to improve their quality of life and survival rates is to make Palliative care available to the maximum number of patients at an early stage.

Currently, about 60 lakh cancer patients require palliative care but it is only available to 2 per cent of the patients. The reason is the non-availability of a desired number of palliative care beds/centres, trained Palliative care specialists, nurses, and the non-availability of opioids (pain killers) which are available to only 3 per cent of cancer patients. So, there are lots of gaps between the need and availability of Palliative care. Most medical professionals, medical administrators and the public do not know what palliative care is.

Role of Counselling
Psychologists and palliative care specialists together have a major role in relieving the emotional, psychological, spiritual, social, and financial problems being faced by not only the patients but also their family members/caregivers. Before starting the management, patients have to be evaluated about what is bothering them the most, their needs and wishes. Discussion with the family members about their behaviour, interpersonal relationship, and cultural and religious beliefs is also documented.

•    Management of such patients includes multiple counselling sessions to achieve the following:-
•    Developing excellent staff and patient communication and relationship
•    Explanation and assurance that symptoms can be relieved to win their trust
•    Facilitating caring and sharing of worries, fears, and anxieties with counsellor/psychologist
•    Correcting misconceptions
•    Developing a strategy for coping with uncertainty by keeping the HOPE alive for maintaining psychological equilibrium and accepting that triumphs and setbacks are part of life
•    Ensuring all their needs and wishes of meeting their loved ones, forgiving people, and their other desires are fulfilled to ensure better interpersonal relationships and survival rates
•    Augmentation with various other therapies e.g. Relaxation therapy, distraction therapy, art therapy, cognitive behaviour therapy, and spiritual therapy by spiritual Gurus
•    In some patients together with counselling sessions and psychological support, drugs may also be used.

The Right Time for Palliative Care
The right time to start Palliative care is the minute diagnostics of late stages of cancer are made. A multidisciplinary palliative care team should be involved in managing the pain, and emotional, psychological, spiritual, and social distressing symptoms, which occur after the patient and family find out that the disease is not curable.

Palliative Care Medicine
Essential palliative care medicines include Analgesics, opioids, antidepressants, antidiarrheals, antiemetic (to stop vomiting), laxatives, skeletal muscle relaxants, antiepileptic, antipsychotics, corticosteroids, etc.)

Dr Suversha Khanna is the Director of Dharamshila Rahat Supportive and Palliative Care Centre.