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Text and pix by Fathima
Riznaz Hafi
A patient diagnosed with cancer goes through a sudden shift from a normal, healthy, secure life to a scary, unhealthy and insecure one. Physical as well as emotional pains are involved but unfortunately during treatment, focus often lays solely on the physical part – such as chemotherapy, surgery and drugs.
Singapore’s Parkway Cancer Centre (PCC) is renowned for its excellence in cancer treatment and through its CanHOPE Patient Care Program – a non-profit cancer counselling and support service – strives to care for the patient through its holistic approach, attending to all aspects of care which include inspiring hope in their patients, helping them cope, therapeutic sessions and providing nutritional guidelines while undergoing chemotherapy.
A team of journalists was invited by PCC Singapore recently to attend a familiarisation tour of their facilities while also being briefed on their approach to patient care. The visit started off with a press conference at Mount Elizabeth Novena where members of their team spoke on different segments of care provided by them.
Outlining their CanHOPE program Vice President Yeo Kim Seek said, “We put the patient in the centre and organise the care. We have an entire team ready to intervene at the right time. If the patient needs dietary care, our dietician will come in; and if the patient is depressed and needs counselling the counsellor comes in. Sometimes we send in counsellors without the patients knowing that they are undergoing counselling because when they know, there is resistance; we want to ensure that the patient does not find it intimidating.”
“Every patient must have a friend at PCC – that friend can be the nurse, doctor, receptionist, dietician, counsellor or even me – but he must have a friend to walk him through the whole journey,” he added.
“There is a lot of fear and anxiety; especially for our foreign patients. It is worse when English is not their first language or even second language. For them, our team organises support groups, education, counselling, and also social breakfasts. At our social breakfasts we gather patients of the same nationality – and that helps because otherwise they are just staying in a hotel room or their friend’s house thinking that they are suffering alone. When they come together, speaking the same language they know they have friends in Singapore and are actually going through the same journey with them,” he said.
Senior Executive, Services Operations Dianah Awaludin spoke of the CanHOPE Support program’s objectives and range of activities. Aiming to promote participant self-awareness and provide guidance, hope, and accurate and timely information, the program, facilitated by professionals, volunteers and cancer survivors, works on educational and therapeutic activities to help ease the patient’s journey, she said.
Support for newly-diagnosed patients includes:
Chemotherapy: What the patient needs to know
Chemotherapy is an integral part of cancer treatment that involves administering cytotoxic drugs to kill cancer cells. Despite its proven success, many patients fear it due to side effects and myths surrounding it. Debunking these myths and sharing her knowledge on chemotherapy, its immense benefits and what the patients need to know before they commence treatment, was Oncology Nurse Tay Sok Kar who has worked in this field for more than 20 years.
“Unlike normal cells, cancer cells don’t know where to stop; they are fast-dividing so through chemotherapy we are giving poison to kill the abnormal cells. The purpose of chemotherapy is to eliminate cancer cells until they are no longer detected in the body. It can also control the cancer from spreading to other parts of the body, slow its growth or destroy cancer cells that have spread to other parts. That is the curative intent of chemotherapy.
“Chemotherapy is also used for palliation – there are patients who are near the end of the road – the treatment gives them a good quality of life by easing the cancer symptoms. When cancer is in the advanced stage chemotherapy may be used to shrink cancer tumours that are causing pain or pressure,” she explained.
Patients fear chemotherapy because of side effects, which include vomiting, mouth ulcers, loss of appetite, constipation, diarrhoea, gastric reflux and hair loss but a significant piece of information noted from her presentation was that although the side effects are inevitable, they are by no means uncontrollable.
“We have drugs to control nausea, vomiting and other problems and specialists such as dieticians are available to guide patients through the meal planning and other issues that result from chemotherapy. The effects can be managed!” she said but added that patient compliance is important. “Listen to our advice and keep us informed; for example if you haven’t passed stools for one week it is important that you tell usand we will treat it immediately. Communication is very important!”
“Through counselling we hope to help relieve their anxiety, let them know what to expect, how to manage side effects of the treatment and most importantly clear misconceptions. Having embarked on this journey, there is a lot of disruption in their lives; they have to change their lifestyle, their work life and family life, so we try to help them normalise their life in the midst of this journey,” she said.
Cancer diagnosis and cancer treatment do not merely affect the physical condition but evoke a wide range of feelings that most people are not accustomed to dealing with. Counsellor Dominica Chua says that a common emotion encountered is denial.
“This helps patients to survive news that’s hard to handle – it’s a ‘defence mechanism’ and is an instinctual reaction which is healthy for a short period but it is not good to prolong this. When they are in denial it is hard to talk to them about this though the facts are there and it prevents effectively dealing with the issues,” she said.
“Sadness and depression are more emotions as they are grieving the loss of their health and the life they had before they learnt they had the disease. Clinical depression occurs in 25% of cancer patients and these sometimes relapse.”
Stress and anxiety are also experienced,which is common for people undergoing life-changing conditions. Other emotions they go through are fear and anger.
These emotions cannot be ignored and Dominica says the team at PCC ensures that they do not feel like they are all alone. The team links them with resources, and ‘look-good’ support groups, and does what is necessary to help patients to cope emotionally. She stressed the importance of empathy in order to really understand what the patient goes through and feel for them.
Patients going through chemotherapy suffer from loss of appetite and other food-related issues and therefore require a different sort of diet. A healthy carefully planned diet is essential in order for them to be able to undergo successful treatment. Hence a revised food pyramid has been created whereby they are given food that is easier for them to eat and still provides the necessary nutrients.
Parkway Cancer Centre Manager Dietetics/Allied Health Fahma Sunarja says patients are afraid to eat and they cut down on a lot of essential food such as protein, fats and iron, without which they cannot go on with the treatment. While it is true that food high in sugar and fats should be reduced, they should not be excluded from the diet altogether.
“The first thing they cut down on is meat and chicken and end up with only plain white fish. But protein is essential for growth; when recovering from surgery they need protein for the growth of their tissues; it enables building of muscles and tissues.
“Some patients completely change their diet and become vegetarians, which is okay but they have to make sure they get enough protein – it is harder to obtain protein from plant-based foods. Therefore careful meal-planning is needed when following a vegetarian diet.”
When it comes to red meat and processed meat, the general guideline is to eat not more than 500 g of red meat per week or 70 g per day. She suggested avoiding processed meat such as sausages, ham, salami and hot dog. Fats are necessary for the body as well, providing essential fatty acids andare a source of energy, while iron is essential for haemoglobin formation and plays a vital role in the production of red blood cells, she added.
During the treatment period patients are advised to adhere to food safety, so as to avoid infections. Foods such as sashimi, raw eggs and shellfish should not be eaten as raw or undercooked food contain harmful bacteria and can cause harm to the patients undergoing treatment. She advised that patients be cautious when eating out as the food may not be fresh or hygienically prepared.
Sunarja added that when meat is cooked at high flames thereby producing charred food, chemicals called ‘Heterocyclic Amines’ (HCAs) known to cause cancer are formed. BBQs, toast bread and French fries are cooked under such condition and should therefore be cut down.
Summing up on the guidelines she stressed that though precautions should be taken and food high in calories, sugar and fats should be under control, patients have to bear in mind that these are very essential parts of the diet and should not be avoided altogether, out of fear. The general rule should therefore be to ‘eat everything in moderation’, she said.
An important area in cancer care is pain management. “Adequate cancer pain management improves the quality of life and helps patients to focus on their treatment. A proper understanding of cancer pain and its management helps patients to enhance compliance, ease anxiety and feel empowered,”said Senior Palliative Care Nurse Zhang Liting.
“Up to 90% of the cancer pains can be adequately controlled and about 5-10% of cancer pains are considered difficult,” she noted.
The pain threshold is lowered by factors such as discomfort, insomnia, anxiety, fear, anger and isolation while the threshold is raised by factors such as sleep, sympathy, understanding, companionship, creative activity and relaxation. It is imperative to note the relationship between the patient’s psychological state and pain threshold. This relationship reinforces the concept that a holistic approach to patient care is highly beneficial and is therefore reiterated by PCC as the key to successful treatment of their patients.
“Art therapy is a form of ‘psychotherapy’ that can be helpful to people who are struggling with difficult and challenging situations such as cancer diagnosis,” says Counsellor Paula Rusly.
When the patient keeps his pain to himself and suffers alone it exacerbates the illness. Through artwork he has an opportunity to exhibit his fears and feelings and it serves as an outlet providing relief for the patient. Art therapy may be provided in groups or one-to-one, depending on the patient’s needs.
nIt provides opportunity for patients to explore and express their inner experiences such as feelings, perceptions and imagination, in a safe space
Senior Dietician Gerard Wong advised caution in grocery shopping, stating that nutrient claims on product labels can be misleading. Bringing out examples from items that we find in the supermarket he said, “If the label says ‘No cholesterol’, it is misleading because it simply means no ‘animal’ fat so we assume it’s healthy but it’s not – it still has ‘fat’ and is therefore still harmful.”
“If trying to cut calories, switching from fizzy drinks to 100% fruit juice cartons makes no difference because they both use 10 teaspoons of sugar,” he added, suggesting consumers go for food products that are:
Treatment area
The following day, the media was taken on a tour of the facilities at Gleneagles Hospital and observed the intricate details being delivered into the care of their patients. The treatment area consists of comfortable treatment chairs and offers patients access to individual television sets and headsets, as well as storage areas for personal belongings, in steps to help the patient’s treatment experience be relaxing and stress-free. A comfortable seat is also placed nearby for the caregiver or person accompanying the patient.
Evidently CanHOPE’s holistic approach of providing treatment with the support of state-of-the-art equipment, while simultaneously surrounding the patient with an entire team of experts covering a diverse range of care, attending to the patients’ psychological and dietary needs, contribute to the successful care of their patients, an increasing number of whom travel from Sri Lanka.
Further information about Parkway Cancer Centre and the CanHOPEPatient Care Program can be obtained through their local Patient Assistance Centreat 389 High Level Road, Nugegoda or helpline 773460000.
