Reactions of patients to the diagnosis and treatment of cancer

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Abstract
More effective diagnosis and improved treatment have changed cancer from an inevitably fatal to an often curable disease. As a consequence, considerable care needs to be exercised in discussing both the diagnosis and treatment of the disease with the patient or, in the case of children, the parent. Initial reactions to learning that one has cancer include fear of death, disfigurement and disability; fear of abandonment and loss of independence; fear of disruption in relationships, role functioning, and financial standing; and denial, anxiety and anger. An important role of the physician is to recognise these fears and emotions and encourage the patient to share his or her thoughts. It is also important to provide necessary information both to correct misconceptions and to provide hope. Treatment-related concerns add a second source of distress to the patient and, if not optimally addressed, may prejudice the completion of effective treatment. Long courses of treatment may cause the patient to become much sicker symptomatically from the treatment than from the disease itself. Children, in particular, may be unable to tolerate treatment-related side effects. Especially demoralising for the patient are commonly used anti-cancer agents with high emetogenic potential. These include cisplatin, dacarbazine, streptozocin, actinomycin and nitrogen mustard. In many cases, patients suffer so badly from the symptoms of nausea and vomiting that they refuse further treatment. They describe cytotoxic, drug-induced nausea and vomiting as a nightmare. The recent introduction of a new class of anti-emetic agents, the 5-HT3-receptor antagonists, has improved patient quality of life during cytostatic treatment and, in some cases, permitted more aggressive therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

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