Learning to Centre a Client in Their Cancer Rehab Process

These are my people - my husband and my two wonderful children. They are my reminder that life is precious and every minute spent with them is important. It was heartbreaking for me to learn that 32% of people with cancer feel a desire for a hastened death. This is linked to their levels of pain; functional impairment; sense of hopelessness and levels of depression. This insight has impacted my interactions with my two clients who both have lung cancer.

My first client told me last week that she takes a vitamin for skin, hair and nail health because her medication has made them weak. She has been taking erlotinib for five years now and had a course radiotherapy in August 2021. I was able to explain in simple terms the role of her cancer medication in inhibiting kinases, helping her see how her kinase inhibiting medication was stopping her tumour growth. It was also stopping cell division and replication in her once quickly regenerating skin, hair and nail cells. I wondered if her vitamins could interfere with that process? A quick google found an article that suggested some supplements might negatively impact cancer treatment. So I encouraged her to ask for a referral to a nutritionist instead and check in with her oncologist. Prior to the course I would have seen nothing wrong with boosting her body’s health during a physically stressful time, I probably would have encouraged her.

I did recognise that taking vitamins was an act of control over a difficult situation so we investigated further what food might actually help her healing. Cancer research stated that there was some evidence to support turmeric’s role in boosting her health As a replacement for her vitamins she has decided to include turmeric in her juices and smoothies.

My other client is new to her lung cancer diagnosis and is feeling very overwhelmed and scared. She is taking Osimertinib. Before my session with her I used UCL’s library to find its efficacy and safety data. I was able to reassure her that she was on the best medication for her condition. When she told me that she only had a year to live. I queried that statement. We knew that she was strong, she was fit and she was healthy. I knew from my reading that median survival time using osimertinib is 38.6 months. I reminded her that she was not a statistic, she was a person, she did not need to rely on numbers that didn’t recognise her as an individual. We also didn’t know what miracle cure lay around the corner. I boosted her confidence not to lead her astray but because the course reading emphasises the importance of psychological wellbeing in decreasing illness burden.

We worked together to create an imagery based relaxation script that I recorded for her. It incorporates her faith which is very important to her. It helps to give her a sense of control, of capability and focused on shrinking her pain. The recording is below:

Chapter four of our online module in Supportive Care and Special Pain Problems states that:

“Social support is another key element and evidence suggests that lower levels of social support are associated with greater pain”

With this knowledge in mind I chatted to her about her Church - were they a source of support? When she said no, we went together to visit a neighbour who is a member of a different congregation. This neighbour has now organised a Tuesday prayer group for her. I am an atheist. It is only through my reading for cancer pain that I have come to appreciate that a person with a terminal illness feels spiritual pain. My beliefs are irrelevant when supporting someone’s well being and this person’s faith brings her hope, lifts her from depression and keeps her engaged with social networks.

Learning about cancer and cancer pain has changed the way that I interact with people. I wonder about three past clients - two with prostate cancer and one with breast cancer. My approach with them was different. I didn’t actively centre them in their rehab and work collaboratively with them to boost their physical, emotional and spiritual health. I think my current clients are getting a better quality service.

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