Personalised medicine in the ‘war against cancer’ started with the era of biological markers. There were ‘magic bullets’ or targeted drugs to target important biological markers on tumour cells that came to be known as immunotherapy and helped reduce the side effects of conventional chemotherapy.
Today, however, it is not just the medicine but also the physician-patient relationship that needs to be personalised. A physician has to figure out ‘what, how and when to convey’ and ‘How to help fight the patient fight his own mind’ to treat the patient effectively.
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The answers are unique to the patient. This personalised treatment and physician-patient partnership is of no less importance than the actual medicine, especially in case of cancer where an oncologist must play multiple roles of physician, psychologist, mentor and friend.
According to current WHO data, almost 50 per cent of cancers globally are ‘curable’. The word ‘cancer’ in real terms would mean a death sentence to most; however what we, as oncologists, aim at are to attempt to create awareness to prevent it whenever possible, diagnose it early and treat it as effectively as practically possible keeping in mind quality of life.
As oncologists we realise that cancer is not just a battle against the disease but more importantly a patient’s war against guilt, fear, suffering and agony. We realise that breaking this news does not merely cause a magical disappearance of all happiness in a patient; it is more profound devastation in terms of unplanned events in a person’s life: thoughts of child’s marriage or education and fear of the unknown to name a few. The misery is compounded with repeated diagnostic investigations and frequent clinic or hospital visits for treatment.
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At this juncture what is of utmost importance is the confidence imparted by the physician through ‘open communication’. With this the battle is redefined... Battle is about joys, sorrows, rewards and challenges of caring for people with cancer.
This is a battle, which we fight daily as oncologists. As we go through our challenges and dilemmas, we battle through the ambiguity of the situation. How much to disclose? When to disclose? What is the most appropriate way? The goal still remains to use available data and resources judiciously to help patients live longer and better.
Flood of emotions
Oncology is not just a science but an art, a philosophy of human relations and understanding of human experience to a very serious ailment. There is no ‘blunting of emotions’. There is always a flood of emotion when you see a new patient and understand his/her circumstances. The important thing to remember is that this relationship is ‘forever’, from diagnosis to treatment to surviving cancer.
Cancer is not the end but the beginning of a different journey; advances in oncology have truly given life wherever possible. It starts with ‘never lose hope and faith’; then comes ‘telling the truth’. The relationship has to go beyond ‘the physician knows best’ attitude and enter a partnership in care, treatment planning and delivery.
In this era of overflow of information, it is very important to add meaning to the information that the patient or his/her family want to share and comprehend.
The writer is a Bangalore-based Consultant Medical Oncologist