“The cancer makes the hard harder.” - A lymphoma patient at Grace Hospital, Ibadan, Nigeria
Despite innumerable innovations and advancements in patient care, cancer continues to be a complex, difficult-to-treat disease. Cancer presents great expense to both society and patient— a burden that will only increase in the years to come, with the global annual incidence rate projected to reach 22 million cases per year within the next two decades.
Although cancer certainly has disastrous effects on a patient’s body, the diagnosis and treatment of cancer also take a toll on his or her mental well-being. A cancer patient’s physiological complications can be accompanied by a wide array of different psychological difficulties.
This management and treatment of cancer’s effect on the patient’s mental health has been termed “psycho-oncology,” and can take many forms, from individual psychotherapy sessions to group art therapy to psychoeducational cancer information sessions. Thanks to pioneers in the field such as Dr. Jimmie Holland of Memorial Sloan Kettering Cancer Center in New York, the number and scope of psycho-oncology services offered in US hospitals have increased rapidly since the 1970s. Many developed nations have followed the United States’ lead in ensuring widespread patient access to these services, but many patients still lack the access to psychosocial treatment that they need to achieve the best possible treatment outcomes.
A lack of access to psycho-oncology care is especially common in low- and middle-income countries. Although psycho-oncology is beginning to become established in places other than Western Europe and the United States, many medical facilities in low-resource settings cannot offer psycho-oncology services due to a variety of reasons such as finance, lack of patient and provider awareness, and institutional organization. A patient’s psychological struggles often negatively affect cancer treatment and recovery, so the international standards for oncology care include treatment for cancer’s adverse psychosocial effects. But along with the increasing recognition of the importance of the treatment of the psychosocial effects of cancer comes the harsh reality that many medical facilities across the globe are not equipped to provide complete physical oncology care as outlined by international standards, much less comprehensive psycho-oncology care.
Psycho-oncology might be even more important in low-resource settings, where patients often do not seek help until their cancer has already progressed past most treatment options and the best approach might simply be psychological and palliative care. The World Health Organization (WHO) endorses a focus on palliative care, estimating it would be possible to give 90 percent of advanced cancer patients relief from physical, psychosocial, and spiritual problems through palliative care alone. Fortunately, in spite of the structural roadblocks, there are a few psycho-oncology programs pushing forward in different parts of the developing world that provide hope for a future of psychosocial cancer treatment in low-resource settings.
I spent ten weeks researching one of these programs at the University College Hospital (UCH) in Ibadan, Nigeria. UCH is the site of Nigeria’s premier medical school and is the best funded of Nigeria’s public hospitals. Dr. Chioma Asuzu, who mentored my project, has worked tirelessly to increase the degree of psychosocial cancer care available to patients at UCH.
One effective program Asuzu developed was the psycho-oncology clinic, which is designed for cancer patients, their family members, and their caretakers. A cross between group therapy and a cancer-education session, the clinics are structured to first discuss cancer, its causes, and treatments. Then the floor is opened to patients’ questions, which range from concerns about diet to clarifying treatment procedures to freely offered testimonies of personal experiences with cancer. Each clinic concludes with a stress-relief exercise of some sort, and patients who appear to be especially distressed are often asked to remain for brief one-on-one counseling sessions.
Although Asuzu’s clinics are now well-attended, and she has been able to get an academic appointment at UCH to develop these programs, her path was not smooth. “At first,” she told me, “I had to bring my own chairs”; the department did not want cancer patients to sit in the regular chairs. Despite the success of these clinics, often attended by patients frustrated by the broken radiation machine (as one husband of a breast cancer patient told me, “it is always two months—when I was here two months ago, the radiation machine would be fixed in two months”), there are many obstacles that make it difficult to expand the reach and implementation of this essential programming in Nigeria. Like so many pressing issues in low-resource settings, psycho-oncology continues to be underrecognized and underfunded.
There is a lot of hope for the future of psycho-oncology in low-resource settings. In addition to advancing the cause of psycho-oncology at UCH, Asuzu devotes a lot of time to furthering the cause globally. She serves as a board member of the International Psycho-Oncology Society (IPOS) and is the president of the newly-formed Association for Psycho-Oncology in Africa (APOA). I spent one week of my time in Nigeria at the inaugural APOA conference, where I got to meet passionate doctors, nurses, psychologists, and social workers from across sub-Saharan Africa. All of them are committed to expanding psycho-oncology services at their hospitals and in their countries.
Cancer care, both psychologically and physically, will only become more important in the coming decades. Nigeria and Africa’s populations are rapidly expanding and life expectancies are rising, which means that cancer incidence is increasing. As Asuzu wrote in a 2015 volume called Global Perspectives on Cancer: Incidence, Care, and Experience, it will continue to be “important to address the structural roadblocks [in Africa] that prevent the incorporation of psycho-oncological services in the continuum of care.” It is only with increased political will, smart policy-making, and devoted implementation that all cancer patients will gain access to the psychosocial care that they need.
Evan's research experience this summer was possible thanks to the support of the University of Chicago Center for Global Health and their generous donors.
The image featured in this article is licensed under Creative Commons. The original image can be found here.