Section 8
Psychosocial Issues in Breast Cancer Management

PHYSYCYAN-PATIENT COMMUNICATION
Communication is a two-way street, and oncologists should not feel that the burden is all on them. It’s also up to the patient to bring up issues and ask questions. It needs to be done jointly. It’s easy for an oncologist to take 30 seconds and ask the patient something like, “How much information do you want? Do you want to know everything, or you just want to know the basic essentials?” We actually conducted a study looking specifically at that, 67 and we found that this is very much age-related, with older patients much more likely to say, “I don ’t want to know all this stuff. This is what I’m paying my doctor for. Let my doctor take care of it.” The younger patients were more likely to want to be very actively involved. But there’s not always a perfect relationship between communication style and age — so, it’s best to ask.

Communication has been made terribly difficult today with managed care and all the paperwork that oncologists have to do, which is enormously stressful. I think they’re in a very difficult position. These days oncologists are supposed to be experts in palliative care, pain management, financial management, alternative medicine, ethics and so on. It is absolutely impossible for anyone to stay up on all of these things. It’s hard enough to keep current in one’s own subspecialty area of oncology.

—Barrie Cassileth, PhD

THE EMOTIONAL IMPACT OF BEING AN ONCOLOGIST
What I see is people working much too hard — being in the hospital 14 hours a day and then going home and doing more work It’s really too much. Oncology is a much more difficult field than it was ten years ago, and one of the biggest new stressors — and this is documented by research — is the paperwork associated with managed care. It’s terribly frustrating for someone with a large number of patients to deal with useless, ridiculous, duplicative paperwork.

To cope with all this and the tragedy they see, oncologists must find ways to separate themselves emotionally, or they become wiped out — and many people are. It is a very tough life. Oncologists can take mini-vacations just as we encourage patients to do, and they can also benefit from learning strategies like meditation to help them calm down and relax. They also greatly benefit from massage and other techniques used for patients. We have classes for both staff and patients, and for example, we have more staff than patients signing up for our yoga classes.

—Barrie Cassileth, PhD

I love oncology. I have amazing patients and amazing people whom I work with. My students often ask, “How you can do this? Isn’t this horribly depressing?” And at times it is, but there are also incredibly wonderful moments. Our patients are not and should not be willing to share those wonderful moments with us if we’re not willing to share the sad times with them. You can’t have it both ways, and those good times are just too good to pass up. There is also a wonderful gift in what I do. My patients make it impossible for me to not remember what’s really important in our lives, which is easy for us to do. We all know that we’re going to die sometime, and that life is uncertain and there are no guarantees. However, those things just seem so far off that they tend not to affect your day-to-day life. But as an oncologist, I can’t do that — I can’t take those things for granted, because my patients won’t let me. It’s a constant reminder that we truly have no guarantees and life is precious. And that ’s a wonderful gift that my patients give me.

—Kathy M i l l e r, MD

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