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Main principles Informing the patient of the seriousness of cancer is not enough to ensure that he will accept the different therapies involved in its treatment. A clear explanation of each treatment phase is necessary. Here again, it is very important to repeat information rather than to give it all in one fell swoop, and to let the patient ask his own questions, for the most important concerns for the patient do not necessarily coincide with those of his physician. In a multidisciplinary team, it is important to co-ordinate the information given to the patient. Care teams are used to reformulating information already given by the physician. To do so, when information is given to a patient, it is recorded in his medical file, thus enabling the care team to take this information into account when responding to the patient’s future questions. All hospital personnel is involved in this information (including cleaning staff who spend a great deal of time in the patient’s room, and who, for the patient, are not implicated in care management). It isessential that such personnel undergo training to improve their listening skills, for they hear patients express their anguish and their personal or family situations, for which help or solutions can often be offered. Information hierarchy, as described in ‘Cancer Ward’ (Alexander Soljenitsyne, autobiographical work based on his experience of recovery from cancer) exists and constitutes a special world with which the patient must cope and in which he will try at all costs to be included

Practical advice Information that is difficult to digest should be diluted over several visits in order to help the patient to cope. However, occasionally, consultations are never-ending and the patient wants to know ‘everything’ straight away. Each new piece of information should be given positively, in the form of a more detailed explanation of what has already been said, and not like another layer of misery that we did not have the courage to utter at the previous consultation. It is important to precisely inform the patient on how long he is likely to stay in hospital, on the fact that treatment can be more or less difficult to live with, on its side effects, on anticipated functional sequelae after surgery or radiotherapy, on pain after surgery and the different ways of relieving it, and on his rehabilitation possibilities in the case of mutilation. There are many phantasms around mysterious words such as surgical exeresis, radiotherapy, and chemotherapy. The creation of explanation booklets which are clear, educational and use a simple, easy to understand vocabulary, is important so that patients and their families can quietly inform themselves and find, in these booklets, the answers to questions they may not have asked during consultation. There is no such thing as a ‘small operation’, ‘small chemotherapy’ or ‘small radiotherapy’: they are all aggressions, however necessary they be, to the patient concerned. Minimising them can only suggest to the patient that he has very little personal resistance if he has so much difficulty in coping with them.

Therefore, paradoxically, major chemotherapy for which the entire care team is called up in view of the severity of its expected complications, will finally be better tolerated by the patient from a psychological point of view, than ‘small adjuvant chemotherapy’ which the care team will tend to deal with in a routine manner. There is no such thing as ‘routine’ for the cancer patient.

The patient needs to ‘arrange things’ before treatment: misleading him on the duration of his hospital stay, on the constraints or infirmity that may be caused by surgery, or the duration of his incapacity to work, can only be of harm to him. In the future, he will mistrust information given to him by the physician and the care team, and this may lead him to refusing necessary therapy.