Hope cherishes a desire with expectation and anticipation. It may be a wish or belief that gives joy and peace. It is also an important coping mechanism in hostile situations.
Fear is in everyone’s mind in extreme stress. Cancer patients are no exception and all live in hope. If detected early, cancer has an answer. Studies have shown that there is no difference in hope between patients who undergo curative treatment and those who receive supportive care only. The emotional turmoil which the patient undergoes is often not adequately addressed, though the medical treatment may be proper and evidence-based.
In Anand, a Hrishikesh Mukherjee film released in 1971, the cancer patient, played acted by Rajesh Khanna, enjoyed quality life before impending death. The doctor, played by Amitabh Bachchan, kept faith and hope till the very end. The 122-minute film was breathtaking — it symbolised cancer treatment, hope and reality.
Hope exists wherever there is life.
Slogans
Leading cancer centres all over the world have given enormous importance to hope in their slogans.
- Sheba Cancer Centre, Israel — Hope without boundaries
- Memorial Sloan Kettering Cancer Centre (MSKCC), New York — Changing how the world understands and treats cancer
- Royal Marsden, London — Life demands excellence n Tata Memorial Hospital, Mumbai — Service, research, education
- MD Anderson, Texas — Making cancer history n Victorian Comprehensive Cancer Centre, Melbourne — Overcoming Cancer Together
In an Instagram post, an actress who had received chemotherapy visited the same place four years later and was overwhelmed. She wrote: “Saw the chemotherapy suite, the same waiting room, faces were different. I felt like telling the patients that there is hope and I am there on the other side.”
Those who derive hope from getting treated abroad should be aware that the world’s most famous cancer centre — MSKCC, New York — will be operating from Chennai shortly.
Assessment
It is difficult to assess hope in an individual as it is always a subjective feeling. However, the Snyders hope scale (SHS) and Herth Hope Index (HHI) have been evaluated in most trials.
HHI records a patient’s response to 12 questions and the maximum score is 48.
Studies have suggested that hope has no definite relationship with age, sex, level of education, marriage or type of cancer. However, there is a negative relationship with depression, psychological distress and symptom burden.
Hope has a positive relationship with social support, religious support and better quality of life.
Communication
Honest information even in the most distressing situation maintains hope. Studies have revealed that 98 per cent of all patients desired correct and updated information to place complete trust in the treating oncologist.
The majority accept the diagnosis and are determined to face the challenges. It is also a legal requirement as the patient has the right to know the true situation.
The approach needs to be individualised for every patient. Communication of negative news is really demanding for the patient and oncologist. It does cause emotional turmoil though truth cannot be denied. Usually, positive information is given first. For associates and friends, it is best to avoid unsolicited advice, talk of past discomfort and provide empty offers for help.
For basic communication, it is necessary to:
- Engage the patient
- Elicit patient’s concerns
- Educate the patient
- Address emotional aspect
- Enlist collaboration of patient and caregivers
Oncology nurses do play a crucial role in conveying honest information in the correct manner, thereby keeping hope alive.
Trials
There has been significant progress in cancer treatment in the past years. With every advancement there has been increasing hope.
Recently, a drug called dostarlimab has created a huge impact in the treatment of rectal cancers worldwide.
The trial has been done only with 12 patients of a rare type of rectal cancer, which constitutes around 5per cent of total rectal cancer cases. The results are short-term, mentioning only response rates and not overall survival. These patients did not undergo any treatment other than the drug. It is only a Phase 2 trial and has a long way to go for achieving long-term results.
Present treatment protocols in rectal cancers cannot be changed based on this trial. The cost of treatment with this drug in India may be around Rs 75 lakh. However, this treatment protocol has infused new hope in many cancer patients as there has been no drug which has achieved a 100 per cent response rate among all patients in a trial.
The common perception is that even if a small percentage of rare rectal cancers are benefited today with further research, many other cancers may be cured in future. The perspective of the oncologists and patients may differ though hope is always a common factor.
A serious illness is a reminder that life is not infinite, but living in hope and expectation is also realistic. Hoperekindles and enhances the fighting spirit already present in individuals when the situation is tough.
On many occasions, hope changes the perception and the hostile situation becomes more favourable.
Hope instils confidence to face the challenges of life.
Gautam Mukhopadhyay is the secretary of the Bengal Oncology Foundation and clinical director of the department of surgical oncology, Peerless Hospital
