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Cancer is a multifactorial disease and these diseases are usally
managed in a multidisciplinary fashion.Traditionally lifestyle factors in
chronic diseases are addressed in order to prevent, anticipate and reduce
the impact of disease.So for hypertension for example,we usually go for
weight reduction ,smoking cessation,salt reduction etc before introducing
medical treatmenst ,and then we start with the lowest dose of a single
drug that will manage the problem.(unless the disease is serious at the
outset).
With serious disease like some cancers ,Hospital treatments seem to
predominate from the outset,and health promoting changes are not uniformly
introduced to the patient ,either in Hospital or in Family Medicine.This
is in contrast to the multiple sources of advice a person with Diabetes,
hypertension or dyslipidaemia receives, whose diseases, though serious
,are not at all as frightening for the patient,who may feel impotent to
help herself in the face of a powerful disease.
I wondered why there seems to be this exclusively secondary ,
mechanical treatment bias, to the management of this group of chronic
diseases, when there is ample evidence of spontaneous regression of some
tumours, the documented dispapearance of life threatening diseases with
non medical treatments alone,after surgery chemotherapy and radiotherapy
have failed.
Gawler,Weil,Pert,Bensen,Siegel,Terayama,Simonton,King ,Hays,Dossey.Le
Shan,Meninger-to name but a few- have written extensively about this.
It is also interesting to view the array and proliferation of
treatment algorithms ,management plans,guidelines, and flow sheets for
asthma,mental illness ,Diabetes and hypertension and contrast them with
the paucity of 'care plans" in Family Medicine ,for a much more complex
disease like a cancer.
Depending on the TNM findings at diagnosis should not a phased
response to the disease be activated?.Passive "Watchful waiting' could be
reframed as a "trial of 1' of active lifestyle intervention at the
Primary care level.Multilevel interventions could be directed to the
physical dimension(exercise, nutrition sleep),the psychlogical areas of
life(counselling, problem solving, relaxation) and the Spirit.
This strategy would engage the patient actively,early on,in their own
management,and involve them in a network of supportive care.
If we used the time of diagnosis of a disease like prostate cancer
,not as a time of giving bad news, but as a time and opportunity to give
a balanced view of the illness, and advice on methods of active
intervention in the cancer experience, that have been shown to improve
health, the term "watchful waiting" could be discarded.
We can give the patient advice about the benefits of relaxation and
visualisation in the disease ,discuss the importance of rediscovering
meaning and purpose in their life,teach about and overcome the
immunodepressive effects of despair and negativity ,and promote the
immunoenhancng effects of hope.
We can still do a lot for people in Family Medicine when they are
seriously ill,and abandoning the accepted era of "watchful waiting" could
be considered.
time to move on in cancer
Cancer is a multifactorial disease and these diseases are usally
managed in a multidisciplinary fashion.Traditionally lifestyle factors in
chronic diseases are addressed in order to prevent, anticipate and reduce
the impact of disease.So for hypertension for example,we usually go for
weight reduction ,smoking cessation,salt reduction etc before introducing
medical treatmenst ,and then we start with the lowest dose of a single
drug that will manage the problem.(unless the disease is serious at the
outset).
With serious disease like some cancers ,Hospital treatments seem to
predominate from the outset,and health promoting changes are not uniformly
introduced to the patient ,either in Hospital or in Family Medicine.This
is in contrast to the multiple sources of advice a person with Diabetes,
hypertension or dyslipidaemia receives, whose diseases, though serious
,are not at all as frightening for the patient,who may feel impotent to
help herself in the face of a powerful disease.
I wondered why there seems to be this exclusively secondary ,
mechanical treatment bias, to the management of this group of chronic
diseases, when there is ample evidence of spontaneous regression of some
tumours, the documented dispapearance of life threatening diseases with
non medical treatments alone,after surgery chemotherapy and radiotherapy
have failed.
Gawler,Weil,Pert,Bensen,Siegel,Terayama,Simonton,King ,Hays,Dossey.Le
Shan,Meninger-to name but a few- have written extensively about this.
It is also interesting to view the array and proliferation of
treatment algorithms ,management plans,guidelines, and flow sheets for
asthma,mental illness ,Diabetes and hypertension and contrast them with
the paucity of 'care plans" in Family Medicine ,for a much more complex
disease like a cancer.
Depending on the TNM findings at diagnosis should not a phased
response to the disease be activated?.Passive "Watchful waiting' could be
reframed as a "trial of 1' of active lifestyle intervention at the
Primary care level.Multilevel interventions could be directed to the
physical dimension(exercise, nutrition sleep),the psychlogical areas of
life(counselling, problem solving, relaxation) and the Spirit.
This strategy would engage the patient actively,early on,in their own
management,and involve them in a network of supportive care.
If we used the time of diagnosis of a disease like prostate cancer
,not as a time of giving bad news, but as a time and opportunity to give
a balanced view of the illness, and advice on methods of active
intervention in the cancer experience, that have been shown to improve
health, the term "watchful waiting" could be discarded.
We can give the patient advice about the benefits of relaxation and
visualisation in the disease ,discuss the importance of rediscovering
meaning and purpose in their life,teach about and overcome the
immunodepressive effects of despair and negativity ,and promote the
immunoenhancng effects of hope.
We can still do a lot for people in Family Medicine when they are
seriously ill,and abandoning the accepted era of "watchful waiting" could
be considered.
Competing interests:
None declared
Competing interests: No competing interests