"Remembrance of Places Past IV"
Vojen Wilhelm Cech-Colini     Allentown, Penn.    egg tempera, 1995

Before cancer: I have been a recognized painter in Europe and America. My sole focus was successful communications between a painter and his patrons.

Then I was told about the cancer . . . .

Since then, my life is more intense. When I visit my hometown, there are the same abandoned corners, houses from bygone eras, ancient narrow streets, just as I used them as props in my pictures. However, now I can focus further and sense some of the miseries, hopelessness, and dying that took place behind the dark, empty windows. There are moments one can almost sense something even more distant and obscure. Essence of the city? One can almost imagine the subject communicating with the painter.

© Vojen Wilhelm Cech-Colini, 1995

Where practitioners turn when a patient gets cancer

Most practitioners need to educate themselves in cancer treatment methods or refer their patients to experts.

By Lisa Rabasca
Monitor staff

Patients with cancer often expect their psychologists to know enough about their disease to assist them with treatment decisions or to help them deal with the stress of a cancer diagnosis.

But for many independent practitioners, the discovery that a patient has been diagnosed with cancer may be the first time they're faced with providing this type of care. It may lead a practitioner to develop a specialty in cancer treatment--or it may mean the psychologist must find a local expert who can provide the patient with the needed psychosocial treatment, such as guided imagery for pain management or self-hypnosis to prevent nausea during chemotherapy.

Only a psychologist thoroughly trained to care for cancer patients can ethically provide a patient with the right kind of treatment.

However, it's important that the practitioner not withdraw from a long-time patient who discloses a cancer diagnosis, says Leslie R. Schover, PhD, a staff psychologist at the Cleveland Clinic Foundation in Ohio.

Catherine Acuff, PhD, for instance, began treating cancer patients after a long-time client who came in for a weekly psychotherapy session 15 years ago revealed that her physician had found a lump in her breast during a routine exam that morning.

"At that point, everything else we had been working on was on hold," says Acuff, a member of APA's Board of Directors. "Within a day or so a diagnosis of cancer was confirmed and we set aside the other issues and focused on the cancer."

Acuff, who had a private practice in Connecticut at the time, immediately tried to educate herself about breast cancer. She met with her patient's primary-care physician to learn what issues the patient would be grappling with and what her prognosis was for recovery. She read articles and spoke with other clinicians that worked with cancer patients.

"I tried to get a medical education about the disease," says Acuff, who is now senior policy analyst at the U.S. Substance Abuse and Mental Health Services Administration Center for Mental Health Services in Washington, D.C.

Her experience was not unusual. With one out of three people expected to be affected by cancer in their lifetimes, most psychologists will, at some point, see a patient diagnosed with cancer.

It's also not unusual for former patients diagnosed with cancer to seek help from the practitioner who once treated their depression or anxiety, says Sandra B. Haber, PhD, who has a private practice in Manhattan.

Haber developed an expertise in treating cancer after one of her patients died from the disease.

"I didn't have the tools to help her," says Haber.

To learn more about treating cancer patients, she read research materials, interviewed cancer patients, observed cancer-care programs, spoke to the directors of these programs and enrolled in a training residency program at Sloan-Kettering Memorial Hospital in New York City.

While only 20 percent to 25 percent of Haber's patients have cancer, she says it consumes about 95 percent of her professional interest.

"The field is constantly changing," she says. "Just knowing general trends is a fair amount of work and even once you master it, you don't stop learning."

Her colleague, Lynne Hornyak, PhD, agrees that developing an expertise in treating cancer patients takes time. Practitioners need to have knowledge of the biological bases of the disease, common psychological and social factors, the different stages of the disease and usual courses of treatment, says Hornyak, a private practitioner in Washington, D.C., who treats patients with cancer.

To develop skills for working with patients who have cancer:

* Have the patient sign an authorization for release of information so you can talk with their oncologist about their diagnosis and treatment, says Esther Lerman Freeman, PsyD, a private practitioner in Virginia Beach, Va., who treats patients with cancer and other health-care problems.

* If possible, join the staff of your local community hospital, says Lerman Freeman. Every hospital has different procedures for applying to be on staff and some require psychologists to have a physician sponsor, but being on staff allows you to see patients and write notes on their medical charts when they are hospitalized during their illness.

* Attend teaching conferences and rounds at a local teaching hospital to learn about the practice of medicine, says David Bearison, PhD, adjunct professor of pediatrics at Mount Sinai Medical Center and School of Medicine in New York City.

* Continue your education by reading, talking to physicians and taking workshops, says Hornyak. For example, practitioners should learn what happens physically and emotionally when a patient gets chemotherapy or radiation treatment so they can teach the patient to use relaxation, hypnosis and visualization to tolerate these procedures.

* Find a psychologist in your community who is an expert in psychosocial cancer interventions and ask that provider to supervise your work, says Lerman Freeman.

* Volunteer to work with cancer patients in your community, says Leslie Schover, an Ohio practitioner.

* Get on the mailing list for Cancer Care, Inc., a Manhattan-based organization that provides training seminars for health-care providers and support groups for patients over the telephone, says Schover. For more information, call (212) 302-2400 or visit the group's web site at www.cancercare.org.

* Talk to former cancer patients and ask them what was most difficult about their cancer treatment and how they think it could have been handled better, Haber says.

* Recognize you're treating a patient who has cancer, not a cancer patient, says Lerman Freeman. Just because the patient has been diagnosed with cancer, it doesn't mean they will always need to talk about their cancer. Like other patients, they have a full gamut of issues to discuss. For example, the psychologist might assume that tolerating chemotherapy or facing death will be most important to the patient, but sometimes it's hair loss or an unresolved family issue that is more significant.

* Be flexible, says Lerman Freeman. When you're working with people who have cancer, you may need to make a home or hospital visit and they might not always be able to keep their appointments.

* Work on your own issues about death and dying and any feelings you have about family members or friends who have had cancer, before you start working with patients, says Lerman Freeman.

"When we first learn to practice, we learn by reading, supervision and doing," says Lerman Freeman. "By reading, getting supervision and seeing cases, you can bring yourself up to speed to treat patients with cancer."

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