 Good day viewers, welcome to another edition of Cancer with Dr. Denise H. O. C. O. of Comod Cancer Foundation in partnership with Plus TV Africa. This month, we're going to be looking at quite a lot of things, but let us talk about today. Today we're focusing on the socials, psychosocial effect of cancer on survivors. In the house who am I God, I've got Dr. Elizabeth Akin-Adenye. Thank you for joining me. Doc, how are you? I'm good. Thanks for having me, Dr. Denise. You have a lovely smile today. No stress. Today's Saturday. Yeah, very nice to have you today with us. And we're going to be looking at the psychosocial, but let us recognize what July is. July is the Sakuma Awareness Month and what is Sakuma? Sakuma are uncommon cancers that can affect any part of your body. A key symptom of Sakuma is a lung that gets bigger quickly. Most people get diagnosed with their Sakuma. When their Sakuma is about the size of a big or a large tin of big beans, a large tin of a lot of things that we have in Nigeria. So that's what Sakuma is and that's what this month is all about. Somewhere along the line we'll be talking about that, but today let's look at the psychosocial effects of cancer because it is a very important aspect to the experience of a cancer patient and without that we're not going to get very far. So in the house we have Dr. Lizzie. Who is Dr. Lizzie? Dr. Lizzie is the current president of the Psycho Oncology Society of Nigeria and a clinical psychologist at the University College Hospital Ibadon. Her research focuses on psychosocial and behavioral dimensions of cancer with emphasis on addressing factors that contribute to advanced stages of cancers and how cancer affects the overall well-being of the patients and their caregivers. As I said, this is called the Cancer Foundation. We're going to be talking to Doc today and we're going to hopefully have a lovely time. So here we go, Doc. How are you? I'm okay. Thank you. I'm going to read something about psychosocials. There is high evidence that people with cancer suffer from psychosocial distress, not only in the early stages following the diagnosis, but during the entire course of the disease. I can affirm to that. Psychosocial distress includes many emotional, cognitive, social and functional problems which have been documented in many studies across the world. Every 10 years after treatment, even 10 years after treatment, 54% of cancer survivors still suffer from at least one psychological issue. Doc, you're going to be confirming all this for us, but it's very important that cancer patients understand that we are aware. Psychological distress is a significant and ongoing problem for cancer patients. This is why we've always talked about the importance of regard in our work as a treatment for cancer patients. The concerns of people with cancer patients are generally the most significant and important problem for cancer patients. What is the importance of regard in our work as a treatment for cancer patients? So in this case, time cancer is focused on the treatment of the disease rather than every other thing that happens to a cancer patient. Doc thank you for joining me this afternoon or this afternoon or this evening wherever you are in the world we want you to sit back listen and let's hear what doc has to first Dr Elizabeth at doc because I really have a good love with Dr Elizabeth okay or I'll call Dr Lizzie so please just understand it is the space what does psychosocial mean and why is it important to discuss when treating cancer patients thank you very much one thing first of all to look at is psychosocial psychosocial has two keywords psychological and social so the psychological beat of it refers to those aspects that are internal to us they are subjective only us can tell how we feel them and like you've said earlier they relate to our emotions our perceptions of issues even our spirituality will fall into that psychological because it is subjective it is internal the social aspect of it has to do with interpersonal relationships and that is external to us it's not within it's not all that subjective it has to do with how we relate with others perhaps maybe how we relate with our environment better and so why is this important it is important to consider these psychosocial issues because the cancer patient is forced to human being before he or she is a patient and as a human being he or she has multiple parts there is the social aspect for them there is the psychological aspect there is the spiritual aspect and there is the physical physiological aspect so to say and you cannot take one without considering the other and so if the focus is only on the physiological impact of cancer how to control the spread or the growth of the disease or how to kill the cancer then we may you know neglect those other parts that are also integral to this patient and so there's a need for how do I put it in comprehensive and holistic care of the patients take care of the physiological aspects without leaving out the social psychological emotional or spiritual parts awesome doc I like the way you've actually put it because very rightly so it seems to be in a very neglected aspect of our journey however in my view it is not a neglected aspect it is a key aspect I always try to say this and I sometimes maybe maybe it's said wrong or whatever but I always say to people that the treatment plan of a cancer patient is like 30 40 percent of what we go through but a lot of the time the focus is always surrounded is always talked about around the social yeah about the disease rather than everything else which is everything else is us in my view that is everything about us our families our friends so okay so what are the psychosocial aspects then therefore let's be very specific in in of the cancer patient okay let's let's because a typical human being to what a cancer patient is a typical human being and so this person is a father a mother is a parent this person works in an organization or is a business owner this person has a relationship with a god that he or she recognizes as supreme this person lives within a society and a culture that defines how their perception of health and disease and how it is what do we assess this person lives in a system where there are policies there are policies that govern healthcare system education the all of these together in fact policies that govern your finances do we pay from out of pocket and yet enough insurance is the insurance coverage comprehensive enough all of these are psychosocial aspects you know that are important to the patient and then look at this patient also as a physical being with identity cancer has the way of also altering an individual sense of who i am i find patients sometimes asking questions why me who am i because sometimes there's that sense that who i was has been altered by having an experience with cancer by encountering cancer and so there are multifaceted aspects to this psychosocial issues and how it impacts cancer cancer patients like for example the issue of work when cancer comes in the patient's ability to continually be at work when he or she should be is at least for the period where he's receiving treatment is limited and there will often be the needs to take excuses even if it's for a caregiver because the cancer does not just affect the patient it also affects their loved ones and so as you know i've made parents especially mothers they are working on establishment even while they are working there they are thinking about their child in school maybe they will soon get a call to say your child is having social and social symptoms and then another journey to the hospital to and through and you'll be taking multiple excuses from the place of work if it's a government established a private establishment there's often the concern of is it not better you who could resign and go and be taking care of your of your child or your loved one as the impact of cancer on a patient's life and not just the patient because oftentimes the caregivers are neglected the caregivers are actually unseen patients and so the impact is far-reaching that a 30 minutes program may not be enough to talk about it but it's just important to know that these problems are there and they actually need to be addressed thank you doc um you know you've just hit a lot of key points on why this conversation is even taking place because a lot of people have put us put the us in a box the disease in a box are well-being in a box are socially you know everything are we're now boxed up and we don't even realize we're boxed up so everyone let's take a break now and we'll be joining it we'll be back in a few minutes to continue this conversation with dr elisabeth i'm hope i hope you all sit back watch while we take a quick break and we'll be back in a few minutes welcome back everyone to this conversation on the psychosocial effects of on cancer patients of the disease i want to thank dr elisabeth for being with us and just a quick recap on what we've been talking about the challenges that cancer patients face that are not necessarily all about the treatment but actually the person that is carrying the disease so doc back to you again and i'm going to give you your next question and thank you for sitting and joining us everyone who's watching us it's called cancer foundation you can opt to follow us on any of our social media platform what is a psychosocial support or what is psychosocial support for cancer patients specific site what is the support well psychosocial supports or the support for cancer patients would refer to any form of assistance a patient can have access to and the assistance may come from different angles oftentimes the family caregivers are the first you know online to provide the support the healthcare providers are there they should provide this support there should also be community agencies churches mosque i mean pretty dust centers community organizations and NGOs non-governmental organizations could be there to provide the support friends and loved ones would be there to provide the supports and the supports can be of different types they can be instrumental in which case they are tangible that these patients would need their practical things that these patients could need who'd be money it could be assistance taking care of the children or running arounds or transportation to the hospital and the support could also be emotional i mean having an ear you know having someone listen to you having a shoulder to lean on when you are when you are in you know in a tight corner when you want to talk and things like that so the support can be diverse and oftentimes i'd also say that the support is the kind of support that the patients need is what the patient needs in other words sometimes we may feel like we know what the patient needs but the best thing is to ask the patients what they need and how they would love that need to be made because we can never understand the need like the patient that is experiencing it thank you doc you made it very straightforward because keep point everybody tells us what we need i just don't get it and sometimes people don't understand that we then shut down because you are telling us somehow you're not listening so we get to a point where we say okay just you can keep talking and that's because people are not listening sometimes it is honestly about how do we get to the hospital or i don't feel like eating this and then you are told no they say this is the best thing however that best thing you are offering me i'll throw up so why are you trying to force it down my throat when it's not working i don't know i i thank you thank you for bringing this up because it's very important what is there for the best psychological is that how they put it therapy for cancer patients what would you say is there is no there is no one there is no best it's like asking what is the best treatment for cancer there is no actually it depends on what this patient is presenting with that's what the same thing with psychological support or social support but you know a patient borrowed me a word which is what i want to use name in one of our sessions the patient said that irrespective of the kind of treatment you are receiving you must have self therapy here's what any other person is telling you as a patient what are you telling yourself that is very very important to your your internal language what you are saying that other people are not hearing is very important but which reacts to the best type of psychotherapy or support it all depends on what is this patient presenting with and so you may have a patient that is just about to be diagnosed the patient is anxious he does not really understand what's going to happen or what is happening well for that kind of patient is psychoeducation may you know come handy for that patient in in terms of preparing the patient asking the patient questions taking the patient know that if this then there are x y c that can be done so hope is not lost don't just you know reassuring the patient of the experts is available the resources that are available to help this patient go through the journey we may also have patients that are at the end of life and they are struggling with existential issues they are wondering what's next how do i survive uh issues like that they could have existential psychotherapy for instance that would be there to help them um through their hard questions the questions of eloneness meaninglessness the question of death and dying you could have someone there experts really to explore these um issues with the patients one thing we want to know about psychotherapy or psychosocial treatments for cancer is that the therapy may not be able to clear out the cancer but it makes the journey easier for the patients you know the struggling you know when we're talking about food i mean not wanting to eat something and things like that in the context of therapy you are able to educate patients about what to eat what not to eat and even the emotional role that food play is the psychology of eating so there's the emotional role there are times when yes when there are certain things are not okay to eat but at this particular point this patient is ill has no appetite can't tolerate anything and is asking for something that we would say oh that's not healthy don't take it it's not at that point and we say the patient should not eat it a part of support you can give on a therapy is play along with the patient flow with what is on ground let the patient take something in best strong enough have have the necessary energy and then you go on and so sometimes the kind of support or the kind of psychotherapy that patients needs is supportive psychotherapy meeting the patients where they are and just going with them as new things unfold tackling each problem as they unfold thank you doc because i can see that's one of the reasons why i actually like this conversation because it's not a one box fits all there are no straightforward rules about how we go um i think a lot of people have missed the point that we also have the occupational therapies the physiotherapists you know everybody has put us in this box of just the disease but the occupational therapies a lot of people don't even know for a lot of cancer patients is a requirement because with time we may not be able to walk properly or or use our hands to even feed us so people don't realize that and i think it's an important aspect that needs to be looked at so what would you say you brought up something that was that interested me just now you said something about end of life it's a no no area in low middle income countries especially countries like Nigeria however it is an important part because on the cancer journey nothing else is promised anymore how do you get through to families because if if if there's no preparedness especially young families children are really really in a very bad place and somehow it is not addressed then what happens how do you deal with that or how do you help the families especially those with young young or middle age adults those are in school that require i think you get what i'm trying to ask i do i do um personally what i do is i try to be um empathically frank so i'm frank um i tell them what is as is but with empathy in such a way that we know what is but it's not as if you are rubbing salt into the injury as you are presenting this you are also explaining the rationale for xyz i'll i'll speak particularly say in terms of pediatric cancer and you have a child with cancer and the parents are there in a dilemma wondering whether to sell xyz to cure this child of the cancer which is already advanced and most likely incurable anywhere in the world and so a way i'd normally approach it is ask the patients or ask the parents because oftentimes with pediatric cancer the parents is like the focus of intervention you want to ask the patients what is it they know about this condition and would they want to have more information about these before they go ahead and sell whatever it is you want to sell and so i've been clear that they want to know have more information i'll tell them plainly in a situation like this only one out of ten will survive we don't know who that one is and that is why i wouldn't say give up caring for your child but you have other children i would not say sell all you will use to take care of them to support this child i mean to treat this child for a disease we are not sure can be cured you know one out of ten but in the meanwhile show this child love be present create memories that would outlive this child right now but don't think about tomorrow don't think about this child we shouldn't die as long as this child is still breathing this child is still breathing engage actively engage as much as the child is able to engage and some can apply with adults adults having younger children i mean the patient if cancer patient having younger children or grand children engage with them in the way you can because that is one of the create one of the ways we can create meaning in life despite cancer once there is cancer and the patient chooses to withdraw to disengage then there is a problem but even when you are immobile you know you can't move you are right there on the bed even right there you can engage you can find a way of engaging with life i have a patient once will say that uh at the point she had um this cancer has to do with the truth she couldn't talk because she was going to die even as she was on that bed she decides what is eating in the house she can't cook it she can't eat it but she engages she decides what you go to market to buy what you cook for a husband an x y z by the time i met her she was better she in fact i think she was in remission she could talk and things like that so being able to engage in life gives you a sort of creates a sense of meaning and that's what i try to infuse in patients when they are at the end of life even if it is just 60 seconds you have or 60 months or 60 years ensure we engage in life and that is what um a sacrificial expert would help the patient to do at the end of life thank you doc because that's that's very interesting a lot of people are you actually yourself hit a lot of nails on the head because a lot of people don't know why i actually do this this this awareness campaign if they really realize that it is out of engagement rather than sit down and feel sorry for myself um for those who don't know i live with the disease i have about 24 seven years seven years in august and i'm still here thanking god for each day even though it's a state for cancer well well at the end of the i am so grateful and i thank you for sharing this because i want people to hear that you have to engage on your good days in your bad days engage you nobody knows tomorrow know all our hands our lives are in the hands of god and he's the only one that will decide the day we're going so why are we dying before our time just engage thank you i love that word engage oh my goodness that's my that's going to be my theme now on this topic engage so what finally what my last question my last question is going to be what next for a cancer patient with everything especially focusing with Nigeria um what next for me is that every clinician working in the cancer space every family members and friends and neighbors of cancer patients should do the beats even the government the NGOs everyone should do the beats they can so that living life despite cancer we can they can live that life well that living life well despite cancer will become a norm in Nigeria rather than an exception that would just be my parting words that we should all actively ensure that cancer patients live their life well live their life meaningfully as much as it's possible despite their cancer thank you you've actually said you've actually said oh i really appreciate it because you were speaking to me as well i should live well i should live well so i am actually very grateful those are your parting words and to all of us out there who are listening um that is actually the truth that is what we have left and no matter what there are no promises but one thing is important make sure your life has meaning once it has meaning it's not about how many minutes or hours or days or months or years but it's how useful or how well you serve society serve humanity and made a difference for those around you oh this is an also i've actually enjoyed this and as you rightly point there are lots of things we can ask and talk about and hopefully i'll have you again on dr elisabeth because this conversation on the psychosocial is very important it's something that draws me a lot because i have benefited from all your different medical teams yeah that help cancer patients so honestly this conversation has helped and to everybody online i want to say thank you to all of you um watching us today in different from your different platforms on spaces and on television and on the youtube channel any way you're watching want to say that together we fight together we win if we're all together in this working together somehow you give us the cancer patients a lot more strength than you actually realize because we draw strength from you and if you are sorry for us then you are weakening the little strength that we have so thank you thank you dr elisabeth i really really really enjoyed this conversation so everybody following us on our social media handles you can find the comode cancer foundation on any of them ccm instagram facebook youtube channel this video will be out on the youtube channel as well so everything you will see you can find us share it with your friends share it with family i use it as a tool we don't do this for for just creating their awareness but as a tool to help others doc thank you and you can imagine it really it really has made my day it really has made my day because honestly it's a very tight conversation as you appreciate yeah thank you i really appreciate you thank you very much so everyone you can follow us on on any of our social media platforms comode cancer foundation together we fight together we win we look forward to seeing you again soon as we go on to let's talk about cancer let's talk about it cancer it's it you know it's that disease thank you everyone for watching us today and we look forward to seeing you soon