 Welcome to another edition of cancer with Dr. Denise Edgeall in partnership with cross TV Africa We want to thank you for joining us again and welcome you back for those of you who are joining us for the first time Thank you. And for those of you that are just and I have been with us before we welcome you back And we hope you have a really nice time and it's the season of goodwill So let us now think about those who are going through cancer and the mental health challenges that they face as a result of The disease Thank you for joining us and let's go. So today in the house. We've got dr. Ralph and make up Doc, thank you for coming in and throughout the conversation. I will refer to him as doc for the entire conversation Um, and we'll take it from there Doc, how are you? Can you hear me? Yes, I can thank you. Thank you for having me Welcome and thank you for accepting to come on because we don't take people like you for granted I'm not a medical doctor. I am just a doctor book. So I want to say thank you for coming in So let me give you a brief background of who dr. America is He's a native of a Neucha south local government of deltas state and started his school in Washington, DC, usa where he grew up until 1978 He said as secretary of the medical and dental consultants association of nigeria Lagos chapter between 2012 and 2014 and then chairman between 2014 and 2016 He's currently actively engaged in psychiatry work in the uk and will be joining us to talk about Cancer and the mental health the psychiatry or psychology whichever way we look at it He's going to guide us and tell us how we need to navigate. So doctor welcome and once again I want to say thank you for engaging with us. We appreciate your time and we do not take it for granted So are we ready to go? Yes, we are All right, so let's start with it. What is the role of a psychiatrist in the journey of a cancer patient? so psychiatrist is meant to be Part of what we call the psycho oncology team which is a specialized field in psychiatry that deals with The psychological aspects of people who have cancer So the the psychiatrist is one member of a multidisciplinary team which should include psychologists counselors And other therapists and so the journey usually should start from The period when the person is going through the diagnostic process Because they are you can say there are four stages The first would be of course the person's first experiences symptoms And because most cancers have non specific symptoms It's a journey before eventually someone says oh, let's investigate this person for cancer And so that's where the journey actually starts ideally Before when the person is going through the diagnostic process They should have psychological support because there's a lot of anxiety provoking Exercise the person is going through what we can call a grief reaction all through That is the person first could go into denial Okay, and then after that some people will go into Anger they're angry Angry at god angry at things, you know and then some will go into the stage of bargaining And then that's when they bring in religion. No, if you god if you heal me I will never do this. They're trying to negotiate with god And then eventually they go into the stage of grief Where they've now accepted that well, this might just be what's happening to me And then the final stage is acceptance Now people could go through this in the diagnostic phase Or actually in the treatment phase or in the recovery phase So the involvement of psychology and the psychiatric team Is really crucial right from the beginning once the diagnosis has been made Through the period of treatment which can which comes with his own psychological challenges as well And then also the recovery phase And thank you You just woke me up now. You see it's whenever things like you ever start like this It makes me very happy because you start you start helping me So I'm going to ask you so is the role of the psychiatrist the same? It's not the same as the cycle Psychiatrists and sociologists. They're not the same. No, it's not So can you differentiate? Yeah, yeah, so the psychologist mainly deals with Helping the person by way of non medication approach Okay, so talk therapy Supporting them and then if the person is going through mild periods of depression just talk therapy The psychiatrist gets involved when the person now needs medication for psychological issues they're going through So the psychologist does not prescribe medication The psychiatrist prescribes medication So some people may only need the help of the psychologist But if it's getting more severe then the psychiatrist gets involved Wow, that that is an eye opener because You've just differentiated. So I've always had the psychologist in my journey as the cancer survivor, it's interesting because You know when I talk to you Medics you help us you help me to be able to Help all of us that go through it understand that it's not about just There's no one one size fits all and there's no particular um process that works because I've had counseling um during covid and I think that was as a result of having my um five year You know where you get to five year mark and you're trying to see am I going to cross this line because apparently five years is a key line for cancer patients And then I've just gone to book myself back into psych into the cancer law and I've said to them look is I'm not coping anymore And so to all those who are going through cancer, please be like me accept it when you're not coping it doesn't it doesn't matter It doesn't people say it's stigma cancer already is stigmatized. So just take the best help you can I'm going to ask you the next question. So at one stage of cancer treatment is a kind of psychologist needed because based on what you're saying We have different stages There are different stages of the process which is correct. I think almost all of us will say We have gone through Two maybe three of the five you mentioned So at what pace say do we really need to say look look look is getting hard as a cancer patient or family members of a cancer patient Looking at their relative or friend going through it and can't identify. What is it? They need to Whether they need to know they need help Ideally once someone is going through the diagnostic process The psychologist and counselor should be involved because there is pre diagnostic counseling That helps people go through the difficulties the anxieties, you know, the sleepless night in somnia all of that That's where they should be involved. So you don't wait It should be right through the the beginning of the journey through the diagnostic process Into the recovery process through the treatment process. So it's from the very beginning. That's the answer Whoa, okay. Okay. Okay. So what emotional um disorders? Can a cancer patient Develop and I'm asking this. I'm trying to think to myself. Would that be where we start crying? Is that the stage where we're? Yeah, so yeah, so so it's it's um we we Common ones are anxiety Okay, the illness anxiety the person is worried Some will have physical symptoms of anxiety tremors palpitations on all of that Then there's insomnia sleeplessness Okay, that's also one of the common conditions and then you have depression people go into clinical depression Where that's when they're crying their mood is low and all of that and some may at some point during that period Especially if they're not able to get to the stage of acceptance. Some of them feel suicidal and then Also, some have what's called adjustment disorder. Okay, this fan is difficult to adjust to The the changes that come with the con with the treatment and sometimes the condition itself So it's it's like you mentioned before it's not one size fits all because um the treatments I mean as you know Various varied some will require radiotherapy some chemotherapy and some surgery. So these treatment modalities themselves Come with Their own challenges which some people need support getting through so the common things are Rarely very rarely you have people experience things like a delirium or psychosis Where there may be may hear voices or things that lose touch with reality That's you that may be related to the treatment Or the progress of the cancer itself is if it's such that affects the brain. So these are the common ones If it's such that makes the brain Yes, so some some yeah in sense that you know some cancers Are localized especially if they're picked up early So in those ones and that's one of the ones that they will usually recommend Surgery or targeted radiotherapy Now if so for unfortunately the person has maybe stayed in stock in the state of denial And they haven't started treatment early And the cancer has now disseminated Has spread through the body if one of the parts of the body that the cancer cells get to includes the brain Then the person could have more severe psychiatric conditions. That's what I mean by that That's why early treatment is really crucial Thank you, you know you're bringing a reality to me Which I'm hoping that other people who are going through this will understand that They're not on the journey alone And it's nothing It's not just about them because okay, I'm going to let me put a question that's just come You know, there's this challenge with them It's not my portion And it's a very Afro-Caribbean statement When we bring in religion And that's what you call denial However For us that goes through it. Is it really about denial Or is it about All we can see is dying because No matter how we want to be politically nice or correct about this Cancer patients live in the fear of dying And it's a reality that we have to accept So in your in your from what you're saying What how do you think we should Yes, I see it's it's it's Those the processes the stages that I mentioned They are natural There's hardly anyone who will not go through those stages. It's normal But it's being stuck in those stages. That's where the problem is So yeah, the denial it comes naturally. Nobody wants to immediately accept But we should you stay stuck there if you stay stuck there, then that's where your dread which is dying becomes Greater likelihood because you've not started treatment. I remember As a young doctor one of the when I was not into psychiatry So we're doing all all all fields then as a young medical officer And I had a cancer patient who had press cancer And she told me she was so she was in this ward because her cancer had Spread and she didn't come for treatment early And so they thought she had now developed stroke. So she went to a stroke ward Now while I was Of course as a young doctor we would administer the medication and all of that and so she told me She had gone through these stages. She had now gotten to the stage of acceptance and she said That she is funny to her that the fear just what you said is always oh am I is this going to kill me? Am I going to die? But she was in that stroke ward and saw people who didn't have cancer People who were younger than her who had stroke and died right there and she said so she's living. She's alive Fearful of death, but these people Who had suddenly had had blood pressure had stroke and died They you know so death can come But it's the risk that's I mean it is now the difference. Yes. We know that there's a there's slightly I mean there's a greater likelihood When you have some conditions compared to others, but everyone's in the fear of dying So it's how you address that in terms of doing what you should do which is receive treatment That's what reduces your risk. That's what reduces the likelihood So to stay stuck in denial You're only increasing the likelihood of dying and thank you for that Nice starting because it's it's it's quite relaxing when When I'm not stressed thinking about what's what's what's am I supposed to be doing here? So how can a diagnosis of cancer affect the social life? of a patient And this is important. So I'm going to let you start and then I'm going to add to it Yeah, so the diagnostic process involves again It depends on the type of cancer that is suspected that the person has So that will guide the how invasive that is how How Intrusive the diagnosis is some may require surgical, you know diagnostic procedures Some may just require blood tests. Some may require x-ray That's that's difficult for a lot of people And and people go through emotional challenges anxiety that is called illness anxiety. Should I should I not Should I go through this or what about it and sometimes the procedures themselves come with their own risk? Okay, so that's also things that people have to deal with or is this is it this procedure? Is it worth it? Should I go through it? Not forgetting that the cost especially in our society where people have to pay out of pockets That costs a lot and you can drain people doing several tests You have sometimes you have to journey to different centers from where you were far from where you live And that takes its own toll on your finances your family Okay, your your caring role if you you have children and things that so these are things that the person is having to go through So beyond the illness itself There are associated factors stressors That can affect one psychologically and that's why the need for support organizations Systems in place that support people which unfortunately we don't we don't have enough of but these are things that Ah doc, you know you hit a lot of key points for me going from this point um, and I think this is where a lot of people get it wrong because One of the first things that I picked up from the world cancer congress 2022 Was when I had to be asking about our finances a lot of people do not realize that statistically globally cancer patients become broken two years So they lose their homes. They lose their means of livelihood they Become poor from a very comfortable place all of a sudden cancer has hit them and Yes, you are right living in where for instance we come from It is why we hear stories from survivors about Having to take what they call half cocktails and these cocktails and you're wondering what the ought is all this the disease is I'm I get sad and it's I think about it because somehow it's like our lives don't matter I say shame to have to say but If we don't have the money we don't you just that's it, you know, and it's hard to accept But it's a reality That we have to be aware of And with this therefore comes emotional disorders, which you then have to treat am I correct? Yes, that's it. Yeah Okay, and how would you now go about that because a lot of it is emotional Is it's how we feel? I mean when I found myself last week With my my team and I was told my chemo had to stop because it was affecting another organ I I woke up and realized that What does that mean and no matter what I'm still human No matter how strong you want to be you're still human You've got emotions and you've got to get past them Yeah, that's it. And that's why the support is key because there's no prescription. There's no I mean that fits all You know, so it comes with the circumstances And so that's why it's like You need someone to hold your hand through the journey because There could be different ends some people's journeys are different and that's what that's where You know the One other thing that's really important why it's it's key to I know it's difficult but to be hopeful because there's a lot of Where we are in terms of constant treatment Today is not where we were 20 years ago It's not where would the world would be five years 10 years down the line There is constant research because we recognize it's a big problem But the thing so one should Be hopeful first of all that yes, you can beat that five year line. You can beat the cancer because if you Don't go with that mindset and you already give up Then you won't see that you won't you won't get there because you've given up And this is not just with the person who has the cancer But with the people who are treating them because we have um Not just the person who you said the word cancer what comes to mind is for a lot of people is deaf You understand am I dying or this is it? It's not just the person who has the cancer, but even people who treat them some people That's why we talk about the the the needs to train Those who are treating people Because the body language of some people is like oh well, what's the point? And if that's the body language of the person who's supposed to be giving you hope Who's supposed to be treating you and that's a problem So and that's where the whole stigma is the stigma isn't just the person who has the cancer But even people who treat the person who has cancer some of them feel stigmatized. Okay, they make you feel that This is this is a waste of resources Which is which is wrong, which is a very wrong a message which um, some people not by not necessary by what they say But the body language and if you're passing that body language to someone who has cancer Then what do you want the person to feel? So that's why it's that's where the role of psycho oncology services come into play Unfortunately, we don't have much of that in our country And that is a key issue that we have And we have to accept Yes Yeah, because if you look at it and I I look at it from I'm very realistic, which you appreciate um about this challenge because We are stigmatized no matter what the world says and I think the world is now learning to understand that cancer patients are stigmatized because even in our own Nigerian culture There's already an issue once you once somebody knows remember the family has had cancer You find people saying you can't marry into that house because that they will give you cancer as if cancer is Move from one person and that advocacy really has played a big role in that i'm going to ask you one question that It's not so much or is it about how people Cancer patients access psychiatry and is it a very expensive access For people, you know, because we already have to pay the kakimo bill We have to pay our transport around we have to pay all these blood tests. We have to pay. Yeah, we have a lot to pay Psychiatry as well. Is that also part of the costed bills that we have to pay especially in Nigeria It's it adds to the cost I mean that's I won't I mean we can't deny that It's but it you now have to look at the cost benefits of it being In a better state of mind improves your response to treatment for the cancer So therefore If even if it's good it's going to add to the cost on the long run It's more beneficial If your mental well-being is better Okay, is in a better place. You're more likely to respond better to it whether it's chemotherapy Whether it's Radiotherapy all the treatment modalities, which means you're likely to live longer Which means your quality of life is likely to improve So that's where the issue is would you want to Not do that because the immediate cost now Is is a challenge whereas in the long run it would make you better So no without a doubt it's it would add to the cost, but I can tell you that it's less Expensive compared to the other treatment modalities. Now, how do you get access to? Right now in Nigeria, I mean most cancer centers or treatment centers Do know how to reach a psychologist a psychiatrist because most of them one Largely situated in Teaching hospitals or multi-special centers So usually what what what we what we're trying to do is work with the oncologists Okay, the radiotherapists and all the others to Get them to spot signs That Will alert them to the need to oh, I think you should see a psychologist Oh, I think you should see a psychiatrist. So all the all the person needs to is ask them If they've not spotted it ask them Do you have access to a psychiatrist or psychologist? I could see Do you have access to a psychology team that can support me ask? That's what I would say I was just about to ask you my actual big last question Give me three things That will help So the three things I'm going to try and narrow it down I want one for the government to do for us because honestly with like you said the cost Implication is is one of the most heartbreaking which which is why statistics is saying 70 to 80 percent of people we cancer in developing countries More likely to die, especially places like Nigeria than anywhere else as against like England where 70 to 80 percent are more likely to live um Give me three Points that we want to take away that we hope people will hear one for a survivor One for the government and the government the first one is the major one and one for The medics the people that care for us Three things that we get right For the government, I would say They should expand the national health insurance scheme To include cancer treatment That would go a long way in easing the financial burden. It is not it is not covered currently If they can't get cancer treatment Covered at least to an extent on in the national health insurance scheme They should ensure that psychological treatment is covered So that's what I will ask the government to do on the on the on the part of the survivor. I would say during this festive period Try some mindfulness You can go on youtube on the internet and see shots you know Talks or trainings on mindfulness Mindfulness will really help anyone who's a survivor Okay Then for the people who treat them. I will say Mind your body language Be psychologically aware and psychologically minded even though you're not a psychologist or psychiatrist Do some training In the emotional disorders that are associated with psych Cancers it will help you To provide better care to people you're treating. So those are the three tips I'll give Thank you very very much for your time. I am very very I've run out of a lot of time, but Let's see how we'll get all this together for the general populace so that we can actually learn It is a season of Christmas and the new year and I want to say to all our viewers We really hope you have a lovely lovely Christmas And I will be speaking to you before the end of the year When we will also look at other things that are important for you as cancer patients to add Special guests today doctor. I want to appreciate you appreciate your time And everything and the time that you spend Guiding us and you will see this program on and everyone else you can follow us on the commode cancer Foundation, we have it on the web. We have a website. That's the name. We have it on We have a youtube channel and this video will be out there and all other videos that allow you to Engage and find the facts about what's going on because they're always medics or patients that are talking not um unqualified medics that have Recognized that are recognized in Nigeria. So don't worry about it. The facts you're going to get are from professionals Who are specialists in this field? Um, you find um snippets and stuff on our facebook page or youtube follow us shares and Click on the share button also also subscribe because Together we get the message out. We save lives I hope that we will see you again before the end of the year And I wish you all a lovely merry christmas in advance Please pop in and visit somebody who's going through cancer. Just have a good laugh Jam and eat jello fries or whatever and just be happy with them. Have a lovely christmas and thank you for joining us