As the festive season draws near in Singapore, we are thinking about the warm and love we have seen in our patients for the year. At OncoCare Cancer Centre, Singapore, we are frequently amazed at the support that spouses or partners of our patients show to them. The best cancer care involves harnessing the positive energy from the family. Love and care is best demonstrated through actions. Cancer can be a dreaded disease, the human determination and resilience removes the fear. It is not faced alone but with the strength of two, it is easier!
Of the patients who attend our cancer clinic, it is the women who frequently shed tears rather than the man. However, the need for support when told of a cancer diagnosis is needed for everyone. I have written this with the women in mind, but these work for man too!
1. Hug her
I remember this patient with ovarian cancer whose husband is always present at our discussion and consultations.He would hold her hands tightly when we are going through the results of tests. The gestures are not often noticeable but the touch and comfort is felt by her. Hugs have been reported to reduce stress hormones, make a person less anxious and say that “I am with you in this”. The prescribed frequency is daily as needed.
2. Make arrangements to come with her to the appointments
I am always encouraged to see a spouse come with a patient. He may be on his phone outside trying to settle work matters and join in later but just being there shows his support. In modern day Singapore, when many families have both husband and wife who work, it is not taken for granted. The patient can get medical leave but for the spouse, leave to attend appointments may not come easily.
Even if it is for the first few appointments, it helps to have an understanding together about what is going on. There is often quite a bit of information to assimilate and having another listening ear to clarify what was discussed is important. The patient herself might sometimes be emotional and might have forgotten some details of the discussion with her oncologist doctor. An additional listening ear being around is good.
3. Learn about the illness and treatment
There is a lot of information and misinformation on the internet on cancer. Myths abound and recommendations on what supplements, herb, diet, and lifestyle changes are available a click away. However, there are reputable objective sources of information and there are subjective personal experiences that may not apply to the patient. Differentiating the wheat from the chaff is not easy, and learning involves time and reading.
4. Listen to her
Husbands are sometimes surprised at what troubles the wife. Some frequently associate the concerns to be related to the chemotherapy. One lady with lymphoma reported that her husband was not helping much as her main concern was her son’s PSLE preparation during the period that she is undergoing treatment. She is concerned her fatigue or nausea might affect her tutoring her son and was hoping her husband could help out.
Other concerns might be more intimate. Patients who undergo surgery for cancer may have physical changes and a different body image. Colostomy (an opening or stoma created for stools for colorectal cancer), mastectomy (breast surgery), hysterectomy (removing the womb) and other surgeries can create physical changes in a woman. In addition, hormonal changes related to disease or treatment can also affect intimacy and a patient’s sex life. Listening to a spouse’s needs is the beginning to supporting that need.
5. Buy her flowers
Flowers are lovely. It is often a winning formula when you do not know what else to say or do. Some husbands might shake their heads and say it is an unnecessary expenditure, but it works!
6. Shave your head to support her
Alopecia or hair loss is common in many chemotherapy regimens. It also happens for radiotherapy to the head. Chemotherapy induced hair loss is important to patients. The type and dose of medication or chemotherapy determines the amount of hair loss. There are chemotherapy drugs that do not cause hair loss, but sometimes it is not the most effective drug to use for that cancer.
Maintaining a healthy body image with good support from family and friends is important. Shaving one’s head is asking a lot of some husbands… I had a lung cancer patient’s husband remark that since he is balding now, each strand of hair he cuts is even more precious!
7. Prepare the support team
Concerned friends and family want to know what is going on. Some patients are more private and do not wish to let others know of their illness or treatment. Someone is needed to be gatekeeper for information about her condition. This person is frequently the spouse of partner.There are well-meaning friends and love ones who would be helping out or offering to pray for her condition as well. The patient herself might be too tired to be regulating or updating on treatment. So a supportive spouse can be a great assistance. The spouse himself is part of the support team too and taking care of his own health, having adequate rest, is just as important.
8. Household adjustments
There might be a need to take over or manage some of the chores that the spouse had been doing such as fetching the children, doing tuition, applying for leave, settling household bills or arranging meals. In Singapore, most families are small and harnessing the help of friends and relatives to do little bits of work can make things more manageable. Other household adjustments like moving the telephone or TV remote for a spouse who might be bed bound for a while, toilet grab bars, anti-slip mat for the rooms can be easily arranged.
Clinic visits can be long (at OncoCare Cancer Centre, Singapore, we try to reduce the time patients spend in the clinic if we can) and visits for blood tests, CT scans and other appointments may sometimes require a friend or relative to accompany if a spouse cannot make it.
9. Check on the paperwork, finances
Not being prepared for sudden additional healthcare expenditure is stressful. Not being aware one’s medical insurance coverage increases the stress! Several patients had in their youthful days bought extensive medical insurances in Singapore and have not touched the documents since. Some are already well covered but fret about the cost of treatment and are not aware of cancer finance. Many of our patients are not aware that they can claim from medishield life for private cancer clinics too!
Medical or cancer financing terms such as : co-payment, deductible, medisave, medishield life, integrated shield plans, etc are often alien to patients until they are needed. Integrated shield plans for AIA, Prudential, Great Eastern Insurance, NTUC and Aviva cover chemotherapy for Singaporeans, above what medishield life covers. Other private or company insurance plans cover for treatment too. Patients also frequently look at the wrong category. For private cancer treatment cost support, the amount is under outpatient chemotherapy treatment in medishield life and other private integrated shield plans. (At OncoCare Cancer Centre, Singapore, we do e-filing for outpatient claims which lessens the stress for patients)
In many Singaporean families, the husband is the one managing the insurance coverage for the wife and children. Digging out the old files and documents to check is needed for peace of mind.
Many companies cover their employees with benefits and these could be checked with the human resource (HR) department. For some patients and families, it may be a time to review wills and do estate planning as well.
10. Join in the new eating preferences
Taste and smell perception is an important and enjoyable aspect of eating, particularly in Singapore. In that sense, this makes cancer treatment in Singapore so much more difficult for foodies! Side effects of cancer treatments and radiotherapy, as well as cancer itself, can cause altered sensory perceptions in some patients. Some chemotherapy medications used for common cancers like lymphoma, breast, lung and colon cancer affect the taste buds. Other cancers affecting the gastrointestinal tract such as oesophageal cancer, stomach (or gastric) cancer, oral cancers is associated with significant weight loss after surgery or radiotherapy. Easy satiety or feeling full very quickly happens when the stomach is reduced in size following surgery. It can also happen when food tastes bad to the patient or following certain medications and radiotherapy. Being able to understand and plan meals accordingly shows sensitivity to the spouse and encouragement.
In other situations, putting on weight is a real danger! Some patients may require steroids as part of their treatment. These medications are used for non-Hodgkins lymphoma, myeloma or as premedication for certain chemotherapy drugs such as docetaxel (Taxotere) and paclitaxel.
This increases the appetite and for one patient, it affected her eating habits. She might have craving to eat certain food but at certain times she would refuse when the food is served. Her husband would dutifully finish the food for her!
“Expert knowledge means better care for cancer”
Dr Peter Ang
MMed (Int Med)
FAMS (Medical Oncology)