Group Psychosocial Therapy for Cancer Patients
Reynaldo O. Joson,
MD, MHA, MHPEd, MS Surg
Jacqueline I. Joson, MD
Ma. Lilibeth R. Tumambing
1999
Abstract
This paper contains a description of a mode of group psychosocial therapy for Filipino cancer patients. It includes suggestions for longer sustenance. The reactions of patient participants and their relatives to the group therapy are also represented.
Group Psychosocial Therapy for Cancer Patients
Reynaldo O. Joson,
MD, MHA, MHPEd, MS Surg
Jacqueline I. Joson, MD
Ma. Lilibeth R. Tumambing
Introduction
Treatment of cancer consists of two inseparable parts. These are the treatment of the cancer itself and the management of the person who has been afflicted with the cancer. Surgery, chemotherapy, radiotherapy, and other modalities of cancer treatment constitute only one part of the treatment. The second part, which is as important as the first, is psychosocial therapy, which consists mainly of emotional and behavioral support.
Psychosocial therapy may be done within and outside health care centers. Health care centers may be the physician's clinics, hospital rooms, and clinics specializing in psychosocial therapy.
Psychosocial therapy may be done by the health care providers such as physicians and nurses and nonhealth care providers as well, such as relatives and friends. Self-help groups providing psychosocial therapy are those organized primarily by patients themselves. Psychosocial therapy may be done on an individual patient basis or in group.
This paper describes a mode of group psychosocial therapy for cancer patients, how it was designed for longer sustenance and how patients and relatives reacted to it.
The Annual Get-Together of Cancer Patients as a Mode of Psychosocial Therapy
From 1988 up to the present (1999), on every first Sunday of December, upon the invitation of the authors, a group of cancer patients accompanied by their relatives and friends would troop to a theatre in the Manila Doctors Hospital for an annual Christmas get-together. The program would consist of the following: registration; introduction of members of the Cancer Crusaders Club; sharing of experiences both in public as well as on an individual basis; inspirational talks; entertainment (songs, dances, raffles, gift-giving); awarding, lunch, and then group picture taking.
The Design for Longer Sustenance
The present design of a mode of group psychosocial therapy was influenced by the senior author's (ROJ) past personal experience. In 1979, when the senior author was in his senior year of surgical residency at the Philippine General Hospital, a government hospital, he formed the Philippine Stoma Association [1, 2]. The members consisted of patients with an abdominal stoma, such as colostomy, ileostomy, and ileal conduit. Most of the patient-members had permanent colostomy as a consequence of cancer.
There was great difficulty in maintaining the association and administering the intended group psychosocial therapy. The Philippine Stoma Association lasted only for two years. The major lessons learned from this experience were:
1. Getting the members to come together on a regular frequency and often at that, such as monthly or even quarterly, would be difficult, if not impossible. The difficulty could originate from both the organizers and the members. Lack of motivation and commitment, hesitancy for group dynamics, conflict with priorities at home and in work, and travel expenses were the major causes of difficulty identified.
2. News of death of officers had a dampening effect on the zest of members for a group gathering.
3. Attachment to and rapport with organizers tended to promote attendance and participation.
4. An imposition of a fee could deter participation.
In 1988, when the authors decided to put up the Cancer Crusaders Club, the following design was adopted aiming for longer sustenance:
1. The central group activity would be an annual get-together. Other peripheral group activities might be organized during the year as the need arises.
2. There would be no officers. The authors would serve as organizers and coordinators.
3. The members would primarily consist of patients of the senior author. However, patients of other physicians would be welcome.
4. There would be no membership fee. The only requirement would be a manifestation of intent to join. There would be no fee charged for the annual get-together. The expenses would be taken care of by the authors.
The Sustenance
Since 1988 up to 1999, 12 years now, on every first Sunday of December, there has been an annual Christmas get-together of the club members. The participants averaged 100 per gathering, 50 cancer patients and 50 guardians. Of the average 50 cancer patient participants per gathering, about 20 were regular annual attendees; the rest were newly treated cancer patients. Of these 20 regular annual attendees, 5 had been attending the gathering for the past 12 years without fail.
The patients who attended were mostly those who had been managed by the senior author. The bulk of patient attendees had breast cancer (85%), thyroid cancer (10%), colorectal cancer (5%), and others such as melanoma, lymphoma, soft tissue sarcoma, and osteogenic sarcoma (5%).
Author MLRT would take care of the invitations of members and entertainers as well as the whole program. Author JIJ would take care of the foods and financial support. ROJ would serve as a stimulus for the members to attend.
The total expenses would ranged from PHP 15,000 to 20,000 ($480 - $500), shouldered by the authors. There would be occasional voluntary donors. Manila Doctors Hospital would provide the venue for free.
The Reactions of the Members
In 1996, the authors conducted a survey to get a formal feedback from cancer patients and their relatives who had attended the annual get-together of the Cancer Crusaders Club. The questionnaires are seen in Appendices 1 and 2.
The main objective of the survey was to determine the effects of the annual get-together on the cancer patients and their relatives.
Feedback from Cancer Patients
The number of respondents consisted of 30 patient attendees.
Practically all respondents liked the usual programme of the annual gathering. Two mentioned that they felt shy talking about their experience in public.
Practically all considered the gathering to have the following beneficial effects:
1. It made them feel stronger in living through life with a cancer.
2. It boosted their morale; it boosted their hope for living.
3. It changed their outlook in life for the better.
4. It made them feel like an ex-cancer patient already.
5. It helped them accept their cancer.
6. It made them realize that they are NOT the only persons on earth with a cancer.
7. It gave them an opportunity to share experience with and to listen to the experience of other cancer patients.
8. It made them learn more about cancer in general, the cancer that they have, and about patients with cancer.
9. They felt the get-together was a reunion for cancer patients.
10. They looked forward to attending the get-together each year.
11. They looked forward to getting the most durable award.
12. The gathering was a form of therapy for them; it provided psychosocial support to them and their relatives.
Nobody considered the gathering to have harmful effects.
Feedback from Relatives
The number of respondents consisted of 20 relative or guardian attendees.
Practically all considered the gathering to have beneficial effects, like those mentioned in the feedback from cancer patients. Nobody mentioned the gathering had harmful effects.
All of them attended the gathering to accompany their cancer relatives who wanted to attend. Three mentioned they encouraged their cancer relatives to attend.
All considered the get-together as helpful to them as guardian in the care of their cancer relative and by attending, they also learn more about cancer and cancer patients.
Comments
In the Philippines, there are various support groups for cancers. To mention a few, aside from the Cancer Crusaders Club, there is the Philippine Cancer Society Cancer Support Group; LAKAS (Laban sa Kanser), Coalition for Breast Cancer in the Phillippines; the cancer support groups of St. Lukes' Medical Center, Philippine General Hospital, and Rizal Provincial Hospital.
All these support groups have one common objective, that is, to provide psychosocial therapy for cancer patients. Most of these support groups are led by lay persons. Some by oncologists.
All these support groups have one common problem, sustenance. The factors affecting sustenance of these support groups have been mentioned in the early part of this paper.
The authors have described a design for sustenance of a group psychosocial therapy. Being in continuous existence for 12 years is enough proof of the effectiveness of the design in sustenance used for the Cancer Crusaders Club. Sustaining it is not very taxing for both the organizers and the participants, in terms of time and financial resources. At the same time, the objective of psychosocial therapy of cancer patients is always achieved year in and year out.
Summary
This paper contained a description of a mode of group psychosocial therapy for Filipino cancer patients. It included suggestions for longer sustenance. The reactions of patient participants and their relatives to the group therapy were also represented.
References:
1. Joson, RO. Problems and Rehabilitation of Filipino Stoma Patients. J Enterostomal Ther (USA) Sept-Oct, 1983;
2. Joson, RO. Problems and Rehabilitation of Filipino Stoma Patients. J Phil Med Assoc 6(1):13-17. Jan-Mar 1985.
Questionnaire 1 || Questionnaire 2
Questionnaire for Cancer Patients
Name _____________________________________________________________Age ___ Sex ___
Pls.check under which classification you like to be in and specify the type of cancer you had before.
|
|
Type of Cancer |
|
___ Cancer patient |
|
|
___ Ex-cancer patient |
|
|
___ Others ___________________________ |
|
1. How many times have you attended the Annual Get-Together of the Cancer Crusaders Club? _____ (1x to 9x)
2. The following activities are usually done during the Annual Get-Together of the Cancer Crusaders Club. Pls. select two activities which you LIKE most and which you DISLIKE most and pls. give your reasons.
|
Activities |
LIKE MOST |
DISLIKE MOST | |
|
Sharing of experience with other patients in public (on the stage) |
|
| |
|
Sharing of experience with other patients in private (on the seat) |
|
| |
|
Entertainment (songs and dances) |
|
| |
|
Raffle and gift-giving |
|
| |
|
Inspirational talk |
|
| |
|
Most durable award |
|
| |
|
Lunch |
|
| |
|
Group-Picture Taking |
|
| |
|
Others: _________________________ |
|
| |
3. Pls. consider each statement below that describes the effect of the Annual Get-Together of the Cancer Crusaders Club and check if it is APPLICABLE to you and to your relative. For the checked statements, determine whether they have positive (BENEFICIAL) or negative (HARMFUL) effect on you.
|
|
BENEFICIAL |
HARMFUL | ||
|
1a. It makes me feel stronger in living through life with a cancer. |
|
| ||
|
1b. It makes me feel weak in coping with my cancer. |
|
| ||
|
2a. It boosts my morale. |
|
| ||
|
2b. It lowers my morale. |
|
| ||
|
3a. It boosts my hope for living. |
|
| ||
|
3b. It depresses my hope for living. |
|
| ||
|
4a. It changes my outlook in life for the better. |
|
| ||
|
4b. It changes my outlook in life for the worst. |
|
| ||
|
5a. It makes me feel like an ex-cancer patient already. |
|
| ||
|
5b. It reminds me that I am a cancer patient. |
|
| ||
|
6. It helps me ACCEPTS my cancer |
|
| ||
|
7. It makes me realize that I am NOT the only person on earth with a cancer. |
|
| ||
|
8a. It gives me an opportunity to share experience with other cancer patients in public (on stage). |
|
| ||
|
8b. It gives me an opportunity to share experience with other caner patients in private (on the seat). |
|
| ||
|
8c. It gives me an opportunity to listen to the experiences of other cancer patients. |
|
| ||
|
9a. It makes me learn more about cancer in general. |
|
| ||
|
9b. It makes me learn more about the cancer that I have. |
|
| ||
|
9c. It makes me learn more about patients with cancer. |
|
| ||
|
10a. I feel the get-together is a reunion for cancer patients. |
|
| ||
|
10b. I look forward to attending the get-together each year. |
|
| ||
|
10c. I look forward to getting the most durable award. |
|
| ||
|
11. It is a form of therapy for me. |
|
| ||
|
12. It provides psychosocial support to me and my relative. |
|
| ||
4. For those who had attended the Annual Get-Together more than once - What made you attend AGAIN? You may have more than one answer.
___ The Annual Get-Together is BENEFICIAL to me.
___ My relative forces me to attend.
___ Others: ____________________________________________________
5. For those who had attended the Annual Get-Together only once - Why did you not ATTEND AGAIN? You may have more than one answer.
___ No invitation/no reminder
___ Problems in travel (distance and expense)
___ Conflict in schedule
___ No companion
___ I am afraid to be called to the stage to share experiences.
___ The Annual Get-Together has a harmful effect on me.
___ I don't like to be reminded of my cancer.
___ Others: _____________________________________________________
6. Comments and suggestions for improvement of the Annual Get-Together of the Cancer Crusaders Club:
Questionnaire 1 || Questionnaire 2
Questionnaire for Relatives of Cancer Patients
Name _____________________________________________________________Age ___ Sex ___
Pls.check under which classification your relative wants to be in and specify the type of cancer he/she had before.
|
|
Type of Cancer |
|
___ Cancer patient |
|
|
___ Ex-cancer patient |
|
|
___ Others ___________________________ |
|
1. How many times have you attended the Annual Get-Together of the Cancer Crusaders Club? _____ (1x to 9x)
2. The following activities are usually done during the Annual Get-Together of the Cancer Crusaders Club. Pls. select two activities which you LIKE most and which you DISLIKE most and pls. give your reasons.
|
Activities |
LIKE MOST |
DISLIKE MOST | |
|
Sharing of experience of your relative with other patients in public (on the stage) |
|
| |
|
Sharing of experience of your relative with other patients in private (on the seat) |
|
| |
|
Entertainment (songs and dances) |
|
| |
|
Raffle and gift-giving |
|
| |
|
Inspirational talk |
|
| |
|
Most durable award |
|
| |
|
Lunch |
|
| |
|
Group-Picture Taking |
|
| |
|
Others: _________________________ |
|
| |
3. Pls. consider each statement below that describes the effect of the Annual Get-Together of the Cancer Crusaders Club and check if it is APPLICABLE to your relative. For the checked statements, determine whether they have positive (BENEFICIAL) or negative (HARMFUL) effect on your relative.
|
|
BENEFICIAL |
HARMFUL | ||
|
1a. It makes my relative feel stronger in living through life with a cancer. |
|
| ||
|
1b. It makes my relative feel weak in coping with my cancer. |
|
| ||
|
2a. It boosts the morale of my relative. |
|
| ||
|
2b. It lowers the morale of my relative. |
|
| ||
|
3a. It boosts my relative's hope for living. |
|
| ||
|
3b. It depresses my relative's hope for living. |
|
| ||
|
4a. It changes my relative's outlook in life for the better. |
|
| ||
|
4b. It changes my relative's outlook in life for the worst. |
|
| ||
|
5a. It makes my relative feel like an ex-cancer patient already. |
|
| ||
|
5b. It reminds my relative feel that he/she is a cancer patient. |
|
| ||
|
6. It helps my relative ACCEPTS his/her cancer |
|
| ||
|
7. It makes my relative realize that he/she is NOT the only person on earth with a cancer. |
|
| ||
|
8a. It gives my relative an opportunity to share experience with other cancer patients in public (on stage). |
|
| ||
|
8b. It gives my relative- an opportunity to share experience with other caner patients in private (on the seat). |
|
| ||
|
8c. It gives my relative an opportunity to listen to the experiences of other cancer patients. |
|
| ||
|
9a. It makes my relative learn more about cancer in general. |
|
| ||
|
9b. It makes my relative learn more about the cancer that he/she had. |
|
| ||
|
9c. It makes my relative learn more about patients with cancer. |
|
| ||
|
10a. My relative and I feel the get-together is a reunion for cancer patients. |
|
| ||
|
10b. My relative looks forward to attending the get-together each year. |
|
| ||
|
10c. My relative looks forward to getting the most durable award. |
|
| ||
|
11. It is a form of therapy for my relative. |
|
| ||
|
12. It provides psychosocial support to me and my relative. |
|
| ||
4. For those who had attended the Annual Get-Together more than once - What made you attend AGAIN? You may have more than one answer.
___ I had to accompany my cancer relative who wanted to ATTEND AGAIN.
___ The Annual Get-Together is BENEFICIAL to my cancer relative.
___ The Annual Get-Together is helpful to me as a guardian in the care of my cancer relative.
___ The Annual Get-Together is helpful to me as a person even though I don't have a cancer. It helps me learn more about cancer and cancer patients.
___ Others: ____________________________________________________
5. For those who had attended the Annual Get-Together only once - Why did you not ATTEND AGAIN? You may have more than one answer.
___ No invitation/no reminder
___ Problems in travel (distance and expense)
___ Conflict in schedule
___ My cancer relative does not want to attend again.
___ The Annual Get-Together has a harmful effect on my cancer relative.
___ Others: _____________________________________________________
6. Comments and suggestions for improvement of the Annual Get-Together of the Cancer Crusaders Club:
Questionnaire 1 || Questionnaire 2
In 2001, the Cancer Crusaders Club held its 14th Annual Get-Together. It is still going strong. It had about 200 attendees. Ms. Nanette Inventor and Doctor Larry Mallari were the main facilitators.
In 2001, the Manila Doctors Hospital has adopted the Cancer Crusaders Club as its official psychosocial support group for cancer patients and will consider such support group as part of its social responsibility programs. Another strategy for sustenance!