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The Journal of the Royal Institute of Thailand Vol. 27 No. 3 Jul.-Sept. 2002 Are We Managing Cancer Problems? ˆˆ Are We Managing Cancer Problems? Kris Chatamra Fellow, the Academy of Science, the Royal Institute In the present climate of eco- nomic gloom it is perhaps incon- gruous to take a critical look at a certain aspect of health care. The management of cancer patients world-wide is notoriously inade- quate. Society is as strong as its weakest link and sadly one of our weakest links is still the pathetic way we look after our chronically ill. Most people, including the super- specialists, have a blinkered view of patients’ requirements to cope with cancer-related prob- lems. These inherent problems arise the moment diagnosis is made. The instantaneous psycho- logical trauma is devastatingly deep and disproportionately long lasting. In addition, the socio-eco- nomic impacts on the patient to- gether with the relatives and friends are difficult to measure confidently with any degree of ac- curacy. It requires an insightful and astute leader to recognize the overall problems and a courageous one to try to solve them. Globally there are special cancer units, hospitals and even in- stitutions but almost all of them cater for certain aspects of the par- ticular types of cancer. They are all important but a great number of patients’ problems remain un- solved. They treat the disease but fail to manage the patient. The patient as a “whole” is not treated in total, body and mind. John Milton summed it up in “Paradise Lost”. “The mind is its own place, and in itself can make a heav’n of hell, a hell of heav’n”. The model for this sugges- tion can be constructed in the man- agement of any type of cancer but probably and ideally it is exem- plified in breast cancer. The breast has always been viewed symboli- cally as the center of femininity and when a woman is diagnosed having breast cancer her life will never be the same again. Her world is shattered. This generali- zation is true at all levels, from the richest to the most deprived. They may live in different “worlds” but the gargantuan impact in their lives is the same. They cannot cope with the problems alone. In an excellent article in a recent in- ternational magazine a breast can- cer patient wrote “you don’t get through this without friends”. This very simple comment sums up the special need. Friends and relatives are of great comfort to the patients but sadly and rather para- doxically they can instill fear and mistrust through ignorance with misguided advice and thoughtless remarks. “The road to hell is paved with good intentions” is often a very apt proverb in this context. The psychology of self- loathing patients is occasionally difficult to mitigate. The hard-core and life-saving treatments, which must be the same for everybody in any civi- Key words : cancer problem, breast cancer, management