สำนักราชบัณฑิตยสภา

«“√ “√ √“™∫— ≥±‘µ¬ ∂“π ªï ∑’Ë Ú˜ ©∫— ∫∑’Ë Û °.§.-°.¬. ÚıÙı Kris Chatamra ˆ˜ lized and self-respecting society, usually dictate the main direction of management of a particular cancer. In the case of breast can- cer these include, of course, ap- propriate surgery, irradiation, che- motherapy, and relevant hormone therapy. In addition to the ob- vious and obligatory treatment of the disease, the initiation of subtle ancillary therapy should already have begun. This can be collec- tively grouped as “support for pa- tients”. The support group should ideally be made up of full-time specialist personnel and dedicated volunteers. The volunteers often function admirably with breast cancer patients because they are independent and are regarded by patients as friends. They are not just “any friends” but are well in- formed, sympathetic and kind and above all they are well adjusted to support patients; they can act as a rock for patients to lean on. The volunteer should also function as a quality audit of the treatment the patients are receiving. They are volunteers with no financial re- wards; they simply give and help constructively. A breast cancer center should, in the modern context, be com- posed of several sub-specialties, but all must have one common aim, the best care for patients at all social levels. The paragon of breast cancer management is, of course, the highest rate of cure and minimal morbidity in patients with breast cancer, but with the best will in the world there will always be incurable cases. These must be catered for, and they need mainly palliative treatment. These patients, however, will drain more from the common resources and require a constellation of special people to support them from the moment diagnosis is made to the final stages of their lives. Gentle and sympathetic care and pain control form the mainstream of management for this group of pa- tients; eventually for some pa- tients, the need for hospice service cannot be neglected. In all pa- tients, when modern science has failed to cure or palliate, supple- mentary and complimentary medicines which do not have a negative effect should be consid- ered; at the very least, they give the patient a sense of not being abandoned and may enhance the quality of life. Also, in all patients, their dignity must be maintained to the end. This issue can create a conflict among the many parties involved including their relatives; the inability to tackle it would be tantamount to failure to address intellectually the indisputably im- portant aspect of human life, hu- man dignity. It is universally accepted that the treatment of cancer, particu- larly in breast cancer, requires a multidisciplinary approach, but there must always be one person with overall responsibility. When conflicting ideas are presented, the person in charge must make the decision, which may at times be exceedingly difficult and painful. This very same person must view the patient in total, bodily as well as holistically, with compassion and scientific discipline. It is al- most an impossible task but again cancer is not easy. Shakespeare reminded us of the above concept very succinctly in King Lear : “...........we are not ourselves. When nature, being op- pressed, commands the mind To suffer with the body”.