This case study illustrates some of the off-treatment issues your patients may face when their coping support system is inadequate. Some of the psychological effects cancer patients deal with do not manifest until years after treatment is completed. It is important for patients to establish a foundation for successful survival while still in treatment. It is equally important for patients/survivors to understand their disease and its ramifications, both medical and psychosocial.Patients/survivors need to feel they have some control over their situation, and while the family is generally the vehicle to helpachieve this, they are not always the best resource. It is central for the clinical care team to recognize these situations and help put their patients in the best situation to be successful in their life after cancer, whether that involves frank discussions with the family and/or the patient or helping them find resources that will help them cope. Do not be afraid to step in and offer advice. More often than not patients/survivors and their families are ill equipped to deal with the numerous obstacles of a cancer diagnosis.
An Overprotective Mother
In 1994, at age 6, Billy was diagnosed with Wilms' tumor. He completed a standard protocol early in 1997. He had just started first grade in a private school when diagnosed. His teachers and classmates were very supportive. Throughout treatment, Billy remained upbeat and did not experience any issues that required counseling. After 8th grade, he moved to a new neighborhood and started 9th grade at a public school.
Since his father's profession required a lot of travel, he was absent during much of Billy's transition to the new school. Thus, his mother became his sole support. She had never let Billy participate in sports or go on excursions with his classmates at the private school, but he had such an excellent support system, he was able to cope with her actions. After the move, however, Billy gradually lost his former support system, and his father continued to be away on business trips. His mother had been anxiety prone prior to his diagnosis and was seeing a psychologist. However, after they moved, she stopped the therapy sessions.
Billy began to experience anxiety that his tumor would return. He felt increasingly isolated at the new school; he began skipping classes, his grades dropped, and he became aggressive and started to bully his mother when his father was away. He soon fell in with a gang in his new neighborhood and was arrested with them for trespassing on school property, joyriding, and painting graffiti on the gym walls. He received probation, which required him to undergo counseling. Billy was on the "slippery slope."
After Billy's latest fiasco, his father contacted the social worker they had used when Billy was in treatment; she recommended a local psychologist. This was a turning point for Billy. The new psychologist had also survived cancer and had experienced some similar issues post-diagnosis upon his return to school. As a result, the psychologist was empathetic with Billy's plight and had practical experience to share with him.
The psychologist's assessment led to the conclusion that Billy would best be served by a period of residential treatment, including pharmacotherapy. The goal was to stabilize Billy and gradually reintroduce him to his family.