The psychosocial experiences of the patient and family of skin cancer diagnosis and treatment

Abstract

Skin cancer is the most common cancer in South Africa with about 20 000 reported cases every year and 700 deaths. The Cancer Association of South Africa (CANSA) urges all South Africans to be SunSmart to reduce the high incidence of skin cancer in the country. The World Health Organization (2014) reports that between two and three million non-melanoma skin cancers and approximately 132 000 malignant melanomas occur globally every year. South Africa has the second highest incidence of skin cancer in the world after Australia (CANSA, 2014). Skin cancer is an increasing phenomenon in South Africa and enough is not done to raise awareness. The researcher has a very personal interest in skin cancer, the emotions around it, the needs, thoughts and experiences of patients diagnosed with skin cancer, due to various family members having suffered skin cancer. The researcher also learnt through own experience that there is a lack of support systems for the traumatised family to fall back on, specifically when it comes to skin cancer. Individuals who wish to support the patient may also need education, support and information regarding the condition in order to do so. The latter was confirmed through consultations with a Dermatologist and a Plastic Surgeon with regards to the emotional effects of skin cancer. Both specialists expressed eagerness to learn more in this regard and committed to assist the researcher in this study in finding suitable participants, who were selected and interviewed. It was clear from the first interview that none of the participants had expected skin cancer and many emotions were expressed. When a person is diagnosed with skin cancer he or she will often experience anxiety which can be very severe. Anxiety may make the pain experienced by cancer sufferers worse. Anxiety is a normal response to stressful events and is part of the process of coming to terms with an illness. Fear of the unknown is often a significant cause of anxiety. Patients may feel less anxious when they are given more information about their illness and their treatment, or when they find out more from booklets available from cancer charities and patient groups or from websites. Patients also usually begin to feel less anxious as they become more accustomed to seeing the doctor and going to hospitals. As they get to know hospital staff they gradually feel more at ease and less threatened by fears of the unknown. (Gillie, 2005:42). The patient participants had some form of treatment for skin cancer. Various emotions and experiences were observed and expressed by both patient and family participants and it became evident that from diagnosis, through treatment and even post treatment, the participants had a lot of emotions and each phase brought along its own experiences, feelings and needs. This supported theory around the issue of skin cancer and the experience around it being studied. The emotional effects of cancer may last long after the end of treatment. People often find they continue to feel anxious about minor signs of illness or pain, fearing a recurrence. Regular check-ups may be necessary and these can be very scary times. Permanent changes in lifestyle, as a result of cancer, or bodily changes may be daily reminders of the cancer and cause sadness. As distressing as these emotions may be, they are natural reactions to a cancer diagnosis. Talking to family and friends may be helpful (The Cancer Council of New South Wales Coping with Cancer (2005:1). The researcher followed a qualitative approach in this study and attempted to understand the subjective life experience of the participants who suffer from skin cancer and have been diagnosed and undergone treatment. In order to add to the development of insight and a better understanding of the experiences skin cancer patients have in the current South African context, the researcher was able to obtain first-hand information through the use of unstructured interviews as it allowed the participants to share their thought and feelings and experience without guidance from the researcher. The information gathered was in the form of words and concepts, which gave meaning to the participants experiences of a skin cancer diagnosis and treatment. In total 13 participants were selected as part of the study, who included both skin cancer patients and family members. These participants were selected from existing patients and family members of patients of two private medical specialists in Panorama, Parow and Cape Town. Unstructured interviews were conducted with the participants and were voice recorded with their permission. These interviews were then transcribed. The data was then analysed by the researcher and from that, themes and sub-themes were identified. The research findings are presented by the biological profile of all the participants being portrayed and a thematic analysis of the themes and sub-themes. Literature and verbatim quotes were then given in support of the findings. Five themes were identified as follows: Theme 1: Lack of knowledge around skin cancer Theme 2: Reaction to diagnosis Theme 3: Treatment Theme 4: Post-diagnosis mindfulness and behaviour change and Theme 5: Support structures. Each theme had sub-themes which were also discussed. In conclusion, it was eminent that skin cancer patients and their family go through a lot of emotional turmoil and therefore it is of vital importance that the medical personnel or the multi-disciplinary team is aware of this when working with skin cancer patients. It was clear that at the point of diagnosis, patients and their families experience a lot of shock and disbelief which they have to work through. Some even have immediate fears of death, whereas others are oblivious of the severity of the condition. It was mentioned as a need from participants, but also noted in theory that knowledge or a good understanding of a condition and of the treatment lowers anxiety levels. All members of the multi-disciplinary team should ideally be aware and motivated to ensure patients emotional needs are identified and addressed. Social workers have a vital role to play as their skills to identify needs are highly developed and have a good understanding of the family as a support system, as well as connecting patients and families with support systems within their environment and community.