Interview with Sònia Fuentes, psycho-oncologist at the ICO in the Germans Trias i Pujol Hospital in Badalona
Sonia Fuentes Sanmarín is a psychologist and coordinator of the pyscho-oncology ward at the Catalan Oncology Institute in the Germans Trias i Pujol University Hospital, in Badalona (Barcelona). Sonia is a clinical psychologist and has 18 years of experience in the field. We had the opportunity to ask her about some of the aspects that can affect a person who is diagnosed with cancer: personal image, how to talk about the disease, possible infertility....
Sonia, attending a patient
Not all hospitals currently provide psycho-oncology services. Why do you think the role of psycho-oncologist is important in the treatment of a haematological or oncological disease?
Because the ill person is not only a disease; he/she is a full being, combining the physical, psychological, social and spiritual level, among others. To quote Cassel; "Those who suffer are not the bodies, they are the people". In addition, the families and teams also need help.
What is your daily routine?
I guess it's as busy as my colleagues in the hospital. I start the day with external consultancies and day visits. Then I go to the oncology ward to visit patients in their rooms. We also attend the patients and families that are in the Transplant Ward.
What are the most frequent consultancies that you encounter each day?
People with a recent cancer diagnosis, those with an elevated emotional impact to the diagnosis, or those who have suffered a recent relapse of the disease. Also a common group is young people who have difficulties accepting the oncology treatments, and their families...
Is it normal to treat the families of patients as well as the patients themselves?
Of course, it is very normal. Fortunately, the Mediterranean culture is for the process of the disease to be played out in the family, but therefore the families often need our support. They also suffer a lot.
What is the relationship between doctors, nurses, social workers and psycho-oncologists like?
The relationship is based on working well together against an oncological disease. We have to work together as part of a multidisciplinary team interacting constantly with efficiency and effectiveness, for the good of the patient.
In the case of women, what is the affect of the change of image due to the treatment?
In the majority of women (and also men) oncology treatment produce an alteration in the corporal image; alopecia (hair loss), weight gain, cachexia (state of extreme malnutrition, muscle atrophy, fatigue and weakness), change in some body functions, amputations, etc. these changes significantly change people individually and in their relations with others.
How can you help patients in this situation?
There is no formula. Each case is individual, each patient, each person... We provide the resources to improve the way in which the impact of the treatment on self-image is faced. Alopecia for example is tolerated much more by men on a social level; women are more sensitive to this. We are not used to seeing a woman with no hair in the street. We have to implant the acceptance of feminine alopecia: bald women can be and feel attractive too. We also have to remember not to see people on the outside but look at what is inside, and thankfully, cancer treatments cannot affect that.
Surely one of the most worrying issues for women is the possibility that they will be infertile after the treatment. Do you ever find situations like this?
Yes, often. It is a difficult situation for them.
What do you tell them?
It depends on each case, as I said before. What we try to do is work a lot on focusing on the present moment of the patient's life. Often the treatments that they receive are crucial to save their life and they are forced to make complicated decisions in highly stressful situations. If a patient finds herself in this situation we assess her, accompany her, and help her to manage the loss that infertility can cause at a psychological level.
Another issue that we touch upon in this section is sexuality. Do you have any thoughts on this in terms of the patient and their partner?
Normally when patients are recently diagnosed or in the period of treatments, sexual needs loss some importance. There are more urgent needs and the state of wellbeing is really significant; the development of anxiety, depressive symptoms, etc. When people don't feel very well, their libido (sexual energy) goes on holiday in most cases.
Normally these needs re-appear during the period of recuperation, they are a symptom of recuperation. We treat this issue in a personal way to each patient, adapted to each woman, man or couple.
You also treat bereavement? How do you do that?
With lots of respect, care and above all humility. We basically attend the most complicated and difficult grief that is at risk of converting into something psychopathological.
Natural or "normal" grief is something that we try not to get involved in because it is not advisable to "psychologize" the processes of natural loss that form a part of the cycle of life.
How do you explain to a child that their father/mother is ill?
First of all, stopping, pausing. We live in a fast paced society which causes its members to cultivate human relationships with difficulty. When we have to communicate bad news, the most important thing is to take our time to do so.
In the case of children, we approach the situation with honesty, using clear words, simple and short phrases, asking if they understand, and maintaining openness to their questions, that logically need an answer. Parents should always bear in mind that the answer to their questions can be: "I don't know". A mother or a father doesn't have to know everything. When communicating it is important that parents learn to "withstand" the emotions of their children. Younger children are easier to manage in these situations but many people believe the opposite. The older the child the more complicated the situation because they are more aware of life and its consequences.
How can we help in cases where the patient is physically isolated?
We can help them to prepare for the isolation that they are going to feel from a psychological point of view before they go into the ward. In this way we can find out what type of person they are, what their fears are, and what resources they have to confront the situation. We have to identify the tools (emotional resources) that the patient has and develop new tools. Previous contact with the transplant ward team could be a big help: to talk with someone who has lived through the situation or to visit one of the isolated wards can reduce fears and develop more adaptable skills in which to face things.
In your case does the treatment of a patient extend beyond their stay in hospital?
In transplant patients, yes it normally does. We have a protocol of follow up visits to help the patient and their family in the post-transplant stage: to learn to live with medical controls, to face up to the fear of a relapse, to live again...we try to carry out this follow up after a month, 3 months, 6 months, and a year following the transplant. These follow up sessions are carried out in the day clinic in the same way as my haematology colleagues.
What do you like the most about your work?
The people with whom I work, the patients, the families...the Exchange that is generated. The most amazing thing is that they allow me to accompany them during the most traumatic stage of their lives. They teach me every day to value what is really important in life they help me to be a better person...I am also so grateful...