With loss of taste, speech, and smile, oral cancer can leave those affected socially crippled. Clinical psychologists try to help them adjust.
For the doctors of the university clinic for oral surgery on the 7th floor of Vienna’s General Hospital (AKH), it is a normal day. Perhaps not a good day, but a normal one. For Nathan*, the patient sitting across from them, it will be traumatic. The odd spots on his tongue have turned out to be malignant growths, and soon he will lose the ability to taste, eat, and speak.
And there is more yet. "This type of cancer and its treatment affect all aspects of social life," explains Christina Bacher, the department’s clinical psychologist. The surgery often leaves the patient disfigured, and social interactions, from a simple smile to the intimacy of sex, become near-impossible hurdles.
Bacher is there when Nathan learns of the diagnosis. "It’s a crisis situation. People aren’t capable of making decisions. They can’t take it all in," she highlights. "Defence mechanisms, such as denial, are there for our protection but limit our ability to manage the situation as well."
Diagnoses of head and throat cancers have increased over the long-term: In 2009, Statistik Austria recorded 1,124 new cases, compared to 800 in 1983, a rise of 40 per cent.
Stepping aside into a vacant examination room, Bacher speaks to Nathan alone. "I need to know what the person’s resources are, and the coping mechanisms they have to get them through to the next appointment," she says.
Problematically, patients’ typical coping behaviour is often precisely what may have caused their disease: decade-long smoking and alcohol abuse. It’s a chemical concoction that, together with the ageing process, reduces the mouth cells’ resistance.
But blaming the victim for an unhealthy lifestyle is reductive: oral cancer disproportionately hits working class men, a group that tends to have fewer coping skills, more unhealthy habits, and less access to health care, according to a 2009 World Health Organisation paper by Poul Erik Petersen. This makes a late diagnosis leading to a terminal outcome more likely.
As the diagnosis and treatment of the illness are on different floors in AKH, Bacher is often the only one to accompany a patient throughout the ordeal. "When the patient returns for treatment, I think it’s important that there is one familiar face," she says.
It is easy to see how her warm demeanour, red hair, and freckles would make the AKH’s anonymous corridors seem less daunting. While some may see this is a luxury, Austrian hospitals are in fact required by law to employ a certain quota of psychologists for patient care. But funding is tight, as government spending cuts conflict with rising patient numbers. "Not all patients’ psychological needs will be covered in 2012," laments Gerhard Rumpold, board member at the Association of Austrian Psychologists (BÖP).
Patients facing radiation therapy are in particular need of support, Bacher finds. "Psychologically, chemotherapy hardly plays a role anymore. People have a picture in their minds of how it is done, and of the side effects: nausea, loss of hair...With radiation therapy, many find it stressful and surprising to be tied to a table, with a wedge in their mouths and a mask over their heads, and then be asked not to move." Bacher helps patients prepare with relaxation techniques and visualisations, but sometimes also with the use of tranquilisers.
After oral surgery, psychologist and patient begin the struggle against social isolation. Given "the visibility of the disease and the effects on so many bodily senses, the risk of depression and anxiety disorders increase dramatically," recounts Bacher. Maintaining contact with family and friends is crucial for psychological well-being.
Going out in spite of the stares is the first step. Bacher and Nathan take short walks through the long halls leading to the hospital’s main entrance. Passers-by can’t see that Nathan’s tongue has been amputated, but the large skin graft across his left cheek, lower lip, and chin is plainly in view. "How far can the walk be today?" Bacher asks.
The mental health problems resulting from oral cancer are frequently compounded by financial difficulties: How many jobs are there for people who can’t speak? Nathan – a waiter – will have to change his focus. Together with Bacher, he brainstorms all the employment possibilities still available.
Communicating by writing on a notepad, Nathan takes heart: after all, he still has his wife, and a comfortable chair in front of the TV.
* "Nathan" is a pseudonym. Krista Rothschild is a clinical psychologist practicing in Vienna.