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Chapter 1: What psychological challenges do cancer patients face?
Now, how do you treat the intense psychological trauma of an incurable medical diagnosis? Breakthrough Irish research from the Mater Hospital has found that a unique online therapy programme combining breathing exercises and compassion tools can drastically reduce distress for advanced cancer patients.
To discuss the COMFORT trial, I'm joined by the lead researcher, psychologist Dr Sinead Lynch, and by trial participant Anne Cole, who used these exact tools to navigate the trauma of her own stage four cancer diagnosis. Good morning.
Chapter 2: How does the COMFORT trial address cancer patient distress?
You're both very welcome. Thanks a million for coming in.
Thanks, David.
Anne, take us back four years, if you would. You got the devastating news of a stage four breast cancer diagnosis. That must have been just so traumatic.
It was. And for context, I suppose I had been I'd been waiting. We were very deep in COVID at the time. So I'd been waiting a number of weeks to get into the breast check clinic and initially was told that I most likely had a stage two diagnosis. So I was kind of dealing with that, but also quite relieved and felt, OK, this is going to have a beginning, middle and end.
It's going to be a tough year. And then pretty quickly within a few weeks after scans, we knew that it had spread to the bone. So it was stage four. So, yeah, just that was a turning point, I suppose. Just terrifying, really.
I was 45 at the time with a five year old daughter still in preschool and just, yeah, completely, completely terrified about what might be ahead and completely unexpected outcomes.
And that, I presume, just completely upends your life.
Yeah, it does. You know, I knew straight away that I needed medical treatment and I was with the team in the matter. I still am. They're incredible, that oncology team. And they very quickly got me onto a treatment programme. And, you know, it took a while to realise that I actually wasn't, this wasn't going to be your typical journey where there would be maybe chemotherapy treatment.
surgery and, you know, the things that people expect. I was put onto an oral chemotherapy programme and I'm still on that targeted therapy. So I've been very well. I've never been sick from cancer or sick from treatment physically, but psychologically I knew that I needed help. And I knew that I was in a really tough place, I suppose. You know, it's a very lonely time.
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Chapter 3: What was Anne's experience with her stage four cancer diagnosis?
It's interesting because you get loads and loads of support. It's actually overwhelming. I was completely overwhelmed by the support I got from family and friends. But you also feel a little bit lonely and isolated because you feel like there's nobody else in the world, maybe, who's going through what you're going through.
And I knew that I needed that psychological and emotional support alongside the medical treatment. And that's what led me to Sinead and to the psycho-oncology team.
And Sinead, obviously, as Anne has so eloquently put it, there's the physical aspect of the treatment of the disease, but there's the mental health, there's the psychological aspect. What would be the traditional existing ways of approaching that?
Of approaching kind of how to support. Yeah. I mean, like psycho-oncology as a field has been around since the late 70s. In the matter, we started the service in 2021, but it's been in different hospitals like Vincent's and James's for the last 20 years. And there's loads of community cancer support centres. So I think it's about building awareness.
You know, obviously there is funding and we're funded by the NCCP, but... I mean, to answer your question, how do you go about it?
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Chapter 4: How did Anne cope with her cancer diagnosis during COVID?
I guess it's about asking and about informing the medical teams so that the medical teams are treating the patient as a whole person. So like that, I had a patient the other day and she just said, I had a really bad day having chemo. I was in the chemo ward and my nurse said to me, you know, you're not yourself today. Are you linked with the psycho-oncology service? And she said, I am.
And thanks for checking in. You know, so it's their awareness that actually works. we are treating the whole person. And that's really important.
Okay. And in terms of this new programme that you've developed, I mean, what are we aiming to do?
Well, like that, again, there was it was a research trial. It was funded by the Irish Cancer Society. And the first thing I did was meet patients and say, what is it that you need at this time? So it was targeted towards patients with recurrence or like Anne, where it was a progression of disease very quickly and suddenly and shocking.
And they just said, it's fear, it's terror and it's a loneliness like Anne described. You know, it's an existential loneliness. I have support, but I'm in my own head. I don't want to always, you know, burden my family and my friends anymore.
And so I created this program based on psychological theory that's out there that would address, you know, anxiety, which is breath work, really, essentially. Your breath is your friend, as my friend Lizzie says, and also compassion. So the thing about compassion is that people mistake it for compassion.
oh, it's pity and I'm going to pity myself if I let down my defences or I give up this fight, which is often used, you know, that word, that term. And it's great. It's a drive to get you out of bed. But it's not great when you're suffering, because the most important thing to do when you're suffering is to actually acknowledge it and to then treat yourself with kindness.
And so that's what we did over the six week programme. It was a research trial, so it has finished and it's been published, but we're hoping to take it to the next stage now.
So when you talk to the patients, who are the most important people, obviously, I mean, you weren't trying to give them some kind of a happy, clappy, be positive thing, because I can imagine that landing really badly.
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Chapter 5: What traditional methods exist for supporting cancer patients' mental health?
Think about if I often say to patients, if a child came to you and they were very upset and they were terrified, what would you do to them? You'd hug them. So how do we give ourselves that internal hug? Well, with that breath work. And then the second door stands for relate. So how do you relate to yourself? And this comes from a trauma informed framework.
So it's the idea that, again, we can't soothe an anxious brain with critical talk with, you know, well, there's nothing wrong with you. We'll get on with it. This, you know, it's very Irish for us to kind of think, I should look at, you know, we weren't taught these things growing up. We may not have had parents who hugged us. So relate to yourself, use a soothing voice.
And one of the things that we practice in the programme was What is an internal soothing voice that you could create for yourself? Like go easy on yourself, pet. I'm not sure if Anne wants to share hers. And then the last one is reason. You can reason with yourself then when you're relaxed. You can reason with yourself and find logic for what you can control or what you can't control.
You can look after the basics and for the things that you can't control that are out of your control. like fear of death sometimes, then you go back to step one. You regulate yourself and you relate to yourself with kindness.
And this is quite a widespread study. I think 160 people were tracked and they found it very helpful. And you obviously found it very helpful, Anne.
Yes, absolutely. I suppose that level of... The level of distress, maybe the kind of trauma response, like I really genuinely sat in that office back in February 2022 with the doctors thinking when they started using words like metastatic in stage four, I looked at them and thought, well, you know, I'm not going to survive this.
And, you know, I had to find ways and I knew that I knew I needed the medical treatment, but I had to find ways to cope with that and to cope with that voice in my head. You know, I am living proof that the science on the medicine out there when it comes to cancer is incredible. And, you know, I wouldn't be, you know, 10 years ago, the treatment that I'm on didn't exist.
The medical treatment didn't exist. So, you know, there's every hope that I will continue to live a healthy life. But I knew that I needed to do that with the psychological and still need to do that with the psychological support.
SinƩad, you've got funding, I think, from Enterprise Ireland to try and develop this further. So what's that going to look like and how soon can it be on, I don't know, every oncology ward in the country?
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