The more and more well known Hungarian psychoanalyst Sándor Ferenczi named the depressed feeling and phenomena of being unwanted in his adult psychiatric patients some decades ago (accurately in 1929).
Today I’ve visited a patient in our department. In her room I didn’t felt that here is the summer. Instead of sunshine and colours shadow and drab were everywhere. She was lying in bad, without whatever movement. Her tears went, she was unable to dab it, but let me to help.
She was able to sum up the hidden influences of her psychotherapy under her first oncological treatment. She planned her somato-psychic rehabilitation: at the same time she got her infusions and visited regularly a psychotherapist in the city working through her emotional crisis. An impartant condition: her psychotherapist was in practice without considerable oncological experiences. The patient thought she has done her best, she is protected in every respect: she has cooperated in chemotherapy and psychotherapy. But the life in the field of oncology is more complex containing uncertain elements.
The patient denied her first “soft” symptoms: pain and growing weakness in her neck and shoulders. She was unable to interconnect her soft neurological symptoms and her “forgot” malignant lymphoma. She insisted that her first somato-psychic rehabilitation was perfect, recurrence is unthinkable. When she arrived to our department her condition was very serious.
Today I visited her and we were able to talk about the real possibilities of psychotherapy during and after oncological treatment: her mending psychosocial quality of life helps her to keep on in the oncological treatment and retain her “good-enough” watchfulness about her somatic and psychic condition in the interest of psychosomatic balance instead of fatalism or maniac defense.
Eva Ottosson is to become the first woman in the world to have her womb transplanted into her daughter.
Mrs Ottosson has agreed to take part in the groundbreaking medical procedure that would see her donate her uterus.
Doctors hope that if successful, 25-year-old Sara, who was born without reproductive organs, could become pregnant and carry her child in the same womb that she herself was carried in.
Cancer is a class of diseases in which a group of cells display uncontrolled growth, invasion and sometimes spreading to other locations in the body via lymph or blood. This growth is caused by modification of the DNA, called mutations. Since the mutation can occur in different genes tumors respond differently to certain treatments, let it be radiation or chemotherapy or application of new-generation drugs. The treatment of cancer is highly dependent on several factors: the time of diagnosis, the progression, the location of the tumor and as mentioned above, the mutation status of tumor cells. In many cases, the surgery itself is sufficient, but chemotherapy or radiation therapy, targeted drug therapy is often added into.
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In order to offer the most appropriate, targeted therapy to the patient, we must determine the mutations of oncogenes in the tumor tissue. We provide diagnosis of drug targets during our molecular diagnostics. It can be selected after the determination of the molecular state of genes which is the most effective treatment for the patient, because in some cases, a mischosen targeted therapy may prove not only ineffective, but also result in unwanted side effects, and in some cases, the patient’s condition may even worsen.
The list of required test are included in the safety information of some drugs, in other cases Health Insurance Fund prescribes molecular pathological studies. However, additional genes, biomarkers are also available to help the oncologist to select the more successful, optimal treatment protocol for the patient. In the Molecular Pathology Laboratory of KPS not only required, but also further recommended examination of the proposed biomarkers are available, so the doctor can offer the best possible therapeutic approach in the light of molecular diagnosis.
I was invited to a film club of the Hungarian Psychological Society. I was interested in the thoughtful film My Sister’s Keeper, so I took part and we had a very interesting discussion about important qusetions: what does it mean to be a donor-child, how the illness of a child influences the whole family, why are the mothers of cancer patients become “hero mothers” (after Michael Balint), why is not interesting the healthy child for the parents in these families, and what kind of atmosphere has the oncological wards, etc.
As clinical psychologist and psychoanayst who works at oncological ward was very interesting the lack of psychologists on the child oncological department. The attendance and intervention of the hospice-staff member was typical and misadventurous at the same time.
I think, Nick Cassavetes knows and feels every important psychosocial aspect of oncological diseases: the patients becomes “wise babies” (after Sandor Ferenczi), the mothers build symbiotic relationships with their children, the fathers must earn money instead of being together with family members, the healthy sisters and brothers are not so important in the eyes of the parents as the sick children, and the process of cancer is a tragic, deep mirror – shows all the lacks, problems and secrets of the affected families, and at the same time the values, bravery and creativity of each family members and the whole Fitzgerald family.
This film is well worth seeing!
Stan Kaye, head of drug development at the Royal Marsden treasures the moments when a new drug turns up that shows real value. The big challenge is to understand who benefits from what.
WHO BENEFITS FROM PARP INHIBITORS?
Mutation of BRCA1 and BRCA2 genes has been linked to hereditary breast, ovarian and prostate cancer. In 2005, the Institute of Cancer Research team in Chelsea, led by Alan Ashworth, discovered that, because these genes were not functioning, DNA repair was defective, and these cancers were therefore exquisitely sensitive to drugs blocking an enzyme called PARP. Early trials of these PARP-inhibitors at the Drug Development Unit showed that around 50% of tumours shrank. This result was replicated in an international trial. Last year, it was announced that Ashworth’s team had discovered that the drug would also kill cancer cells with other types of gene faults apart from BRCA inherited cancers, so its potential is much broader than originally thought. The drug is now moving into phase III trials. According to Kaye, the beauty of PARP inhibitors is that doctors should be able to predict exactly who will benefit from them, because the genetic defect that makes people responsive will have a biomarker.
„… Psychoanalysts dealing with the problem of death like Stanford, Brodsky, Norton and Roose all commented on the continued reluctance to deal with dying. They all noted the ambiguity and ambivalence in the human attitude towards death. …..
In the development of modern thanatolgy special credit must also given to Eissler (19559, – who in his today classical study – brought attention to the problem of the psychiatric treatment of patients approaching death. In this context Eissler also discussed the role of the psychiatrist himself. . In addition to the individual death, he also dealt with the reactions to the death of the beloved person, where the major issues seem to be the ambivalence toward the dying……
Continued progress in this area depends upon a more adequate understanding of the process of denial as it runs its course in the dying patient, the family, and in the physician himself. A proper evaluation of the process of denial makes it possible to develop a better therapeutic approach into the dying patient as well as to the patient’s family….. that valuable support may be found for the dying if they can secure and rely upon a basic trust in the world. The basic question then becomes how this can be achieved. …… I have suggested that the dying person may benefit from making regression with reinvestment of libido into old attachments. This process, however, will often be expected to run into insuperable obstacles, if the dying is to carry this out on his own, beccause of unconsciouus emotional conflicts. If so, then the patient may benefit from therapy. The question then is asked how the therapist should handle this situation. The central aspect which needs to be discussed in this context is the problem of transference and especially countertransference….. The dying patient stimulates the doctor, therapist, or psychoanalyst to encounter his own feelings of guilt…… at the moment when life cannot be saved, physicians are not only narcissistically hurt in their pride, but death also stirs up their own anxietes….. such feelings are often responsible for the fact that dying patients so frequently left to die alone…. Psychoanalysts claim that acceptance and awareness of those feelings may help to avoid our own denial, repression and overprotection… Is there a proper way of dying? I offer only an ambiguous answer to this question. … Towards the actual person who died we adopt a special attitude: something like admiration for someone who has accomplished a very difficult task. ”
This paper helps me a lot in my work with seriously ill cancer patients and their suffering relatives. The most diffucult task to help such kind of patient who has no old positive attachment in his/her life, and refuses the therapist’s offer herself/himself as an available object for deep understanding and love. I have a patient, who is under palliative care, suffers a lot, but she isn’t able to allow to build a „bridge” between us, but clinging on me at the same time. Later i’ll write about her case, about our work in her vanishing world.
An e-grandround tackles treatment issues in a cancer with a particularly poor prognosis. Malcolm Moore of the Princess Margaret Hospital in Toronto provides an overview of what progress has been made treating metastatic pancreatic cancer with combination chemotherapy, and looks at what could be achieved by focusing efforts on more tailored biological treatments that target the multiple genetic abnormalities associated with this cancer.
More: NEW ARTICLE AVAILABLE ON CANCERWORLD.ORG
Today I would like to write about a quite common problem. The case: a women from an another department visted me on her own. She has a metastatic breast cancer and she is under chemetherapy. She wants to discontinue the therapy, not because of the side effects – these are controlled -but because of her life-history. ” I am full of with bad things. I have no future”. Her face is without mimics, her muscles are extremely tense, her gaze is full of sadness. Sometimes she is smiling, but it is not her smile. She pull out her words, sentences, without break, without tone. Word-river. Mass. Chaos. Darkness. There is no possibility, no space for a dialogue between us. She is a victim for long years, I have to be a container, but what I would like to contain is unreachable. I feel myself alone, the woman is not able to do nothing for a human relationship. Her masochistic trait is strong and rigid, her hypomanic life-style is a defence. Her cancer is in the 3rd stadium. Her psychic state in 4th stadium. She needs help, antiemeticum can’t solve this problem. How can we help her in an oncological ward, under chemotherapy? There is a real need for a new department, a combination of psychiatric and chemotherapeutical department inside the Oncological Institut.