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Case History

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Image not available. A 69-year-old woman attends clinic to discuss the management of her recently diagnosed early-stage breast cancer. Her husband, who has mild dementia, accompanies her. A neighbour has brought them but she has to be back in time to collect her children from school. The patient expresses doubt whether she will be able to attend for treatment.

How would you assess how the patient is currently managing?

How should review treatment alternatives be evaluated bearing in mind their social impact?

What are the options for support?

Should the social issues be monitored over time?

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Background

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Image not available. Patients come from diverse backgrounds and with varied social responsibilities. Cancer and cancer treatments disrupt the everyday life of patients and their families. How people cope with the disruption depends on a number of inter-related complex factors including the type of cancer, individual characteristics and available support.1 Although the type of cancer will inform the treatment plan, the social situation of the patient may have a major bearing on any decisions made.

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Discussion

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How would you assess how the patient is currently managing?

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Image not available. When a cancer patient is the main caregiver for a dependent, not only will they have to cope with their illness but also find ways of managing their ongoing responsibilities even though their time and energy are limited. Caring for dependants (children and older frail dependants) is a common concern of cancer patients. A quarter of patients surveyed expressed concern about providing care for their partner.2 Thirty-five per cent of carers of cancer patients report a long-standing illness or disability of their own.3 Running a home is hard for patients with newly diagnosed cancer and increasingly burdensome for those with advanced disease.4 Patients' carers usually step in to take over these chores with 70% reporting increased activity in this area.2 When the patient's partner is dependent this option is not available, although it may be possible to call on assistance from others within their close network.3 Buying in additional support may be another option but only possible if the patient has the resources to do this. Older patients tend to be more financially secure than younger patients as they are likely to have a stable income from a pension, paid off mortgages and not have employment worries.4 However, some will be reliant on a set limited income with very little in the way of savings. Add to this the additional costs of travel, special diets, heating and telephone bills, prescription charges (for those under retirement age) and 'baby-sitting' and the load may become considerable.5 Eighty-five per cent of patients and carers who had incurred additional expense due to cancer received no financial support from any source for this.2

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Evaluation of the case study patient should include assessment of her husband's level of dependency, what ...

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