Rola wsparcia w zmaganiu się z chorobą nowotworową

The process of fighting with cancer is often long, and has an impact on the patient’s current way and quality of life.
Cancer is considered to be a chronic disease because, in accordance with the “Chronic Disease Commission” definition of chronic illnesses, it is “a disorder or deviation from the norm, which has one or more of the following characteristics: it is durable, leaves a disability caused by irreversible pathological changes, requires special rehabilitation proceedings or by any expectations will require long surveillance, observation or care” [1]. A specific feature of cancer is its dynamic process that requires the patient’s ability to cope with the ever-changing situation.
It is believed that the disease of cancer determines the fate of man. The changes that occur as a result of cancer are often irreversible in the patient’s approach to his/her function with in family, social and professional life.
Such psychological stress results from life-threatening, long-term treatment, pain, dependence on others, the need for repeated hospitalisation, loss of control over their own lives and uncertainty about the near future. The patient is powerless and unable to affect the course of the disease. This lack of personal influence to overcome the disease can deepen the patient’s passive attitude towards the whole process of treatment [2].
The information they have about the disease and treatment, and other people’s reactions to the disease, have an impact on how patients cope with experiences related to the disease itself. The lack of reliable information about the disease or false information, based on stereotypes, builds emotional attitudes towards the disease and treatment. A patient diagnosed with cancer at all stages of diagnosis, treatment, rehabilitation, remission or progression meets with a lot of specific problems. They cover both general health, as well as short-term and long-term side effects of the therapy.
The environment of the patient, and hence the family, friends and medical staff who support the patient, have an invaluable impact on the process of coping with the disease. It is important that these people providing care are guided by sensitivity, gentleness, mental resistance and the ability to cope with anxiety.
The impact of support on the patient’s state of physical and mental health is repeatedly emphasised in the literature. Often the support is defined as a specific form of aid directed to a patient, which allows them to overcome their own problems, difficulties and conflicts, and triggers self-confidence and leads to motivation, which contributes to the patient’s ability to overcome difficulties, as well as a fuller development within the limits of possibility and capability of an individual. We could say that the scope of support corresponds to the range of problems which the patient has to confront.
In other definitions, it is added that support is also referred to as positive resources that increase resistance to stress, provided by interaction with other people. The bases of the relationship are social support and positive relationships created between people. It is seen through the subjective evaluation of all its recipients, most frequently in terms of the availability of support, and not receiving it [3].
Social support is also defined as assistance available to individuals in difficult situations, and as a consequence of the patient belonging to asocial network. Social support is identified with auxiliary behaviour or is also defined as satisfying the needs of the patient in difficult situations, guaranteed by significant others and reference groups [4].
Social support expresses the resources provided by interactions with other people [5]. Social support is a form of aid directed to the patient, helping him/her to overcome his/her own problems, conflicts and difficulties through faith in their own abilities and the confidence that they are able to overcome such difficulties. It is referred to as a positive resource, which increases resistance to stress [6].
It is widely accepted that the concept of social support is closely related to the existence of the social network, which links the unit with other people, but the fact is that the unit, in many different relationships, does not provide support. It should be noted that people facing a serious crisis are often left, unfortunately, without any social support [7].
Social support in the case of illness or reduction of a patient’s efficiency can also be understood as a particular way of helping the families of patients. First of all, it helps to mobilise their own forces and resources [8].
Social support is widely expected to help in difficult situations, in which we are not able to help ourselves. This particular way and type of assistance is designed to mobilise the forces to be allow us to deal with traumatic problems, especially in such a situation as cancer. Receiving social support gives meaning to human life and allows us to maintain existing ties.
The exchange that occurs between the supporter and the supported can be unilateral or bilateral; it is important that the type of support is tailored to the needs of the recipient. The main objective of the support is to allow the participants to solve the problems and overcome difficult situations. Depending on the time, support can be ad hoc (one-off) or regular, – long-term support. Support can also be provided spontaneously following momentary emotion, or planned, as it is in different institutions [9]. Support of the patient is dependent on: assessment of his/her emotional state, changes that we see in his/her behaviour, current needs.
Skilful reading of these symptoms is very important to be able to react positively. Areas of support offered should be diagnosed and should be adequate to the needs of coping with cancer. The range of possible support is classified depending on its type and the function of the ongoing interaction support [10].
Depending on the difficulties, patients may need different types of support. The most frequently mentioned types of support include:
1. Emotional support – this kind of support is dominated by feelings; the person who needs support receives information from others that he/she is loved and needed, they can count on the help of other people who are around them and take care of them. People providing support calm sufferers, who can thus be freed from their tension and negative feelings. They can confidently express their sadness, anxiety and fear. Such an attitude is conducive to increasing the self-esteem of the supported person. People suffering may be freed from their tensions and negative feelings through emotional support; they can express their fears, worries and sadness and trigger a sense of hope [11]. In difficult situations, this type of support is the most common. The supporting behaviour is also aimed at creating the feeling of belonging and care, and increasing self-esteem [12].
2. Information support – this is support through legal and medical advice, different kinds of information to help patients troubleshoot problems, as well as enriching knowledge and helping to support the family on the topic that interests the patient. Instrumental support is a type of instruction involving the transmission of information about the specific ways of proceeding. This information could include knowledge about treatment options, rehabilitation, institutions where you can get help and existing self-help groups. Such a type of support is also about the exchange of experiences by those who have survived similar problems and difficulties.
3. Instrumental support – manifested through va­rious forms of counselling, guidance and, most importantly, instruction, which refers to specific procedures. As part of this support, instruments of goods and material objects can also be exchanged, or tools that the other person needs may be provided. The supported person is also relieved from their obligations; for example, they get help with doing shopping, with daily living as well as transferring money.
4. Property support – otherwise known as material support. It provides various forms of benefits, financial and tangible. Increasing financial problems in the course of the disease are caused, inter alia, by significant increases in spending (often more than real opportunities) on things related to the disease [13]. It consists also of physical activities for supported people, such as providing them with medicines, clothes, food etc.
5. Spiritual support – this refers to the sphere of meaning of life and is associated with particularly severe life events such as incurable disease, suffering, pain and struggle with the coming death. Most often it refers to hospice care, where a form of spiritual help performed by priests or nuns is a fairly common form [10]. Speaking of support, its distribution due to the theoretical models can be mentioned: the main effect and the buffer effect. The model of the main effect takes into account the effect of the main structural dimension of support described by relationships and social networks created through membership of social organisations and religious and other groups.
The buffer model is based on the functional dimension of support and it refers to interpersonal resources and the quality of the relationship between the supporter and supported, which protects against the negative effects of stress “specific closer support”.
There are many sources of support, and the literature distinguishes two: natural and formalised. Natural resources of support include: life partner, friends, family etc. Support relationships are spontaneous, mutual and informal, they are most effective for health because they do not stigmatise, and they are generally available accompanied by interpersonal trust. Formalised sources of support are professional groups, associations and institutions that operate according to certain rules, rarely on the basis of reciprocity, although it is sometimes difficult access them [14].
Numerous studies confirm that social ties and the support provided by them have a positive impact on various aspects of mental health and physical health, they minimise the stress caused by the disease [15].
Support has a significant impact on the functioning of people afflicted with cancer in the dimension of their biological, psychological and social life.
The role of support in dealing with cancer is a key element in the recovery process; it increases security, provides a positive experience and shows that life with the disease is more predictable and stable.

References

1. Adamczak M. Wybrane procesy poznawcze i emocjonalne kobiet po mastektomii. Wydawnictwo Naukowe UAM, Poznań 1998; 11.
2. Kubacka-Jasiecka D, Łosiaka W. Zmagając się z chorobą nowotworową. Wydawnictwo Naukowe WUJ, Krakow 1999; 79-90.
3. Kawczyńska-Butrym Z. Wsparcie społeczne w zdrowiu i chorobie. Centrum Metodyczne Doskonalenia Nauczycieli Średniego Szkolnictwa Medycznego, Warsaw 1994.
4. Sęk H, Cieślak R. Wsparcie społeczne – sposoby definiowania, rodzaje i źródła wsparcia, wybrane koncepcje teoretyczne. In: Wsparcie społeczne, stres i zdrowie. Sęk H, Cieślak R (eds.). Wydawnictwo Naukowe PWN, Warsaw 2006; 11-28.
5. Sheridan C, Radmacher S. Psychologia zdrowia. IPZ PTP, Warsaw 1998.
6. Ślusarska B, Zarzycka D, Zahradniczek K. Podstawy pielęg­niarstwa. Czelej, Lublin 2008.
7. Kubacka-Jasiecka D. Interwencja kryzysowa z perspektywy psychosocjokulturowego paradygmatu kryzysu. In: Kryzys. Interwencja i pomoc psychologiczna. KubackaJasiecka D, Mudyń K (eds.). Wydawnictwo Adam Marszałek, Toruń 2005; 93.
8. Zachowania w chorobie. Tobiasz-Adamczyk B, Szafra- niec K, Bajka J (eds.). Krakow 1999; 60.
9. Górajek-Jóźwik J. Filozofia i teorie pielęgniarstwa. Czelej, Lublin 2007.
10. Sęk H, Cieślak R. Wsparcie społeczne, stres i zdrowie. PWN, Warsaw 2005; 246.
11. Sęk H, Cieślak R. Wsparcie społeczne, stres i zdrowie. Warszawa 2004; 17.
12. Zaborski Z. Współczesne problemy psychologii społecznej i psychologii osobowości. Oficyna Wydawnicza „Profi”, Warsaw 1994; 241-4.
13. Wesołowska I, Makowska M. Sytuacja socjalna pacjentów kliniki opieki paliatywnej w Poznaniu. Przegląd typowych problemów. Rola pracownika socjalnego w opiece paliatywnej. In: Holistyczna opieka paliatywna w zaawansowanej fazie choroby nowotworowej. Łuczak J (ed.). Tarnów 2001; 52.
14. Chodkiewicz J. Zmagając się ze światem. Znaczenie zasobów osobistych. Available at: www.psychologia.net.pl.
15. Pammersbach J. Wsparcie społeczne a choroba. Przegląd Psychologiczny 1998; 31: 503-25.

Address for correspondence:

Marzena Kamińska MD
Chemotherapy Word
St. John’s Cancer Center
ul. Jaczewskiego 7, 20-090 Lublin, Poland
Phone: +48 607 234 462
E-mail: mkaminska0@vp.pl