Helping deal with the unthinkable
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Judy Siegel-Itzkovich, THE JERUSALEM POST Aug. 29, 2004
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People diagnosed with cancer can suffer from psychological trauma as bad as the physical effects. Psyco-oncology Prof. Lea Baider specializes in helping patients remember that they are still normal.
A year spent with the Guarani Indian tribe on the Argentina-Bolivia border when she was 16 may have induced Prof. Lea Baider to go into her field of psycho-oncology.
"I saw how they treated the dying - like normal people, first a person and then someone who was sick. They didn't use labels, and they gave total support."
That conviction has served Baider - for the past 20 years director of the psycho-oncology unit at the Sharett Institute of Oncology at Hadassah University Medical Center in Jerusalem's Ein Kerem - and her many cancer patients very well.
After decades of helping people face the possibility of death - and more importantly life - the clinical psychologist has been awarded the prestigious Arthur Sutherland Memorial Prize by the International Psycho-Oncology Society (IPOS) at the organization's world congress in Copenhagen. She is proud to be the first Israeli and the first non-physician to receive the quadrennial award, which previously was given to one Japanese, one English, one German and two American psychiatrists.
She was chosen unanimously by the IPOS board "based on your scientific contribution to the field of psychosocial oncology. This includes your important work on the effect of a cancer diagnosis and treatment on the family, your research in breast cancer among Holocaust survivors and their family members, as well as your outstanding contribution to the clinical practice in the treatment of cancer patients. Your contribution as a scholar," wrote IPOS president Dr. Christoffer Johansen, "a scientist and a mentor for many young clinicians and scientists in Israel as well as internationally is also acknowledged."
Sharett Institute director Prof. Tamar Peretz praises Baider for pioneering the message that a cancer patient should be treated holistically, as a whole person and part of his or her family, and for training most of the psycho-oncologists in Israel.
Her long-term research on middle-aged daughters of Holocaust survivors who are themselves diagnosed with cancer found that while they function adequately in their daily activities, they are vulnerable to psychological distress if they contract breast cancer. They are much more likely than other cancer patients to suffer from intruding, obsessive thoughts, and scored very high on depression, anxiety, hostility and psychosomatic complaints. Those whose mothers are still alive show even more severe symptoms, and some refuse to tell their mothers of their illness.
"Children born to survivors were raised at a time when talking about the Holocaust was taboo, as cancer is still a taboo among many people," Baider reported. "We believe this contributes to their extreme distress."
Psycho-oncology didn't formally exist until the mid-1970s, when it was launched at New York's Memorial Sloan-Kettering Cancer Research Institute (where Baider spent four months as a research fellow in 1986). Before that, oncologists were reluctant to reveal a cancer diagnosis to patients and talk to them about its implications. But with the decline of doctors' paternalism, rising recovery and cure rates (50 to 60% survive five years, and many are cured), patient empowerment and the Internet (which enables patients to research their disease), psychosocial and psychiatric cancer research and therapy began.
BAIDER, WHO was born in Buenos Aires in 1939 and studied clinical psychology at the city's university, moved to the US in the late 60s and studied medicine for four years before earning a doctorate in medical sociology at Brandeis University. She taught there, at Boston University and other institutions, and worked with patients during her 15 years in the US. But as a Zionist who believed in Israel, she was encouraged to settle here by Prof. Zvi Fuchs, then head of the Sharett Institute, and his successor, Prof. Shoshana Biran during their visits to the US. Although she knew no Hebrew, she was hired in Jerusalem as Hadassah's first psycho-oncologist. It was a young field, and it took seven years until the Sharett Institute got another practitioner.
"Today, we have eight, including me," says Baider, founder and president of the Israel Psycho-Oncology Society since 1995; it now has 182 members, most of them women. There are similar national associations in 53 other countries.
Many hospitals in the Western world have full departments of medical oncology whose staff are integral partners in treating cancer patients. Some Israeli hospitals don't have even a psycho-oncology unit: Peretz thinks the Health Ministry should make this mandatory in every medical center. Baider and her team, who get valuable support from the Israel Cancer Association, treat teenage and adult patients individually and in groups, usually within their family environment.
"Cancer is not an individual's disease. It's a family affair and affects everyone in the patient's environment."
CANCER, THE most common serious disease in the Western world, including Israel, is generally harder on women than men, she continues.
"The woman is the center of the house and everybody depends on her. When a man gets cancer, he can depend on his wife for support, but women tend not to want to worry others about their own problems," Baider says. When a subject is open and you can talk about it, there's no mystery. But when it's unmentionable, we can't help."
Although there is considerably less stigma to cancer than there was a few decades ago, Baider says the disease still needs airing.
"For many people, cancer equals death. They say: 'Anything but cancer.' Thinking about the disease makes them feel they have lost control. If they have heart disease, they say; 'I can stop smoking, I can change my diet, exercise, and take medication.' But they feel helpless with cancer. This is the wrong idea. People with cancer can be in control of the healthy elements in their body. They must reorganize their priorities. You can start living now, even if you have cancer."
Patients "have to learn how to live. Dying is a natural process in the life cycle; it is a part of life, like birth. And if they eventually die of cancer, at least we make an effort to improve their quality of life and that of their family before it happens." She recalls that the charismatic Prof. Biran, a leading expert on breast cancer who died of it 15 years ago, held a dinner party at her Jerusalem home two days before her passing.
"She made a fantastic dinner for a group from Germany who were partners in our research... But when she died, a part of me died with her," Baider confesses.
Another charismatic woman who was her patient and friend was Ofira Navon, wife of the fifth president of Israel, Yitzhak Navon, who had breast cancer twice and then succumbed to leukemia in 1993 at the age of 57.
"She was a very courageous woman and had a great sense of life and hope.
Despite her disease, she often said: 'Now, I am alive!'
When offering tools to cope, Baider says, she doesn't tell people what to do.
"They tell me. I don't try to change them or give them a prescription. The prescription to living life is within them. They must have a new appreciation for life and dream for today, not for tomorrow."
Baider asks women who have been married for decades when was the last time they invited their husband to drink a glass of wine, when they last bought themselves flowers.
"They think I'm crazy, but they begin to think and change their list of essentials and start doing things in the next month that they had planned to do 10 years later."
Israelis have lived with war and terror for decades, but they still cope and enjoy themselves, notes Baider. "They should try to enjoy as normal a life as possible despite their cancer."
Some women diagnosed with cancer, she says, decide to divorce their husbands to leave an unhappy marriage; they wanted to before, but never had the push to do so. "After facing the disease, they want to live better."
Baider adds that it is unusual for male patients to seek a divorce, as they need wives for emotional and practical support. Religion is consoling for some patients, while others learn to create their own system of beliefs, she says. "It doesn't have to be religion in the institutional sense. People can put on a tape of Bach, sense a connection to their soul and feel hope."
BAIDER, WHO is a licensed hypnotist, uses the technique on patients, who may be taught self-hypnosis, relaxation, meditation and guided imagery. They may get five to eight sessions.
"Our doctors can help them with pain, but people must learn to cope with their fears. We ask them to take their troubles and put them in a heap on the chair next to them. We ask them to talk to their fears, and help them deal with scary thoughts. We help them learn a new language to deal with something for which they were not prepared."
Some patients, she says, want to know every technical detail about their condition, while others prefer denial or guilt.
"That's OK, but they need to cope with their anxiety and stress. Thirty to 45% of patients in active treatment suffer from a high level of anxiety and depression, while the figure is 55% in those who have a recurrence of cancer. They can be helped with medication and a variety of techniques."
She is grateful to Peretz "for being very enthusiastic about the benefits of psycho-oncology and insisting that all diagnosed cancer patients there be offered help from Baider and her staff. It's as much a part of treatment as chemotherapy." Peretz, Baider concludes, "has a lot of guts and lots of ideas. She's very open to anything that can help our patients. We all adore her, and she's a role model to the whole staff."
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Judy Siegel-Itzkovich
Health and Science Reporter and Software Reviewer The Jerusalem Post.