The suicide note of ADGP Himanshu Roy, which mentioned depression due to cancer, has underlined the need for improved palliative care support and counsellors for terminal diseases in the healthcare system. India records one million new cancer cases every year of which six to seven lakh patients die, a Lancet oncology study states.
“Palliative care has not become a part of public healthcare yet, it is much worse in rural areas,” says Dr Mary Muckaden, professor of palliative care at the Tata Memorial Hospital. The hospital annually receives over 70,000 cancer patients. Those who come to the palliative department are terminally ill and have already developed symptoms of depression.
“Palliative care is not just about end of life, it is also about hand holding a patient with terminal illness to psychologically and socially support them.”
“Our first focus for cancer patients is not pain management but psychological counselling. They are anxious, helpless, and there is the financial burden of treatment. Initially, there are short pangs of depression that lead into clinical depression,” Muckaden added.
According to surgical oncologist Dr Raj Nagarkar, part of the team involved in Roy’s treatment of bone cancer, the 54-year-old was advised counselling for depression during treatment that spanned over two years. “I am not sure if he did take mental health support,” Nagarkar said, adding, “While his (Roy’s) last report showed no trace of tumour, there was still need for rehabilitation. More than physical tumour, the disease can have far reaching impact on mental stability,” Nagarkar said. A meta-analysis titled depression as a predictor of disease progression and mortality in cancer patients in 2009 revealed that depression in patients increases mortality rates by up to 39 per cent.
Dr Vinayak Kale, head of psychiatry at JJ hospital, said depression is common among cancer patients due to the fear the disease evokes.
At KEM hospital, the head of the psychiatry department Dr Shubhangi Parkar said since counsellors cannot be present with each oncologist to provide immediate support to patients, there is need for oncologists to identify symptoms of depression and refer patients to mental health experts.
“It is challenging to counsel a terminally-ill patient. What they need is hand holding and support from relatives. Such patients have emotional turmoil, and counselling at the right time helps,” she said. “Also it is important that counselling is done in initial stages to remove fear rather than wait for the disease to progress into advanced stages.” India continues to have poor palliative support for cancer and other terminal illnesses. In Maharashtra, palliative care programme exists in eight districts but in the absence of trained psychiatrists, patients have nowhere to go for mental support.
The state government has floated a proposal of Rs 3.6 crore for the National Health Mission for 2018-19 but an approval is awaited. In 2014 and 2015, proposed budgets for palliative care were shot down by the union government. Since its launch in 2013, the programme has not been expanded to other districts due to paucity of funds.