The communication style of the clinician has direct bearing on his or her capacity to support effectively. Patients preferred tapes of significant consultations to follow-up letters, saying they lead to better understanding of the predicament with greater resultant satisfaction. The role of the breast nurse counsellor in the treatment team has been established in five randomised controlled trials 5-10 showing greater understanding, adjustment, continuity of care and earlier recognition of psychiatric disorders. Providing detailed information about radiotherapy and its side-effects reduces anxiety and promotes overall adjustment. When women are afraid of the machinery, the environment of the room or being left alone, relaxation therapies including guided imagery are helpful, and can be delivered by several of the team members.
Relaxation therapy is highly effective in reducing anticipatory nausea, but needs to be used early.
2 Multidisciplinary support When cancer is progressive, sustained multidisciplinary support enhances adjustment and quality of life, and must include the family. Early referral to domiciliary palliative care maintains the woman's independence for longer. Fear should not be permitted to delay access. During routine management, clinicians ought to refer one in five women for specialised psychological help. If this is not the case, psychosocial problems are probably going unrecognised.