A unique opportunity to upgrade genitourinary medicine.
Authors: M. W. Adler
Journal: BMJ (1989)

After leaving hospital many patients turn to one of the many voluntary self help groups or cancer support centres.Most of these groups offer simple social support, counselling, and some forms of complementary medicine.These may include sessions of relaxation and meditation, either in a group or individually with a healer, and an introduction to the Simonton technique ofvisualising images designed to promote healing and recovery.67Simple nutritional advice recom- mending vegetarian food is usually also given.Few groups have an attending doctor, and all work outside the con- ventional routes of medical referral.These centres and support groups seldom have any defined link with the National Health Service, and all are self financing.8They do not see themselves as offering cures for cancer but aim at supporting anxious people at a time of crisis, disclosing and strengthening their inner resources, and pointing the way to self help-complementing rather than conflicting with conventional cancer treatment.Their patients are grateful for help given in a sympathetic and unhurried atmosphere, which is rarely achieved in a hospital setting.Some report that the insight they gain has favourably transformed their view of themselves and their role in life, irrespective of the outcome of the cancer treatment.Realisation of the need for psychological support has led to some oncology clinics including a cancer counsellor or psychotherapist, a professional who has had special training in the psychological problems and communication difficulties that arise with cancer."13 We suggest a natural extension of this: oncology clinics should set up their own cancer support group, run as a day centre in or near the hospital for those who need it, with counsellors and other staff working both in the hospital and in the group.Contacts made initially with patients in the wards or clinics could be continued as necessary afterwards.Additional services offered could be those of a social worker, chaplain, art therapist, and visiting doctors, as well as those provided by voluntary assistants.The style of accommodation for such a support centre is important.It should avoid a hospital atmosphere and be informal, comfortable, and welcoming.At least one room should be big enough for group meetings, with other smaller rooms for individual consultations.There should be a kitchen, toilet facilities, and easy access for unwell or disabled patients.Of course there are some extremists in complementary medicine who claim miracle cures based on anecdote and not on rigorous clinical trial.Such people are as damaging as those doctors who think that their relationship with a patient is threatened by sharing it with a colleague outside conventional medicine.But if the patient benefits-why not?Such an organisation would cost money, but this would be only a small proportion of the total cost of cancer treatment.Overcoming the present hiatus between hospital and voluntary support services, it would recognise and integrate the role of support groups, permitting a much needed appraisal of their complementary methods.If the culture of the new National Health Service really will be more flexible then support services for cancer patients and others stand a good chance of success.