I walked into the clinic on Monday morning, to be informed by my clinic nurse that Mr. Chin (not patient’s real name) was unwell. I asked his wife to bring him in for assessment. “Just another week and a half to complete radiotherapy”, I thought to myself. It couldn’t be easy.
I remembered the early days of counseling Mr. Chin for his radiotherapy treatment. I used the ‘Mount Kinabalu analogy’, and if you heard me on repeat, it’s the same story I tell every single time. Radiation treatment for Nasopharyngeal Carcinoma is not an easy treatment. It requires a multi-team approach, from the medical team, as well as caregivers at home. It’s a marathon, not a sprint. And it’s akin to climbing a mountain, the hardest part is always right at the end of treatment schedule.
The first part of management is the CT simulation scan and preparation for the mask. The mask is shaped to the patient to ensure no movement during treatment. This is because radiotherapy itself is precise treatment, and movements or change in shape can affect its delivery.
Prior to starting radiotherapy, Mr. Chin had to be reviewed by a dietitian, speech therapist, and dentist. This was to prepare him for the treatment, assess his status, and also to teach Mr. Chin the exercises needed throughout the treatment.
Radiotherapy for NPC spans over seven weeks, with treatment delivered every single day, five times a week. For the first part of the ‘climb’ (referring to the Mount Kinabalu analogy), the journey might seem easy. Start off slow, pace yourself. Most patients do not experience significant side effects initially.
However, as weeks passed by, the accumulation of treatment effects caused Mr. Chin to have some discomfort. He felt his saliva start to thicken, and his neck became slightly redder, akin to being sunburnt. The swelling in his neck from the cancer also reduced, and he was motivated by this. He worked with the dietitian to maintain his weight, as he lost appetite due to changes in his taste.
We spoke about his daughter’s wedding and how important the event was for him. Since it’s a big life event for Mr. Chin, we ensured he was supported and able to attend the wedding. When he returned to treatment, his spirit dipped as his motivation to continue treatment was low. We discussed it further, and I was glad he sought the help of a counselor, which he very much needed.
“The whole journey has not been easy, Mr. Chin, and we are now towards the end of therapy,” I tried to encourage him. As he was unable to swallow, we admitted him to support his swallowing via a feeding tube. With hydration and nutrition, he felt a little bit better. His wife looked tired from lack of sleep.
We called in the support team, including dietitian and speech and language therapist, to work with Mr. Chin and continue him to the peak of his climb, to finish his radiotherapy treatment. On the last day of his treatment, he was ecstatic to complete it.
The story of Mr Chin’s resilience is a reminder to myself of how important mental strength is in accepting and going through medical treatment. Furthermore, treatment for this cancer requires multiple team members working together to deliver optimal management. Therefore, reimbursement policies need to acknowledge importance of allied healthcare professionals in delivering holistic care to patients.
Nasopharyngeal carcinoma is an endemic disease of South East Asia, especially so in Bidayuh population. It is chemo and radiosensitive disease, meaning it can be cured using chemo and radiotherapy. Due to its location behind the nose, access to surgery is difficult and treatment does not usually involve surgery.
Medical research is warranted to improve cure for this disease. I was actively involved in recruiting patients for clinical trial to review newer therapies available for this disease. Active participation in clinical trial by Malaysians is imperative in moving the needle forward in effectively treating this cancer.
As we sat down 3 months after radiotherapy treatment completed, I was delighted to deliver the news of good response to treatment. The cancer was no longer active, and it showed complete response to treatment. Mr Chin’s mental resilience paid off, and he conquered the mountain peak, all in good time.
Clinical case is based on reflection of authors clinic practice, but patients identify remains confidential
