Caring for immigrants with cancer

Cate Swannell
Med J Aust
Published online: 3 March 2014

Medical psychologist Professor Phyllis Butow spends her time finding ways of improving the care we offer immigrants with cancer

When asked what three things she would do if she were prime minister for a day, Professor Phyllis Butow answers so quickly one suspects she has been daydreaming about that day for a while.

“I’m interested in mental health for cancer patients”, the medical psychologist tells the MJA.

“We know that a lot of cancer patients who are struggling with anxiety and depression are never identified because they don’t talk about it.

“If we had routine screening for distress in cancer care — six short questions that identify if they’re struggling — that would accomplish a lot. Patients are trying to be on their best behaviour when they are in hospital, and unless we ask, we miss it.”

Her second prime ministerial wish involves her current area of interest — immigrants with cancer.

“We need to develop better services for immigrants, for example, a phone service with a nurse or carer with language and cultural understanding to help them liaise with their health care provider.”

And her third wish?

“Improved care for cancer survivors”, she says.

“When cancer treatment is over and the person is back in the community, they are left with a whole legacy of cancer-based fears and anxieties — about side effects, greater risks of recurrence and other illnesses. We need to care for them better than we do now.”

Professor Butow was recently named a Member in the General Division of the Order of Australia — “for significant service to medicine in the field of psychology, as an academic, researcher and author, and to professional organisations” — an honour capping a long list of awards and accomplishments through her career.

She is currently professor of medical psychology at the University of Sydney and director of the university’s Medical Psychology Research Unit; senior principal research fellow with the National Health and Medical Research Council; co-director of the Centre for Medical Psychology and Evidence-based Medicine; co-director of the Surgical Outcomes Research Centre at the Central Sydney Area Health Service and the University of Sydney; and a board member of the Sydney Catalyst Translational Cancer Research Centre.

She has been an invited board member of the International Psycho-Oncology Society (IPOS) since 2009 and chair of its research committee since 2011. She was co-chair of the IPOS World Congress in Brisbane in 2012 and has been a member of the Research Advisory Committee of Cancer Australia since 2010.

Professor Butow began as a clinical psychologist in the Australian Capital Territory’s community health care system, working with patients with anorexia and bulimia, which were the topics of her PhD dissertation.

“My first paying job was with cancer patients and I loved it”, she says. “I’ve stayed in it ever since.”

Medical psychology is, says Professor Butow, particularly interested in how psychology can help patients to adjust to illness and the cognitive tasks that must be done when people are sick — “hearing and understanding the information being given to them, the problems and risks, and decisions about treatment”.

“That sort of communication from doctors, nurses and other allied health professionals can help patients identify and express what they’re feeling before they get to that cognitive work. They can empower patients.”

It hasn’t always been the case that medical practitioners have been the best communicators.

“There’s been a real revolution along these lines”, Professor Butow says. “With the rise of patient-centred care over the last 20 years there is a real interest from doctors in how to do this better.

“We still don’t do it perfectly, but there has been incredible progress made.”

Immigrants with cancer have been Professor Butow’s main focus for the past four or five years.

“I’ve been looking at the particular challenges faced by immigrants with cancer who often don’t understand the health care system. There can be language problems, of course, as well as different cultural ideas about illness and treatment.

“They can be a bit dismayed when their health care journey doesn’t happen the way they want it to.”

Immigrants, she says, have a lower quality of life and more depression and anxiety than those born here.

“People emigrate for all sorts of reasons and some come with a lot of trauma in their background.

“This is a large group of people we’re talking about”, Professor Butow says. “The statistics are that almost 50% of Australians have at least one parent born overseas.”

The new federal government’s plans for health care budget tightening have Professor Butow concerned.

“I’m a bit pessimistic with the budget being closed down”, she says.

“Psychosocial care tends to get sacrificed early, and proven interventions won’t get funded.

“Everybody is doing the best they can and there are some superb people doing great work, but I do worry that funding will be cut.”

  • Cate Swannell



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