A diagnosis of brain tumor changes a person's life in an instant. Nothing is the same anymore. And that applies not only to the patient themselves, but also to their entire close family and social circle. In addition to the physical impairments and the often strenuous and exhausting cancer treatment, the emotional strain can be immense. Questions, fears, and sadness become part of everyday life. An open ear, an understanding conversation, or even psychological counseling can provide valuable support. The staff of the pastoral care team and the specialists of the psycho-oncology service are available for this purpose at Inselspital.
Alexander Wünsch, psychooncologist
PD Dr. Alexander Wünsch has been head of the psycho-oncology service at Inselspital, Bern University Hospital, for a year. The service is affiliated with the University Clinic for Medical Oncology. Psycho-oncology offers cancer patients support with all personal issues that concern them in the context of their illness. This often involves topic-specific counseling, such as dealing with physical changes or limitations, communicating with family and friends, and specific concerns and fears about the future. However, psycho-oncology also includes discussions about existential issues such as grief and sadness, the meaning and finiteness of life, and even longer-term psychotherapeutic treatment for severe anxiety, depression, or other mental disorders.
The seven employees of the psycho-oncology service are available as points of contact throughout the entire treatment period and beyond. «The first contact is often made during hospitalization, with further care then provided on an outpatient basis,» says Alexander Wünsch. «In neurosurgery, patients tend not to stay in the ward for very long.» Just under 20% of brain tumor patients take advantage of the psycho-oncological counseling services.
According to Alexander Wünsch, there are two or three main topics that come up in conversations with brain tumor patients. «One of these topics is sadness and grief. Those affected mourn the loss of abilities, opportunities that can no longer be realized, and life plans that they have to say goodbye to. Another very important topic is fear—especially fear of what is to come. Here, it helps to face the fear in conversation and to name it specifically. And the third important topic area then touches on the existential. What does this tumor mean for me? What meaning do I want to give my life? Am I going to die?»
However, it is not only the patients themselves who receive support, but also their relatives. «We often see patients and relatives at the same time. Sometimes we only provide support to the relatives. From our experience and from a scientific point of view, we know that the relatives of cancer patients are often just as severely affected as the patients themselves,» says Alexander Wünsch.
Marianne Kramer, pastor and pastoral care worker
The pastoral care team at Inselspital consists of a total of 10 theologians who are available to all patients who feel the need for pastoral care and conversation. «We work across denominational and religious boundaries,» says Marianne Kramer, a pastor and pastoral care worker at Inselspital for 15 years and responsible for the neurology and oncology departments. The team is supported by a Muslim chaplain and a priest who are responsible for special services when needed.
Unlike the psycho-oncological service, pastoral care is also organized as a care team and can be reached at any time in emergency situations via the on-call service seven days a week. Even at night. Patient care mainly takes place in the inpatient area.
Marianne Kramer takes part in interdisciplinary meetings or is alerted by the nursing staff on the ward when patients need support or have expressed a desire to talk. Then the trained theologian and qualified midwife simply drops by and introduces herself. «The stereotype is that a pastoral care worker walks around the ward with a Bible under her arm, going from bed to bed. But in reality, it doesn't work like that at all. I don't even have a Bible in my bag (laughs). Just my cell phone, really.» says Marianne Kramer.
When patients accept the offer of a chat, she sits down with them and takes her time. «I was a patient myself, and you notice that hardly anyone ever sits down on a chair next to your bed. Everyone stands. You're lying in bed, and everyone is standing and looking down at you, and you can tell they're in a hurry and have to move on. But we pastoral care workers take a chair, sit down at the bedside, and simply take our time. That's a huge luxury.»
Marianne Kramer mainly listens. «For me, the patient is the expert on their own situation and they tell me how they want to proceed. So I don't come in and tell them what to do. It's often simply a matter of finding out where the person sitting opposite me is at. What exactly is the problem and how can I support them? It's not always what you think.»
Differences and similarities
How do pastoral care and psycho-oncological care differ? Alexander Wünsch answers «Well, first and foremost, I see a lot of similarities. We both work through conversation, we listen carefully, we address existential questions. Issues surrounding the finiteness and meaning of life probably represent the greatest overlap with pastoral care.»
Pastoral care has a higher duty of confidentiality. Psycho-oncological services are subject to medical confidentiality and have a treatment mandate. This means that psycho-oncologists also communicate with the treating physicians and nursing staff, which is sometimes not so clear in pastoral care.
Marianne Kramer also emphasizes that pastoral care does not make diagnoses or provide therapy. «We simply look at what resources the person has that we might be able to remind them of. That's also a difference between what we offer and the psycho-oncological service.» Alexander Wünsch agrees. «The difference is that we psycho-oncologists take a more specialized approach to certain mental disorders, that we have interventions for coping with anxiety and grief or can use psychotherapeutic measures.»
Support services in the future
What does Alexander Wünsch want for the future? «I would like to see a service that takes the whole family into account – including the children of parents with cancer. A service where these children could easily and simply come to a center here at the Inselspital where art therapy, play therapy, and music therapy could be used to create a child-friendly approach to the children's world and their needs. I think such an offer would also be particularly useful in neurosurgery, because many of the patients here are still quite young and have younger children. And some of these children are actually experiencing the death of a parent. I would find it wonderful if these children could receive ongoing support.»
And what does pastoral care worker Marianne Kramer wish for the future? «I hope that this high level of interdisciplinary commitment will continue in the future. I believe that everyone – from the surgeons to the nurses – is genuinely interested in ensuring that every single person here receives good care and support. In my opinion, we have a very high standard here at Inselspital, and I hope that sufficient resources will be made available to maintain this.»
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Related Links
- World Brain Tumor DayEvery year on June 8 is World Brain Tumor Day! This global day of action and remembrance aims to raise awareness of the difficult situation faced by those affected and their families.
- University Comprehensive Cancer Center Inselspital (UCI)The Universit Comprehensive Cancer Center Inselspital (UCI) coordinates and integrates the services of the Inselspital in cancer research, diagnosis, treatment, and aftercare.
- Supporting and accompanying servicesCancer patients and their relatives have access to a wide range of services that can provide support and assistance during and after cancer treatment.
- Pastoral care and spiritual supportDuring their stay in hospital, the pastoral care team supports patients and their relatives of all religious and philosophical beliefs in their personal concerns, whether these relate to questions of meaning and life or spiritual and religious issues.
- Psycho-oncological careOur psycho-oncology team supports you and your relatives according to your personal needs and concerns, even after your hospital stay.