Health education, cancer and postgraduate training

Cancer as a term encompasses a multitude of diseases and is consequently misunderstood. Today, it is still considered sinister and, too often, synonymous with death. It is a complex subject, exciting and challenging, yet the myths associated with cancer are perpetuated even by professionals in the health service. This can be attributed to the scant knowledge of its nature and prognosis, the progress made and the services available. When one considers the breadth of basic training needed to prepare both doctors and nurses to practise it is understandable. In a health service based on disease it is difficult to consider prevention as a priority. Financial implications are enormous and inhibit this aspect of the work in thefield of cancer and allied diseases. However, it is estimated that 80--90% of cancers are caused by environmental influences and can, in theory, be prevented. Efforts to promote health and prevent disease are costly and too often ineffective. Early diagnosis is another contentious subject; efforts are being directed to the establishment of clinics for patients presenting with symptoms rather than detection of symptom-free subjects. Improved approaches to prevention, recognition and acceptance through an understanding of cancer will alleviate the task of those directly involved in the cure and control of the disease. Health education in relation to cancer needs to be directed equally at health service professionals and the public. It would be unacceptable and inaccurate to describe the cancer services anywhere as incapable of further improvement. Research and therapy must go hand in hand and depend on the participation of the patient as a knowledgeable member of the team, rather than as a passive recipient of care. Death should not be considered failure, rather the completion of care. We face constantly the risk of despondency and the efforts of the team must be sustained with optimism and encouragement. Achievements have been made and will be made, however slowly, and the end justifies the effort. The need for postgraduate training is greater now than ever before. Adaptability to rapid change, vision and continuity are vital in our technologically orientated society. This should be considered a prerequisite to ensure improved standards of patient care at home and in hospital.