While a few studies have been done, there is little evidence that there is any set pattern of reaction to a diagnosis or potential diagnosis of cancer. In assessing patients' reactions it is important to consider individual personalities and to remember that many factors other than the patient's present illness may be contributing to his anxiety.

The patient's personality, his home environment, his experiences in the hospital, his knowledge and feelings about cancer, the severity of the cancer, and the emotional support he receives affect his total illness experience. Emotional reactions of the patient may be manifested in a variety of ways-anxiety, depression, hostility, passive acceptance, denial, resistance-to name a few. The behavior pattern of a particular individual in this period of stress will depend on the patient's ability to adapt and mobilize his own resources and on his accepting whatever is available to him in outside support including family, physician, nurse, and members of other allied professions. It should be remembered, however, that in order to be supportive one must give consideration to what the patient himself sees as his primary need or problem. Rehabilitation will be achieved only as the patient and his family are able to accept the changes which have occurred as a result of the treatment.

Since it can be anticipated that most patients will have a hospital stay of short duration, the public health nurse must be prepared to plan and help carry on a program of care at home. She will play an increasingly important role in showing the family how they may best share in this care program. The nurse should learn how the family regards cancer. Do they think cancer is communicable and will they neglect or reject the patient? Will they be overprotec-tive? Are they so emotionally involved that they cannot be of real assistance to the patient?

As long as the patient is capable of productive activity, and of looking after his own personal needs it is important that he be encouraged to do so. This will help to counteract the sense of dependence which is so often dreaded. Consideration must be given to interpreting the need for the patient to resume, in so far as possible, his previous role in the family and community.

The need for and the difficulty of communication are tested by the perennially recurrent question-"Should the patient be told he has cancer?" There is no "logical" answer since everyone differs in his ability to face illness in general and perhaps cancer in particular. Doctors and nurses are not exceptions.

A patient with cancer is rarely told all of the details about his illness. Reasons for giving a patient information regarding his illness are to relieve his anxiety and to elicit his cooperation in the planned program of treatment.

Nurses must accept the fact that not every patient will be told his diagnosis. It is the responsibility of the physician to determine what and how much the patient and his family should be told. However, the nurse does have the responsibility to learn from the physician what the patient and his family have been told, so that if she is questioned she can cooperate intelligently in providing clarifying information and support and reassurance. Most patients are not as interested in information about cancer and surgical procedures as they are in the possibility of survival and treatment results that are long range in their effects. They want to know what limitations may be expected and to be helped in achieving their ultimate rehabilitation.

Guidance consistent with each patient's values and adapted to his life situation takes on meaning, and information about his diagnosis or treatment becomes less important.

Perhaps the most important function of the public health nurse is to listen to the patient and his family. Communication is two-way ; what the patient or his family tells you may be just as important as what you tell the patient. Being a good listener involves making sure that the patient knows you are really interested in what he is telling you. There are many ways of doing this-by looking interested; by sitting back in the chair instead of on the edge; by nodding agreement when indicated; or by interjecting an appropriate sentence now and then.

There are some patients who are not communicative and some who are very immersed in their own problems. The nurse will need to make a special effort to go more than halfway if she is to find out what is of concern to these patients.

Many times the patient will verbalize a complaint about something which is happening to him in the course of his treatment. When this occurs the nurse should make a special effort to listen objectively and to avoid reacting with hostility. Above all she should try not to cut off the patient's flow of conversation.

It is helpful when the nurse is able to assess her own feelings about what is happening between her and the patient. When she gains insight into the relationship which has been established she should be better able to work effectively with both the patient and his family.

The public health nurse should maintain as close supervision as the patient requires, assisting the physician and family as new problems arise.