December 9, 2021
If you’re in treatment for cancer, there’s a good chance that your stress level has increased.
These findings, published by Cardinal Health Specialty Solutions, are the result of web-based surveys taken in September, October, and November 2021. Respondents included more than 240 oncologists in hospital and community-based practices.
Asked what types of mental health distress they see most frequently, 83 percent cited anxiety disorders and 81 percent named mood disorders, including depression. Substance use disorders, personality disorders, and post-traumatic stress disorder (PTSD) were also mentioned.
Dr. David Park is medical director and chair of hematology and medical oncology at Crosson Cancer Institute at Providence St. Jude Medical Center in Orange County, California.
Park told Healthline that he’s not at all surprised by this report.
“A cancer diagnosis is not good, obviously. And whatever underlying challenges you have get amplified. Not just for the patient, but for the family,” he said.
Whatever affects the general population, such as the COVID-19 pandemic, just adds an extra level of stress to people with cancer, Park said.
Manageable stress vs. mental health condition The survey found that more than 6 in 10 oncologists very frequently or frequently talk about mental health with their patients. About two-thirds say they formally screen patients for distress.
The extent of the concern isn’t always clear-cut or easily figured out in a day, said Park. “The first thing patients need to understand is that having stress and anxiety at this time is a normal part of the process. Life doesn’t stop. It becomes more complicated. In the United States, we’re into schedules and being busy and having it all. It’s really an unfair and unrealistic pressure we put on ourselves,” he said.
Social media posts about people with cancer being active can add to the concern. “The intent is good, trying to portray to patients that you can enjoy life and pursue your dreams. That’s true to a certain extent, but when we put it in hyperdrive, we add unnecessary pressure. It’s OK to have bad days,” Park said.
With or without cancer, some mental health conditions need to be addressed. “This is where a physician or counselor can pick up clues. The human psyche is complicated, so you need a whole-person assessment,” he said.
How mental health affects cancer outcomes
In the survey, more than 90 percent of oncologists agree or strongly agree that mental health has a significant impact on cancer outcomes.
Although many oncologists offer in-house support, many indicated that mental health resources are not adequate.
There is researchTrusted Source to suggest that having a mental health condition before a cancer diagnosis can impact outcomes.
“There are obvious reasons, such as the patient not being motivated due to a depressed outlook on life. They may not come to treatment as scheduled or stop taking medications. Then there’s a mind-body connection that doesn’t show on tests. We can’t discount this, though we don’t fully understand,” Park said.
He believes a positive attitude is good but emphasizes a nuanced message.
“We don’t want to give patients another job. And we don’t want them feeling guilty or at fault if their cancer gets worse. The last thing I want to do is give my patients more burden,” said Park.
Palliative care, which focuses on symptoms and quality of life, may also play a role in mental health. Two-thirds of oncologists surveyed said that starting palliative care earlier leads to better outcomes.
But the survey suggests that patient and caregiver resistance is a significant barrier to palliative care. About 1 in 5 oncologists said they only offer palliative care when patients are close to end of life.
Getting help Most oncologists surveyed said they only occasionally refer patients to mental health services.
About 93 percent say they’ve prescribed antidepressants and 95 percent say they’ve prescribed anti-anxiety drugs as a new treatment for people with cancer.
Park explained that traditionally, oncologists referred patients to a mental health professional. But the red tape of medical insurance and the logistics of finding and going elsewhere for can be a barrier to treatment.
“It’s almost like adding another disease and it’s not fair,” he said.
His practice screens for distress and includes navigators and mental health professionals on site.
“Cancer is complex and multifaceted. It affects everyone differently, physically, emotionally, socially, and in relationships. Oncologists are not trained to deal with it all. At St. Jude, we offer these services here and patients appreciate it,” Park said.
Most oncology practices do distress screening, he said, but patients, families, and caregivers can also seek help. Communication may be the biggest barrier.
“Just share with somebody,” said Park. “Then, they can help you figure out your options and follow up.”
“If you’re the recipient of that sharing, be a sounding board. Of course, if the problem is urgent, you should call an emergency hotline,” he said.
“We have a long way to go, but we know more about mental health than ever before,” Park said.