Addressing mental health for cancer patients
Cancer takes a huge physical toll on patients, but it also impacts mental health. Dr. Emaan Lehardy, assistant professor in the Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine, specializes in psychology for oncology patients. She answers questions about the mental health challenges facing patients after a cancer diagnosis and how seeing a psychologist can be beneficial.
Q: What mental health challenges do patients face after receiving a cancer diagnosis?
Lehardy: Initially at the point of diagnosis, people may feel a sense of shock and go into a “fight or flight” mode. The word cancer often elicits thoughts about death and the focus at that moment becomes “what do I need to do to survive?” However, what they might not immediately realize is that with all the recent advancements in treatment, they now have options and cancer survivors are living longer.
As patients start treatment, the focus shifts to logistical issues, and they might ask themselves – what is my life going to look like? Do I have to arrange for childcare? Do I need to step back from work? Once treatment gets going and they start to experience some significant side effects, their quality of life also starts to change. They may have to step back from things that they enjoy doing like going for a run outdoors or attending a concert.
Some patients who are undergoing chemotherapy start noticing changes in their physical appearance. They might appear pale, their hair is thinning or falling out, or they lose eyelashes and eyebrows. Some people gain weight during chemo, which is not really talked about and usually comes as a shock to a lot of folks. The physical changes can be really distressing because patients may no longer recognize their own reflections in the mirror. It’s almost like, well, who am I now? And that is when depression and anxiety can start to creep in.
When you have changes to physical appearance and quality of life, now you’re also talking about changes in identity. Let’s say you were the primary breadwinner, and now you’re not able to work and maybe your loved one has to figure out how to handle the finances. Maybe you were the primary caretaker at home, and now your partner is having to step in and be the one who’s dropping off the kids, making their lunch, taking them to their doctor’s appointments. A lot of people who identify as being caretakers find it especially uncomfortable to make the switch to now receiving care.
Depending on how severe their chemotherapy is, or if they have to undergo a major surgery, patients may feel a loss of independence. When all of these significant changes happen, people tend to be at higher risk for mental health concerns like depression and anxiety, especially if you have a previous history of these conditions.
Q: How does a psychologist who specializes in oncology benefit cancer patients?
Lehardy: I usually come in when the patient requests psychological support or their oncologist or a family member notices that the patient is quieter and more withdrawn. I have some patients who start seeing me right at diagnosis. They may want to be proactive or maybe they have a prior history of depression, and they want help right away. Some people start seeing me in the middle of treatment once they feel like they have other logistical things under control, but they need psychological support. Some people don’t see me until they have completed active treatment and are reintegrating into their life. That period can be very lonely because when patients are going through cancer treatment, they’re seeing their oncologist and care team on a regular basis. After they complete active treatment, they may not have any appointments for a couple of months and suddenly feel completely alone.
I think having a psychologist on staff who understands the cancer trajectory and the kinds of concerns and fears that are likely to come up can be really helpful. Some people just like having a space where they can talk about their fears because they feel like everyone else expects them to stay strong or simply to cry and feel vulnerable.
Q: Sharing news of a diagnosis with family, friends and acquaintances can feel like a burden. How can cancer patients navigate this?
Lehardy: It is entirely up to you who you want to share with and how much you want to share. If you don’t want to deal with all the text messages or emails or calls, you can assign a point person, maybe like your sister or your husband or a good friend, to be the point person of communication. You can also consider different levels of detail that you share. With really close friends, you might feel more comfortable sharing more details. With acquaintances like neighbors or co-workers, you can say – I’m going through a health concern, and I’ll talk about it when I’m ready to. You can always end a conversation if someone is not respecting your privacy. You don’t owe anyone an explanation.
If a patient has young children, we often refer them to an organization called Wonders and Worries. They specialize in meeting with children and discussing what their parent is going through in a developmentally and age-appropriate way.
Q: What else should cancer patients know about mental health challenges?
Lehardy: One thing I regularly see come up – I think sometimes people mistake sadness for depression. You’ve just been given a life-altering diagnosis, and you are going through what’s probably one of the toughest treatments. You’re going to have days where you feel sad, and that’s okay. It doesn’t mean you’re depressed. A lot of times people think that they shouldn’t feel sad or that they shouldn’t be anxious, but these are normal reactions. Where we start crossing the line into depression and anxiety is when the sadness or worry becomes persistent, severe and/or start interfering with functioning.
Another thing that is important to consider is that for a certain subset of cancer patients, end of life issues will come up. As difficult as the conversation is, it can be helpful to keep the door open to discuss not just logistical issues, but also how you are feeling. How do you process this? How do you make sense of the time you have left? What do you want to do? What gives you a sense of meaning? How do you reflect on your life? If you have children, how can you be infused in their future milestones? These are important conversations for patients and their loved ones to have.
By Molly Chiu
