If you or someone in your family has suffered from cancer, or are currently undergoing cancer therapy, you know that the disease doesn't just affect physical well-being. It affects the mental state as well. How do professional medical providers and family members deal with the psychological issues of cancer care?
Below, Dr. Sherry Schachter, a certified grief therapist and registered nurse at Memorial Sloan-Kettering Cancer Center, and Dr. Harvey Max Chochinov, a Professor of Psychiatry and Family Medicine at the University of Manitoba in Canada, discuss the psychological hurdles during cancer treatment.
Is there a way to characterize a "normal" emotional response to a cancer diagnosis?
HARVEY MAX CHOCHINOV, MD, PhD: I think it's fair to say that every patient who is faced with a cancer diagnosis will have a profound emotional response or reaction to the news. It is particularly distressing in the early diagnostic phases when people are dealing with all kinds of uncertainties.
Besides the fear of the unknown, there is the fear of body disfigurement, fear of no longer being able to carry on one's previously held roles. What is this going to mean in terms of my ability to be a husband, a lover, and a provider? Am I going to be able to maintain my position as breadwinner? Those fears start to shift as illness progresses.
What are some important objectives in distress treatment for cancer patients and their families?
SHERRY SCHACHTER, RN, PhD: There are many things that we can do, and that patients and families can do for each other. There are therapies such as guided imagery or relaxation techniques, which help people to calm down, to slow down.
One of the things that I find useful is helping people feel they have some control over what is happening to them. This may mean helping them talk effectively to their physicians-oftentimes patients and families feel overwhelmed. They don't know what to ask the doctors, or they don't understand what the doctors are doing. Helping them come up with a plan of care, and techniques that help organize their questions to the doctor, can be very helpful in reducing distress and anxiety.
Do you recommend that anyone who is diagnosed with cancer go see a therapist?
HARVEY MAX CHOCHINOV, MD, PhD: I like to remind patients that they arrive to a cancer diagnosis with a wealth of life experience already. Bad things happen along the way in life. We've developed coping techniques. We've developed methods that help us deal with our losses. Start with what's worked before, what's worked in the past. What do you usually fall back on when you're seeking comfort, support, and spiritual comfort-a sense of feeling grounded? What do you naturally turn to for comfort? You don't necessarily need to turn to someone else's psychological techniques for help.
For many patients out there, the appropriate source of comfort is family, loved ones, and sources of strength and support that have always worked in the past.
SHERRY SCHACHTER, RN, PhD: I think one problem that patients may experience is that they don't have coping skills that have worked for them in the past. Those individuals have more difficulties and may not have the background or the foundation that may help them through this time.
In those cases, there are many things that we can do. There are therapies such as guided imagery or relaxation techniques. There are techniques that help patients prepare for the future, and help patients feel they have some control over the treatment process. There are a lot of techniques from a non-medical point of view that we employ.
Is antidepressant medication useful for some people?
HARVEY MAX CHOCHINOV, MD, PhD: When indicated, it can be very, very helpful. Just because you have cancer doesn't make you immune from suffering from malignant anxiety. Some patients-and particularly patients with advanced malignancies-can suffer with delirious states or organic mental disorders that can change the way they feel and think. All of these things can be helped with medication.
There is sometimes a difficulty in getting patients to take medication if they are on a whole variety of other drugs already. They think, "Do I want to take one more drug?" As well, patients sometimes feel it is somehow wrong to feel better or calmer or less depressed under the circumstances. I like to remind patients that cancer is not a vocation. It's not like a job that you've got to get really good at. It's a journey that you have to get through.
If somebody is in that anticipatory period where he or she is waiting for information and feeling very anxious and not sleeping well, a short-term use of something that helps them sleep can be a good idea.
We know that probably anywhere from 10% to 25% of patients with malignancies will suffer a major depression or depressive illness. We know that these drugs can be very effective, but they should be used in conjunction with support. Hopefully they are in the hands of somebody who is not only well-versed in drugs and how to administer drugs, but also someone who can provide counseling and support.
Are there studies underway at this moment on how to treat the mental well being of the cancer patient?
HARVEY MAX CHOCHINOV, MD, PhD: Absolutely. There are textbooks devoted to the subject of the mental health of patients. There are journals around the world that are devoted to the issue of presenting research specifically on the issue of mental well-being of patients with malignant illness and their families. If patients are interested in learning more about the subject of mental health issues and cancer, they can ask their doctors to refer them to the appropriate materials.
Below, Dr. Sherry Schachter, a certified grief therapist and registered nurse at Memorial Sloan-Kettering Cancer Center, and Dr. Harvey Max Chochinov, a Professor of Psychiatry and Family Medicine at the University of Manitoba in Canada, discuss the psychological hurdles during cancer treatment.
Is there a way to characterize a "normal" emotional response to a cancer diagnosis?
HARVEY MAX CHOCHINOV, MD, PhD: I think it's fair to say that every patient who is faced with a cancer diagnosis will have a profound emotional response or reaction to the news. It is particularly distressing in the early diagnostic phases when people are dealing with all kinds of uncertainties.
Besides the fear of the unknown, there is the fear of body disfigurement, fear of no longer being able to carry on one's previously held roles. What is this going to mean in terms of my ability to be a husband, a lover, and a provider? Am I going to be able to maintain my position as breadwinner? Those fears start to shift as illness progresses.
What are some important objectives in distress treatment for cancer patients and their families?
SHERRY SCHACHTER, RN, PhD: There are many things that we can do, and that patients and families can do for each other. There are therapies such as guided imagery or relaxation techniques, which help people to calm down, to slow down.
One of the things that I find useful is helping people feel they have some control over what is happening to them. This may mean helping them talk effectively to their physicians-oftentimes patients and families feel overwhelmed. They don't know what to ask the doctors, or they don't understand what the doctors are doing. Helping them come up with a plan of care, and techniques that help organize their questions to the doctor, can be very helpful in reducing distress and anxiety.
Do you recommend that anyone who is diagnosed with cancer go see a therapist?
HARVEY MAX CHOCHINOV, MD, PhD: I like to remind patients that they arrive to a cancer diagnosis with a wealth of life experience already. Bad things happen along the way in life. We've developed coping techniques. We've developed methods that help us deal with our losses. Start with what's worked before, what's worked in the past. What do you usually fall back on when you're seeking comfort, support, and spiritual comfort-a sense of feeling grounded? What do you naturally turn to for comfort? You don't necessarily need to turn to someone else's psychological techniques for help.
For many patients out there, the appropriate source of comfort is family, loved ones, and sources of strength and support that have always worked in the past.
SHERRY SCHACHTER, RN, PhD: I think one problem that patients may experience is that they don't have coping skills that have worked for them in the past. Those individuals have more difficulties and may not have the background or the foundation that may help them through this time.
In those cases, there are many things that we can do. There are therapies such as guided imagery or relaxation techniques. There are techniques that help patients prepare for the future, and help patients feel they have some control over the treatment process. There are a lot of techniques from a non-medical point of view that we employ.
Is antidepressant medication useful for some people?
HARVEY MAX CHOCHINOV, MD, PhD: When indicated, it can be very, very helpful. Just because you have cancer doesn't make you immune from suffering from malignant anxiety. Some patients-and particularly patients with advanced malignancies-can suffer with delirious states or organic mental disorders that can change the way they feel and think. All of these things can be helped with medication.
There is sometimes a difficulty in getting patients to take medication if they are on a whole variety of other drugs already. They think, "Do I want to take one more drug?" As well, patients sometimes feel it is somehow wrong to feel better or calmer or less depressed under the circumstances. I like to remind patients that cancer is not a vocation. It's not like a job that you've got to get really good at. It's a journey that you have to get through.
If somebody is in that anticipatory period where he or she is waiting for information and feeling very anxious and not sleeping well, a short-term use of something that helps them sleep can be a good idea.
We know that probably anywhere from 10% to 25% of patients with malignancies will suffer a major depression or depressive illness. We know that these drugs can be very effective, but they should be used in conjunction with support. Hopefully they are in the hands of somebody who is not only well-versed in drugs and how to administer drugs, but also someone who can provide counseling and support.
Are there studies underway at this moment on how to treat the mental well being of the cancer patient?
HARVEY MAX CHOCHINOV, MD, PhD: Absolutely. There are textbooks devoted to the subject of the mental health of patients. There are journals around the world that are devoted to the issue of presenting research specifically on the issue of mental well-being of patients with malignant illness and their families. If patients are interested in learning more about the subject of mental health issues and cancer, they can ask their doctors to refer them to the appropriate materials.
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