Mental health is never a straight line and that's especially true for a person in every stage of a cancer diagnosis.
Mental health is never a straight line and that's especially true for a person in every stage of a cancer diagnosis.
Just as those physical treatments change and move into different phases, a patient’s psychological well-being will ebb and flow. Taking care of their psychological health as they adjust to a serious health diagnosis and the challenges of treatment and survivorship is important, which is why UW Health | Carbone Cancer Center’s Cancer Psychology Clinic is a continuously available resource to patients.
“We see patients at all points in the cancer journey — from those who are treated in UW Carbone’s high risk clinics to those who have completed their primary treatment or those who are receiving end of life care,” said Erin Costanzo, PhD, co-director of the clinic. “Carbone cancer patients can be referred at any point in their disease or treatment trajectory.”
Diagnosis
Costanzo frequently meets with patients after a new cancer diagnosis. It's normal for them to experience a range of emotional responses to life-altering news and to the adjustment period, as they encounter the ways cancer changes their life in the immediate future and long term.
“Our culture sometimes believes being mentally healthy means feeling good and that’s not how psychologists think,” Costanzo said. “It’s normal to be upset about a cancer diagnosis and it's important to allow for worry, fear, sadness and other intense emotions without equating these feelings with a mental health problem.”
Costanzo sees patients who are having difficulty coping with emotional, physical and social changes related to their cancer. Costanzo notes that Cancer Psychology Clinic is not only a resource for those experiencing challenging emotions but also helps patients develop coping strategies for difficult symptoms like sleep disruption, fatigue and poor appetite.
"Sometimes people think, 'If I go to see a psychologist that means I have a mental health problem or I’m coping the wrong way,'" she said. "And that's not the case; it’s common to struggle."
Additional patient support resources include oncology behavioral health providers, social workers, nurse navigators and community programs, like support groups and peer mentors.
Treatment changes
Aside from diagnosis, it’s also extremely common for patients to experience feelings of anxiety and distress related to transitions in their level of treatment.
Dr. Marina Sharifi, a medical oncologist specializing in breast cancer, said she tries to check in with her patients about their mental well-being throughout their treatment plan so that she can ensure they are being offered appropriate supportive care resources.
"It's really hard to get a cancer diagnosis," she said. "And then we're talking about treatment that has a huge impact on your life. I try to normalize that most people are going to need some extra support of some kind, whatever that might be, to get through these different phases."
Sharifi also talks with patients about medications that can help manage anxiety and depression. Either she or the patient’s primary care provider can prescribe those when appropriate.
She often hears from patients who are concerned that having distress, worry or other challenging emotions will make their cancer treatments "less effective." Sharifi reassures them that's not the case, and in a difficult situation, it's normal and valid to not always feel positive.
"Cancer is already really hard, and you shouldn't be hard on yourself [for how you feel]," she said. "I try to combat that fear that if they’re not being positive enough it will adversely impact their treatment."
Post-treatment
Costanzo said it's common for patients to struggle with the transition away from active treatment, when patients see their oncology team regularly, to follow-up care and monitoring where they may see their provider just a few times a year.
Concerns during this time can include coping with long-term cancer or treatment effects, such as limited mobility and pain, as well as worry about cancer returning.
"It's common to go into 'survival mode' during active treatment," Costanzo said. "There's a lot to focus on. Patients are following the day-to-day plan their oncology team has laid out. Once that intensive phase is over, there’s more time and mental space to focus on emotions and there can be challenges transitioning to a more typical daily routine."
Both Costanzo and Sharifi encourage patients at any stage of care who are struggling to talk with their care team about available help. There is no "standard plan" or set treatment for patients seeking services Cancer Psychology Clinic, Costanzo said. Providers tailor treatment to the patient's unique needs and personal goals and their services can start and stop as needed.
"We usually work with patients in a focused way for a brief period of time — to shore up coping skills, develop approaches for navigating a difficult point in treatment or better manage difficult symptoms," she said. "Scheduling an appointment with cancer psychology does not mean you're signing up for many sessions or indefinitely. It's typical for patients to come for just one or a few sessions or episodically as new challenges come up."