Managing the mental health effects of a cancer diagnosis requires a proactive approach

In an interview with Pharmacy Times At the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, Bruce Feinberg, Vice President and Chief Medical Officer of Cardinal Health Specialty Solutions, discussed how cancer diagnosis and treatment can affect patients’ mental health.

How does a cancer diagnosis and subsequent treatment affect mental health?

Bruce Feinberg, DO: Most people probably don’t think that when you hear the phrase “You have cancer,” it is a shock to your system. And it shocks your system in very emotional ways. The first thing you think of is, am I going to live? Or will I die? How long do I have to live? How much will I suffer? There are quite a few crises that people have to deal with – loss of life, loss of home, loss of a job – and a cancer diagnosis there, in the top 5 crises a person has to deal with. And even more than most other disabling chronic diseases, once you get past cancer and that element of immediate danger and potential life loss, you start to think about vision loss and blindness. And that’s going to happen, obviously, from things like macular degeneration. Therefore, it is a huge huge jolt for the individual and for everyone around him, which has many layers. Not being able to talk about it from friends and family, not knowing what to say, how to say it, and then the layers of anxiety that often lead to depression. And you pile on that, then, all the physical things that happen to people during their treatment. So, it is kind of unique in severity. A kind of PTSD-generating event, even for those who would become survivors.

How can mental health care be integrated into oncology in community settings?

Bruce Feinberg, DO: So, one of the issues we have is that we think about the complexity of cancer, and a cancer patient often sees their primary care doctor, who referred them to a specialist, who then probably did a biopsy, and then referred them to a medical oncologist and [and] They may also require surgical intervention from a surgical oncologist, there may be radiation from a radiation oncologist, and some disruption may require the involvement of other types of specialists. And then you focus on that, once the patient is finally kind of in the course and progression of cancer treatment, more doctors, like getting mental health care and doing that with a psychiatrist, a psychiatrist. It is often just the straw on the camel’s back. I can’t see another doctor, I can’t afford another doctor, and I can’t spend that time outside and go somewhere else. So, fragmentation of our system makes it problematic. And you think that would be better in an academic or hospital setting, but only if you’re an inpatient with all these people coming to see you in one place, which isn’t the case. Nearly all cancer care is done in an outpatient setting. So, the problem is in society, it’s in academia. It is a problem that is difficult to solve due to the complexity and nature of the disease. Optimally, whatever you can do on site of care, at the time of cancer treatment is that much the best. Many cancer programs are incorporating social workers and psychologists in an effort to provide this care within the system. But there are problems, again, with its activation: how is it paid for? how much you pay? Can you afford that employee, given the reimbursement and then again, the patient’s and family’s willingness to be involved in something else? Because it’s not like, at that point, if there’s a pill, can I just take that pill, but there’s no pill. Thus, counseling is a complex process that takes time. And so, sometimes, only one thing is too much for patients, and often the system is able to manage it. This is not the ideal way you want it, but it is a fact.

What mental health symptoms should health care providers watch for in patients with cancer?

Bruce Feinberg, DO: Therefore, you could argue that it would be almost unreasonable with a diagnosis of a potentially incurable disease, not to have such an intense emotional reaction. So, do you need to wait for symptoms? Or in fact, you better understand that this will mess with your mind and that there is something to be done proactively and proactively rather than waiting. The symptoms are difficult from the point of view of many things that, again, happen to that individual physically, mentally and emotionally – the loss of sleep, the change in eating habits, interpersonal relationships and the effect that has on them. And you can assume that all of these things will happen. So, I think it’s better to understand that this would be a normal human response, to have this kind of mental crisis. And be proactive, be protective and don’t think of it as “I’m looking for something.”