When we envision mental illness, our minds might drift to stark, even frightening images of straitjackets and padded rooms. But such representations contribute to a pervasive misunderstanding of mental healthcare, perpetuating stigma and impeding access to vital mental health resources for patients with cancer.
“Cancer is an equal opportunity offender, so why wouldn’t it affect the brain, the heart, and the emotions?” asked Joy Frankel, PsyD, vice president of clinical operations at CHE Behavioral Health Services.
At the 2023 AONN+ Annual Conference in San Antonio, TX, Dr Frankel and Kristina Espinosa, PsyD, PMH-C, oncology psychologist at Miami Cancer Institute at Baptist Health South Florida, emphasized the importance of addressing mental health in oncology, highlighted the stigma surrounding mental illness, and explained its impact on patients’ ability to seek treatment.
The reality is far removed from the sensationalized portrayals of mental health disorders often seen in the media. One statistic reveals that 30% of Americans believe all violent crimes are committed by individuals with mental illness. However, only 4.3% of such crimes involve individuals struggling with mental health issues, and who are also more likely to be victims themselves.
According to Dr Frankel, the research shows that between 25% and 67% of patients with cancer in the United States receive supportive psychotherapy services. “One-quarter to almost three-quarters is a huge range,” she noted. “That tells me 2 things: one, the research sucks, and we need to do so much more to figure out what’s going on, and two: we do a really poor job of getting these important services to our patients.”
The stigma surrounding mental healthcare prevents patients with cancer from getting the care they need. “In order to break through that stigma, the first thing we have to do is unpack it,” she said.
A study done by Texas Oncology delved into the experiences of 150 patients with cancer and highlighted a glaring gap in mental health support. Fifty-six percent of respondents felt unprepared for the mental health side effects of cancer treatment, while the majority (70%) reported experiencing one or more mental health symptoms. Despite this, only one-third sought out resources, underscoring the pervasive stigma surrounding mental healthcare.
She pointed out that physical health is treated much differently than mental health in the United States. For example, we say someone has strep throat, or has cancer. But we say someone is schizophrenic or is depressed. “We make the diagnosis part of them, rather than something with which they contend,” she explained.
One significant barrier to accessing mental health support in patients with cancer is diagnostic overshadowing. Patients with serious and persistent mental illnesses often delay seeking cancer treatment due to various factors, including high pain thresholds, lack of support, and ingrained patterns of self-isolation. Consequently, they present at later stages of their disease, leading to poorer prognoses and decreased quality of life.
Older adults, too, face unique challenges in accessing mental healthcare. Despite the prevalence of mental health symptoms among this demographic, stigma surrounding aging and vulnerability often discourages them from seeking help.
“They hate being seen as weak and vulnerable,” she said. “So they’re less likely to report mental health symptoms, even though they’re a population that needs it the most.”
According to Dr Espinosa, addressing mental health stigma within oncology care requires a multifaceted approach. First and foremost, it necessitates a shift in cultural vernacular. Words matter; they shape perceptions and attitudes. By reframing language surrounding mental health and cancer, we can dismantle harmful stereotypes and foster an environment of acceptance and support.
Moreover, integrating mental healthcare into oncology treatment is paramount. From the moment of diagnosis, patients should be informed of the available mental health resources and encouraged to seek support. Mental health professionals should be integrated into multidisciplinary care teams, ensuring holistic support for patients navigating the complexities of cancer treatment.
Central to breaking down stigma is recognizing the humanity of each patient and their unique emotional experiences. Embracing empathy, actively listening, and validating patients’ emotional responses can foster trust and facilitate open communication. By acknowledging and addressing the emotional toll of cancer diagnosis and treatment, healthcare providers can empower patients to navigate their journey with resilience and agency.
Challenging encounters in healthcare, often labeled as interactions with “difficult patients,” necessitate a paradigm shift. Instead of labeling patients, it’s important to recognize the underlying factors contributing to these encounters—whether it be unmet emotional needs, complex psychosocial factors, or systemic barriers.
Encouraging patients to express their emotions, even by simply ranting, provides an outlet for their fears. Techniques such as journaling and grounding exercises, which focus on present-moment awareness, can help alleviate anxiety and promote emotional regulation.
Breathing exercises can also serve as invaluable tools in diffusing heightened emotions and promoting relaxation. By engaging in techniques like diaphragmatic breathing or the “Take Five” exercise, patients can regulate their central nervous system and regain a sense of calm. These practices, coupled with problem-solving approaches, empower individuals to confront their anxieties and regain a sense of control over their circumstances.
Anxiety and depression are common companions on the cancer journey, and it’s important for healthcare providers to normalize these feelings while equipping patients with coping strategies. Distraction techniques, psychotherapy, and maintaining a healthy lifestyle are all essential components of anxiety management, while connecting patients to spiritual/faith-based resources, psychotherapy, and psychopharmacology can aid with depression symptoms. Additionally, acknowledging the fear of cancer recurrence as a valid concern allows patients to confront and navigate these emotions effectively.
Navigating mental illness within the context of cancer care requires a concerted effort to bridge gaps in support and to dismantle barriers to access. By integrating mental healthcare into oncology treatment, challenging stigma, and fostering empathy and understanding, we can ensure that all patients receive the comprehensive care they deserve, empowering them to face the challenges of cancer with resilience and hope.
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