Mitigating mental health concerns in cancer patients
By Dr Nandan Choudhary, Consultant – Palliative Medicine, Karkinos Healthcare
The word cancer, even if casually mentioned to a person, will send a sharp chill down the spine. Such is the impact of cancer. It is a life-threatening illness and the potential consequences are immense, leading to fear, and anxiety.
Many people have personal experiences with cancer, either directly or through their loved ones, and the uncertainty around diagnosis, treatment, and outcome can all be incredibly stressful. Moreover, the misconceptions and stigma surrounding cancer can add to the emotional burden for those affected.
A cancer diagnosis can trigger a range of emotions, including anxiety, depression, fear, and anger. And, treatment can be physically and emotionally demanding, leading to stress, fatigue, and isolation. Many cancer inflicted persons have concerns about their body image, mortality, and sadly, the financial burden or unaffordable out-of-pocket expenses exacerbates the mental health challenges.
In such situations, untreated mental health issues can worsen physical outcomes, decrease treatment adherence, and negatively impact quality of life. It is therefore very essential to address mental health concerns to improve treatment outcomes, reduce stress, and enhance overall well-being.
This year’s World Cancer Day provides an opportunity to raise awareness about the mental health needs of cancer patients. Closing the care gap in cancer and mental health is a complex challenge, but one we must strive to overcome.
By working together, raising awareness, advocating for change, and implementing targeted interventions, we can create a healthcare system that truly serves everyone, regardless of background or circumstance.
Let’s join hands and make this World Cancer Day a springboard for lasting change, ensuring that everyone has the opportunity to thrive, both physically and mentally.
Palliative Care with a touch of concern for mental health
Palliative care is a concept of holistic care for patients with life-limiting diseases that aims to enhance their quality of life and to provide relief from physical, psychological, social, and spiritual suffering. Palliative care is complex, and it is important to provide comprehensive care for these patients, regardless of their illness or type of care. It can be provided in an out-patient or in an in-patient setting and in specialized units and its protocol varies from country to country. These services can be useful for all kinds of life limiting chronic illnesses.
In India, most of the patients present at stage IV or advanced stage of illness, especially cancer and at this point of time they have many symptoms. Most of the time the disease treatment course leaves us with just palliative or supportive care only. Such cancer patient groups present with many symptoms and these symptoms have a direct consequence on their mental state.
Psychological health and support are extremely important at every stage of life but more so in Persons Living with Palliative Care Needs (PLWPCNs). It is important that psychological care is provided to PLWPCNs and their families. This can be done through a range of medical, nursing, and allied healthcare professionals.
Mental healthcare also focuses on the psychological and emotional wellbeing of their loved ones/caregivers. This is inclusive of self-esteem, adaptation to the illness, consequences, social functioning, and relationships. When a patient has been diagnosed with a life-limiting illness, there is likely to be a range of emotional responses in the patient and their family members.
These emotions include:
Fear: It can be fear of the body deteriorating, total dependence on people, pain, or the consequences their death may have on their loved ones.
Sadness: This can be caused by thoughts that a patient is nearing the end of life. They still have dreams and ambitions they would love to actualize. The end of life is a difficult time for patients and their loved ones.
Confusion: This can happen when the news of being diagnosed with an illness comes as a shock. What next?
Anger: Rage can be expressed as the patient vents. They may ask why it had to happen to them. This emotion can be felt also after unsuccessful treatment.
Low self-esteem: This can be caused by the changes that take place in the body like loss of weight, hair loss, puffiness of face, and dependence on people to live.
Socioeconomic effects can lead to depression: Some patients spend all their resources on treatment and they are drained financially. This brings about agonizing situations at home and within the family.
Factors affecting patient caregivers’ or their family’s mental health
It is usually a close family member or a spouse who attends to the cancer patient’s needs. The attender or the patient caregiver is under tremendous physical and mental pressure while tending to the patient. It is overwhelming at most times causing a high burnout in them. In many cases, the caregiver has to forego work or other revenue-based activities to support the cancer patient. This causes financial constraints or poor revenue options.
Sometimes, a life-limiting illness can have an impact on relationships between patients and their family and friends. You may find that a patient is dependent on a partner or someone who lives with them in feeding, cleaning, and all other daily routines. Even caregivers get overwhelmed sometimes. They wish things could go back to how they used to be, a brother, spouse, sister instead of being a full-time caregiver.
Challenges encountered by patients with cancer
The effects of cancer on patients and survivors are always complex and subtle and can be interpreted in two ways: time and function. Patients’ and survivors’ long interactions with cancer are roughly divided into multiple stages: pre-diagnosis, post-diagnosis before treatment, short-term after treatment, and long-term after treatment. Different stages entail different problems and demands.
Ø Deterioration of self esteem
Ø Body Image disturbance
Ø Sexual trouble
Ø Maintaining social relationship
Ø Treatment related problems
Ø Financial issues
Ø Lack of information or clarity about future
Ø Lack of support system from family symptoms which are refractory to medicine
Ø Lack of availability of essential medicine like strong painkillers.
Solutions that can be considered:
Ø Dedicated psycho oncologist;
Ø Dedicated palliative and supportive outpatient clinic;
Ø Dedicated ward for caring end-of-life patients;
Ø Addressing family members’ mental health concerns equally on time;
Ø Home based care services for patients who will not be able to come to hospital and are dying actively.
There are many young girl cancer patients diagnosed with breast carcinoma, lung carcinoma, who have never smoked or had alcohol. These young patients face a unique set of challenges that can significantly impact their mental well-being. Healthcare professionals can play a crucial role here in supporting these patients and mitigating the mental health issues they may encounter. They can further help by offering individual and group therapy sessions tailored to the specific needs of young cancer patients, addressing issues like fear, body image concerns, or social isolation.
Ways to Cope with mental health issues in cancer patients
Providing patients and their families with information about the emotional impact of cancer and coping mechanisms empowers them to manage their mental well-being proactively. Support groups and individual therapy sessions can address specific needs and anxieties.
Below is a brief guideline for cancer patients on some coping techniques:
Express your feelings:
People have found that when they express strong feelings like anger or sadness, they’re more able to let go of them. Some sort out their feelings by talking to friends or family, other cancer survivors, a support group, or a counselor. But even if you prefer not to discuss your cancer with others, you can still sort out your feelings by thinking about them or writing them down.
Don’t blame yourself for your cancer:
Some people believe that they got cancer because of something they did or did not do. But scientists don’t know why one person gets cancer and one person doesn’t. All bodies are different. Remember, cancer can happen to anyone.
Don’t try to be upbeat if you’re not:
Many people say they want to have the freedom to give in to their feelings sometimes. As one woman said, “When it gets really bad, I just tell my family I’m having a bad cancer day and go upstairs and crawl into bed.”
You choose when to talk about your cancer:
It can be hard for people to know how to talk to you about your cancer. Often loved ones mean well, but they don’t know what to say or how to act. If you want to talk, you can make them feel more at ease by asking them what they’re thinking or how they’re feeling. And if you don’t want to talk about it, it’s okay to say that too. You can let them know when you’re ready to talk.
Find ways to help yourself relax:
Whatever activity helps you unwind, you should take some time to do it. Meditation, relaxation exercises, music, or any activity that soothes the mood are just a few ways that have been shown to help others; these may help you relax when you feel worried.
Be as active as you can:
Getting out of the house and doing something can help you focus on other things besides cancer and the worries it brings. Exercise or gentle yoga and stretching can help too.
Find hobbies and activities you enjoy:
You may like hobbies such as knitting, woodworking, pottery, photography, puzzles, reading, or crafts. Or find creative outlets such as art, movies, music, or dance.
Learn how to manage side effects:
The physical side effects of cancer can affect your emotions. Often if our body doesn’t feel good, we don’t feel good mentally either. It’s then best to distract oneself and divert the mind to do something constructive.
Look at what you can control:
Some people say that putting their lives in order helps. Being involved in your health care, asking questions, keeping your appointments, and making changes in your lifestyle are among the things you can control. Even setting a daily schedule can give you a sense of control. And while no one can control every thought, some say that they try not to dwell on the fearful ones, but instead do what they can to enjoy the positive parts of life. If you can, try to use your energy to focus on what makes you feel better and what you can do now to stay as healthy as possible.
A need for compulsory integration of mental health into cancer care
Every year on World Cancer Day, we take a pledge to close the care gaps. This year too we will close the gap with our relentless efforts towards integrating mental health into mainstream cancer care. The best way to turn the tide of bad health is to stay cheerful with a positive and open mind. Healthcare professionals must also combine oncology services that fosters collaborative care, improved communication, and seamless access to mental health services for cancer patients.
We cannot overlook the option of utilizing telehealth platforms and other digital interventions to expand access to mental health services, especially in remote areas or for patients with mobility limitations. Training healthcare professionals on recognizing and addressing mental health concerns in cancer patients equips them with the necessary skills to provide initial support and referrals.
While all that is done, it is equally important to address financial barriers to mental healthcare, such as the insurance coverage or reducing out-of-pocket costs, ensuring equitable access to services for all patients. Another important way to address is to collaborate with community organizations and support groups that can offer resources, social interaction, and peer support to cancer patients beyond the healthcare system.
By implementing these strategies at different levels, we can work towards mitigating and closing the care gap in mental health concerns for cancer patients, ensuring they receive the crucial support needed to navigate this challenging journey and improve their overall well-being.
Dr. Nandan Choudhary has 8 years of experience in palliative care . He works in close association with other oncologists in managing symptoms of patients, also considering various aspects like social, psychological and spiritual well being of cancer patients. He has been trained in MD Palliative Medicine from the most prestigious All India Institute of Medical Sciences (AIIMS, New Delhi). He has over ten publications in various national and international journals. He is currently national faculty of Indian Association of Palliative Care and Institute of Palliative Medicine. He is actively involved in training healthcare professionals and advising the government of Manipur in Developing Palliative Care across the state.