In an interview with Pharmacy hours at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, Bruce Feinberg, DO, Vice President and Chief Medical Officer of Cardinal Health Specialty Solutions, discussed how cancer diagnosis and treatment can impact on patient mental health.
What is the impact of a cancer diagnosis and subsequent treatment on mental health?
Bruce Feinberg, DO: It’s probably not for most people to think that when you hear the words “you have cancer” it’s a shock to your system. And it’s a shock to your system in a very emotional way. The first thing you think about is, am I going to live? Or will I die? How long do I have left to live? How much will I suffer? There are a few crises people have to deal with – loss of life, loss of home, loss of job – and the diagnosis of cancer is up there among the top 5 crises a person has to deal with. And even more so than most other debilitating chronic diseases, once you get past cancer and that element of immediate risk and loss of vital potential, you start thinking about sight loss and blindness. And that would happen, obviously, because of things like macular degeneration. So it’s a huge, huge upheaval for an individual and all the people around them, who has so many layers. Inability 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 superimpose on that, then, all the physical things that happen to people during their treatment. So, it’s, it’s kind of unique in severity. A kind of post-traumatic stress event, even for those who will become survivors.
How can mental health care be integrated into community cancer treatment?
Bruce Feinberg, DO: So one of the problems we have is that we think about the complexity of cancer, and often times a cancer patient has seen their GP, who has referred them to a specialist, who then maybe has done a biopsy, then referred him to a medical oncologist, [and] they might also need surgery from a surgical oncologist, there might be radiation therapy from a radiation oncologist, and maybe some disabilities would require intervention from other types of specialists. And then you layer that, once the patient is finally kind of on the path and the cancer treatment progresses, more doctors, like getting mental health care and doing it with the psychologist, the psychiatrist. And often it’s just straw on the camel’s back. I can’t see one more doctor, I can’t afford one more doctor, I can’t take this time and go one more place. Thus, the fragmentation of our system makes it problematic. And you’d think it would be better in a university or hospital setting, but only if you’re hospitalized with all these people coming to see you in one place, which you’re not. Almost all cancer care is outpatient. So the problem exists in the community, it exists in academia. And it’s a difficult problem to solve, because of the complexity and the nature of the disease. Ideally, anything you can do at the point of care, at the time of cancer treatment would work best to this degree. Many cancer programs have social workers, psychologists, who try to bring that care into the system. But there are still problems related to its operationalization: how is it paid? How much is paid? Can you afford to staff that staff, given the reimbursement, and again, the willingness of the patient and their family to want to engage in something else? Because it’s not like, at that time, if there was a pill, can I just take that pill, but there’s no pill. And so counseling is a complex process that takes time. And so, again, sometimes it’s just one thing too many for the patients, and often for the system to be able to handle. It’s not ideally how you want it to be, but a reality.
What mental health symptoms should healthcare providers watch out for in cancer patients?
Bruce Feinberg, DO: So you could say that it would be almost inconceivable with a diagnosis of a potentially terminal illness, not to have a severe emotional reaction. So, should we wait for a symptom? Or is it actually better to understand that this is going to mess with your mind and something needs to be done pre-emptively, proactively and without delay. Symptoms are difficult in terms of so many things, again, happening to that individual physically, mentally and emotionally – loss of sleep, change in eating habits, interpersonal relationships and the impact that has on them. And you might assume that all of these things are going to happen. So I think it’s really more important to understand that it would be a normal human response, to have that kind of mental breakdown. And be proactive, preventative and don’t think of it as “I’m looking for something”.