As a cancer patient, you may see many doctors and clinicians from a variety of medical disciplines during your treatment journey. A medical oncologist often leads the care team and helps determine a course of treatment. You may see surgeons or receive treatment from a radiation oncologist. Nurses, physician assistants, nurse practitioners and others may serve as key members of your care team.
For some patients, a psychiatrist may also be a member of their care team. While not the first doctor you may think of when facing a cancer diagnosis, a psychiatrist may play an important role in treating stress, depression and other cancer-related side effects that may sometimes interfere with treatment and impact quality of life.
“Cancer brings a patient directly in contact with his or her own mortality, so that can be very stressful,” says Nancy Schell, MD, Psychiatrist at City of Hope® Cancer Center Chicago. “And it's not likely something that they've really had to deal with before, at least not most people.”
In this article we’ll look at how a psychiatrist may play a role on a cancer care team. Topics include:
- Cancer and mental health
- Cancer patients and PTSD
- The psychiatrist’s role on an oncology team
- Mental health care and cancer survival
- Resistance to psychiatric care
If you’ve been diagnosed with cancer and are interested in a second opinion on your diagnosis and treatment plan, call us or chat online with a member of our team.
Cancer and mental health
Starting a new job, getting fired, having a baby, losing a loved one, receiving a cancer diagnosis—these ups and downs of life often bring on a wave of strong emotions.
Anxiety, depression and stress are normal responses to many life-altering events—both celebratory and difficult. When facing a cancer diagnosis, those emotions may become overwhelming.
“A cancer diagnosis can be a significant source of stress and stress can bring out lots of latent issues,” Dr. Schell says. “For example, if you've been struggling with something and you're getting by and you're doing relatively well and you have a stressor like a cancer diagnosis, it can really cause something like anxiety or depression to manifest.”
Depression is the most common mental health disorder among cancer patients, affecting one in four people, according to the American Cancer Society. Depression may set at any point after a cancer diagnosis. And if it does not go away, it may be considered clinical depression, a serious condition that requires medical attention.
“It may be difficult to discern whether a cancer patient is struggling with depression or whether the symptoms of the cancer diagnosis and treatment are what’s causing behavioral changes,” says Diane Schaab, MS, LPC, Behavioral Health Therapist at City of Hope Cancer Center Atlanta. “A professional counselor is able to assess whether a patient is no longer able to perform a certain activity or whether he or she no longer wants to do the activity because of depression.”
Cancer patients and PTSD
For some patients, the reaction to a diagnosis in the days and weeks that follow may mimic some of the signs associated with post-traumatic stress disorder (PTSD), such as depression, anxiety, sleeplessness and hypervigilance. In a 2019 paper, a team of researchers concluded that up to 22 percent of cancer survivors deal with some level of PTSD.
According to the American Psychiatric Association, PTSD is “a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event, series of events or set of circumstances.” The condition “may affect mental, physical, social, and/or spiritual well-being.”
PTSD may originate in the amygdala, a pair of almond-shaped lobes deep inside the brain designed to put the brain into escape mode during threats to life or safety.
The amygdala (named after the Greek word for almond) also retains memory of traumatic events and triggers responses when stimulated by memories or external stimulus, such as loud noises or sudden movement. When the amygdala is stimulated, it may also release cortisol, a steroid that may cause increased heart rate, high blood pressure and other stress-related symptoms.
Groundbreaking research conducted at the University of Malaysia in Kuala Lumpur concluded that 13 percent of cancer patients studied met the full criteria for PTSD in the first six months after their cancer diagnosis.
The Malaysia study, which sparked international headlines when it was released, found that 6 percent of patients still suffered from PTSD when the four-year study concluded. "While PTSD is more often associated with traumatic events such as violent physical and sexual attacks, serious accidents and natural disasters, this includes being diagnosed with cancer, the experience of undergoing cancer treatment and surviving cancer," the study’s author told the Reuters news service.
For some patients, simply being told they have cancer may trigger a PTSD response. Others may respond during or after difficult treatments, Dr. Schell says, which may impact a patient’s prognosis.
“They may have had a bad reaction to a procedure or hospital stay,” she says. “So, now they’re dealing with fear that really can impact treatment. If they need consistent care and if they have something like PTSD that's not addressed, their care really may suffer.”
Like other emotional or psychological conditions, PTSD treatment varies depending on its severity the needs of the patient. “We address it through psychotherapy, medication management, and offer as much supportive care as we can,” Dr. Schell says.
The psychiatrist’s role on an oncology team
Stress and depression may also sap a patient of the energy and strength often needed to combat some of cancer treatments' draining side effects. Chemotherapy treatments may cause nausea and decreased appetite that then may lead to hair loss and weight loss. Fatigue may set in. Pain is often physically and emotionally taxing.
Some emotional issues brought on by a cancer diagnosis or treatment side effects may be addressed by supportive care services, such as behavioral health counseling or spiritual support. But often, a psychiatrist may need to intervene when symptoms and side effects may get so powerful, they may interfere with what needs to be done to treat cancer.
A psychiatrist may work with your care team to:
- Recommend medications, such as anti-depressants and anti-anxiety drugs designed to help ease stress and improve mood.
- Prescribe drugs such as bupropion (Wellbutrin® or Zyband®) or varenicline (Chantix®) to help with smoking cessation.
- Help patients with eating or sleep disorders, which are common among cancer patients.
- Treat patients suffering from delirium, which is an acute state of disorientation or confusion that sometimes occurs during extended hospital stays.
Before prescribing drugs for mental health conditions, psychiatrists must make a careful assessment of a patient’s cancer treatment regimen to avoid negative drug interactions. For instance, some antidepressants may reduce the effectiveness of tamoxifen, an estrogen receptor modulator drug used to treat breast cancer.
Mental health care and cancer survival
If not addressed, stress and anxiety may have a profound effect on the human body at a cellular level and serious effects on the body's ability to fight off disease, including cancer.
In physically or psychologically stressful situations, the body's glands, like pilots preparing for takeoff, start switching on systems that produce hormones that help the body cope. Adrenaline is released to help increase blood circulation, stimulate quicker breathing and prepare the muscles for exertion. Dopamine sends messages to the body's nerve cells. Glucocorticoids are on standby to deal with inflammation or to help trigger an immune response. Cortisol begins to increase the body's blood sugar.
These are good responses when you are responding to an immediate crisis or physical threat. “During acute stress lasting a matter of minutes, certain kinds of cells are mobilized into the bloodstream, potentially preparing the body for injury or infection during ‘fight or flight,’” researchers at the University of Kentucky wrote in a 2015 paper.
But chronic stress may “has been linked empirically with dysregulation of facets of the human immune system,” UK researchers concluded. Chronic stress may also trigger “systemic inflammation,” increased risk of disease and activation of latent viruses.
“Cancer needs a multi-pronged approach incorporating everything we know about our health, including mental health,” Dr. Schell says. “We know that if you have a diagnosis like cancer or another significant medical problem and if there is depression, anxiety or other issues that go untreated, the person's morbidity is actually increased when compared to a person with the same medical problem but without the depression or anxiety.”
A 2010 study published by the National Institutes of Health linked stress to cancer growth. "Chronic stress results in the activation of specific signaling pathways in cancer cells and the tumor microenvironment, leading to tumor growth and progression," the study said.
Resistance to psychiatric care
Despite the many potential benefits of psychiatric therapy, some patients resist seeing a psychiatrist because of outdated stigmas attached to mental health issues and care.
Research by sociologists at the Penn State University and Indiana University suggested a “decrease in the stigma regarding depression,” but how the public perceives other mental health issues, such as schizophrenia, still need to be overcome. Dr. Schell says some patients are also resistant to taking medications, especially those intended to address mental health issues.
“Some people have never had meds in their life and are now on lots of strong medication,” she says. “Adding something else may be difficult for some patients to accept.”
But, she says, patients are becoming more receptive to accepting mental health and psychiatric services and are better educated on how those services may help them get through the difficulties encountered during a cancer journey.
“The stigma is ever present,” she says. “But I tell people that mind and body are really one. What affects one will affect the other. There is really very little separation between our physical bodies and our minds because our brain is a physical entity. The brain and body are intimately connected and reliant on each other.”
If you’ve been diagnosed with cancer and are interested in a second opinion on your diagnosis and treatment plan, call us or chat online with a member of our team.
