Behavioral health

Adult psychiatry

Depression and anxiety are among the most common mental health challenges experienced by cancer patients. City of Hope psychiatrists and psychiatric nurse practitioners are trained and experienced in conducting emotional assessments and identifying and explaining your treatment options, including counseling and/or medication. City of Hope psychiatric providers collaborate with other members of your care team as part of our comprehensive approach to cancer care.

Cognitive behavioral therapy

Cognitive behavioral therapy is a form of behavioral therapy designed to help patients transform negative or distressing emotions, such as fear, anger and sadness, into more empowering responses. This approach aims to help patients identify feelings and beliefs about significant events in their lives, discern whether their perspective is helpful or not, and choose new thoughts intended to reduce distress and accompanying side effects. Cognitive behavioral therapy techniques have been shown to help patients manage and reduce pain, anxiety, insomnia, negative body image, depression and sexual intimacy challenges.

Coping skills training

Coping skills training may help patients better tolerate and manage the stress associated with cancer treatment and its side effects. For example, a patient having difficulty concentrating and accomplishing tasks may work with a City of Hope counselor to break down large responsibilities into smaller steps. This approach is designed to make goals more achievable and enable the patient to return to everyday activities more quickly.

A few of the techniques our providers use to help patients develop new coping skills include:

• Relaxation and stress reduction exercises, such as deep breathing, meditation and muscle relaxation
• Guided imagery, which involves learning to approach life challenges from different perspectives, especially in ways you may not have considered before
• Cognitive reframing, which teaches how to change negative thoughts into a more positive and productive mentality

Psychoeducation

Psychoeducation combines education, support and counseling. At City of Hope, behavioral health providers educate patients about their diagnosis, treatments, symptoms and symptom management. Patients learn about a variety of resources, including support groups, online and printed materials, videos and smart phone apps. Our providers also offer counseling in group settings or individually—in person or via telehealth technologies.

Intimacy and cancer counseling

A cancer diagnosis may change cancer patients’ relationships with their partners in many ways, including how they interact, share intimate moments and engage in sexual activities. These changes may be caused by physical effects from various cancer treatments or by emotions triggered by feelings of loss, insecurity or lack of control. Discussing your concerns and experiences with your care team may help you and your partner better communicate and take new steps to prepare for and manage cancer-related relationship changes as they occur.

At City of Hope, we offer a variety of counseling, advocacy and other support services designed to help you maintain and strengthen your relationships during and after cancer treatment. Cognitive behavioral therapy, coping skills and education may be part of your and your partner’s intimacy counseling.

Because of the body’s biological makeup, men and women often experience relationship and intimacy challenges differently. Experiences may also differ based on your cancer type and individual treatment plan. For example, these cancer treatments may cause side effects that impact intimacy, sexual intercourse and relationships:

Chemotherapy: For women, some anti-cancer drugs may irritate mucous membranes, making sexual intercourse difficult or painful. A weakened immune system may also raise the risk of yeast and other infections during treatment. Chemotherapy may lead to early menopause in some women, even young adults, and sterility in some men.

Surgery: Depending on the location of the tumors, certain surgical procedures may impair bodily functions and/or self-image in both men and women. For men, surgeries for prostate, bladder or colon cancer may damage nerves or blood vessels, affecting their ability to achieve or maintain an erection. For women, surgeries to remove breast, cervical or other gynecologic cancers may lead to physical changes that make sexual activity painful or that impact their self-esteem.

Radiation therapy: Men treated with radiation therapy to the lower belly may experience scarring or nerve damage that affects their ability to have or maintain an erection. Radiation treatments for women with pelvic-area cancers may develop decreased tissue elasticity or scarring, which may make sex difficult or painful.

Hormone therapy: Men with advanced or metastatic prostate cancer may be prescribed hormone therapies that reduce their production of testosterone and other androgens. This may lead to hot flashes, decreased sex drive, impotence, loss of muscle mass and other physical changes. Hormone therapies for women with ovarian cancer and breast cancer are designed to curb estrogen production. This may trigger physical changes that resemble menopausal symptoms, including decreased sex drive, hot flashes and vaginal dryness that makes sexual intercourse difficult or painful.

Sexual wellness

Cancer patients may experience changes to their sexual desire, function and relationships during their treatment journey. Even patients who are not sexually active may benefit from City of Hope behavioral health services that educate patients in preventing or managing treatment side effects associated with sexual function, such as urinary incontinence and pelvic pain.

Patients with any type of cancer may experience some level of sexual dysfunction, but those with breast cancer, genitourinary cancers or gynecologic cancers are especially at risk for symptoms and side effects that may affect sexual wellness. At City of Hope, our allied health professionals include experts trained in helping patients cope with psychological and physical challenges, including negative body image, erectile dysfunction and pelvic floor dysfunction that impairs their sexual health.

Learn more about sexual wellness services at City of Hope.

Survivorship support

Survivorship support at City of Hope is designed to help patients identify and manage potential short-term, long-term and late effects of your specific treatment. After primary treatment is completed, patients are introduced to the survivorship team, which may include behavioral health and other health care and supportive care providers. Some of the goals of our survivorship program include:

• Preventing and detecting new or recurrent cancers, including making recommendations for screening options for other cancers and a genetic risk assessment, when appropriate
• Providing interventions for side effects resulting from cancer and/or treatments, helping patients manage both the medical and emotional impacts of their disease and providing health education regarding diagnosis, treatment and potential late and long-term side effects
• Coordinating communication between specialists and primary care providers to help see that patients’ needs are met

Offering guidance on diet, exercise and living a healthy lifestyle after cancer.