In an interview with Pharmacy Times at the 2022 Annual Meeting of the American Society of Clinical Oncology (ASCO), Bruce Feinberg, DO, vice president and chief medical officer at Cardinal Health Specialty Solutions, discussed how cancer diagnosis and treatment can affect patients’ mental health.
How does cancer diagnosis and subsequent treatment affect mental health?
Bruce Feinberg, DO: Most people probably can’t 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 will I live? Or will I die? How long should I live? How much will I suffer? There are several crises that people have to deal with – loss of life, loss of home, loss of job – and the diagnosis of cancer is right there, the 5 most significant crises that someone has to deal with. And even more than most other chronic debilitating diseases, once you overcome cancer and this element of immediate risk and potential loss of life, you begin to think about loss of vision and blindness. And that would happen, obviously, from things like macular degeneration. So, this is a huge, huge shake-up of the individual and all the people around them, which has so many layers. Inability to talk about it from friends and family, ignorance of what to say, how to say, and then the layers of anxiety that often lead to depression. And then you layer on it all the physical things that happen to people in the course of their treatment. So, this is unique in its weight. A kind of event generating post-traumatic stress disorder, even for those who will survive.
How can mental health care be integrated into oncology treatment in the community?
Bruce Feinberg, DO: So, one of the problems we have is that we think about the complexity of cancer, and often a cancer patient has seen their primary care physician refer them to a specialist who might then do a biopsy and then refer them to medical oncologist, [and] they may also need surgical intervention by an oncology surgeon, there may be radiation from a radiation oncologist, and it is likely that some deactivations will require the involvement of other types of specialists. And then layering on that, after the patient is finally somehow on the path and progress of cancer treatment, more doctors, like getting mental health and doing it with the psychologist, the psychiatrist. And often it’s just the straw on the camel’s back. I can’t see another doctor, I can’t afford another doctor, I can’t take that time and go to another place. So the fragmentation of our system makes it problematic. And you would think that this would be better in an academic or hospital environment, but only if you are stationary with all these people who come to see you in a place that is not. Almost all cancer care is outpatient. So, the problem exists in society, it exists in academia. And this is a difficult problem to solve due to the complexity and nature of the disease. Optimally, whatever you can do at the site of care during cancer treatment would be best to this extent. Many cancer programs include social workers, psychologists, who are trying to bring this care into the system. But again, there are problems with its operationalization: how is it paid? How much is paid? Can you afford to hire this staff, given the cost recovery, and then again the desire of the patient and family to want to commit to something else? Because it’s not like at the moment, if there was a pill, can I just take that pill, but the pill isn’t there. So, counseling is a complex process that takes time. So, sometimes it’s just one thing too much for patients, and often for the system they can manage. This is ideally not the way you want it to be, but a reality.
What mental health symptoms should healthcare providers monitor for in cancer patients?
Bruce Feinberg, DO: So you can argue that it would be almost unthinkable with a diagnosis of potential terminal illness not to have a severe emotional reaction. So, do you have to wait for a symptom? Or it’s actually best to know that this will upset the apple of your mind and something needs to be done preventively, proactively, not waiting. The symptoms are difficult in terms of so many things, again, happening to this individual physically, mentally and emotionally – loss of sleep, change in eating habits, interpersonal relationships and the impact it has on them. And you can assume that all these things will happen. So, I think it’s really more with the understanding that this would be a normal human response, to have this kind of mental crisis. And be proactive, be preventive, and don’t think of it as “looking for something.”