Psycho-Oncology
What is it?
Psycho-oncology is a mental health specialization that addresses the psychological, social, behavioral, relational, and emotional aspects of cancer. Cancer affects all facets of life. Mental health is needed in concurrence with all physical difficulties, but especially cancer.
Whether you are a loved one of a person diagnosed with cancer, or the person diagnosed, cancer has a huge impact on all facets of life.
The more we talk about the emotional weight of cancer, the more people will receive the mental health treatment that they need. I believe that anyone going through physical illness, especially a life-altering, unexpected disease, deserves mental health care.
Why is this my passion?
If you know me you know that this is an area that I am hugely passionate about, and have been working with in private practice and through Cancer Support Community. I plan to continue to work with those impacted by cancer throughout my career.
So you may be wondering, Jordan, that seems like an interesting thing to be passionate about, how did you get there? I have always had an interest in how the brain works, and also an interest in biology. I thought I wanted to do something with biology and in the medical field for all of one semester of college, until I found psychology. Cancer and chronic illness has impacted my life in many ways and so finding this niche just fit. I have a family history of cancer, and for as long as I have been alive (and longer) my amazing mother has participated in the Susan G. Komen 3Day walks. The 3day is a 60-mile experience, full of pink, laughs, tears, dogs, and watermelon boobs, all for the purpose of bringing awareness and fundraise for breast cancer research. When I was 16 I completed my first 3day walk with my mom, and I have never looked back! The 3day is a weekend I look forward to every year, and one of the most incredible, meaningful experiences of my life. It also ignited my passion for helping those who are impacted by cancer. Through my participation with Susan G. Komen, and work at the national organization Cancer Support Community, I have seen an immense need for mental health treatment in the face of physical illness. I do not only mean with cancer, but with ANY physical difficulty, illness, or ailment that a person goes through. Physical challenges impact our minds, and that is why I am a huge advocate that mental health and physical health should always go hand in hand.
Whenever I tell someone about my work with people impacted by cancer, I usually get the response of “Wow that is so sad.” or “How awful.” But no, work with cancer does not always have to be sad. I used to be so scared of the word “cancer” but I am less scared now because of my experiences. This work is meaningful, and rewarding, and fascinating, and nuanced, and hopeful. Cancer is so much more than a sad, scary word.
Why is psycho oncology so important?
Cancer affects every possible aspect of your being. Cancer splits your life into a pre-cancer and post-cancer existence. Your future is uncertain, the next few days are uncertain, and you are forced to confront your mortality. Treatment decisions are incredibly difficult and the emotional toll may not fully hit. Post-treatment could be when the overwhelming weight of what you just went through comes, even though doctors and other medical professionals tell you that you can just go back to normal life
For people who are going through long term treatment or dealing with end of life, the mental toll may be even more dramatic. This is why mental health care at diagnosis, during treatment, post-treatment, and in anticipation of end of life is crucial.
At Diagnosis
A diagnosis of cancer completely uproots your life, and changes your present and future. Quite often, people who are diagnosed with cancer immediately go into survival mode. You have this life altering news and now your mind goes into “Alright, how do we begin to fix this.” You start the long journey of treatment which can include chemotherapy, radiation, surgery, and other procedures. Oftentimes, people do not deal with the emotional toll of cancer until treatment is done because you have no time to process what you are going through.
When you are diagnosed, one of the hardest parts is to think about how to tell your loved ones. Especially when theres kids involved, this part is tricky. I have included a resource of a talk that I gave at Cancer Support Community called “What Do I tell the kids?” which details, what you can guess, of how to tell your kids. Some tips are that itt is important to be clear and concise while talking to kids. Don’t elaborate as that gets confusing. Once you know what your treatment is going to look like, use the specific treatment words such as “chemo” and “radiation.” Also let your kids know what treatment will be like and how it may affect your body. For example “on chemo days mom may be feeling really tired. And mom may lose her hair.” In the resource linked below I give more detail on how to speak to kids based on their developmental stage.
-It is ok to say “I don't know” with kids. Make sure to emphasize support systems. They might have a new schedule and routine such as who will pick them up from school, but ensure that they will always be loved, supported, and cared for throughout. Find more information by clicking the Youtube link below to access the workshop.
Letting your partner, friends, and other loved ones know about your diagnosis can be very challenging. Some may not respond how you expect them to. Don’t be afraid to ask for help and let your loved ones know what you need from them.
During Treatment
You are chugging along going through treatment, and taking it one step at a time. Treatment is terrifying. There are so many questions of how long treatment will last, if it will work, how it will affect you, etc. It is so important to advocate for yourself. You know your body best. If you do not feel that you are getting adequate care, if you feel that something is wrong, if you have any questions at all, say something. Doctor’s are the medical professionals, however you are the authority over your own body. When you have cancer you are a patient but you are also an advocate, don’t be afraid to ask questions and push for what you need and deserve. When making difficult treatment decisions, it is natural to look towards family, friends, and doctors for guidance, but the main decision comes from you and your gut. When talking to doctors about treatment decisions, an important question that some of my clients have asked their doctor is “If I was your loved one, what would you want them to do?” These clients feel that asking a question like this elicits an authentic response from their doctor.
Cancer can exacerbate existing mental health difficulties and spark new ones. Cancer impacts your body, your relationships, your loved ones, your identity, and so much more.
Identity shift
Not feeling like yourself,physical changes such as hair loss, skin and weight changes. Change in cognitive function with chemo brain. Disconnect with the identity of man or woman. This particularly happens with genital specific cancer such as breast, ovarian and prostate cancer, to name a few. For nonbinary and transgender people, cancers that affect genitalia take on a new meaning and complexity that cisgender people may not experience.
Relationships
New layer to navigating family dynamics. There may be many role reversals and role shifts with members in the family. For example, partners or spouses shifting into the caregiver role, or kids taking on more responsibility in the house.
Changing socialization needs which can impact your friend relationships. There may be anxiety with seeing others with your new body and new look, having to fend off questions of what you are going through.
May be surprised with how people react. People react in a strange way to cancer, some smother, some disengaged.
Advocate for your needs: Have to tell people what you need ”How are you” is a loaded question. When people ask it is sometimes hard to know what to say.
Grief
Grieving the life you once knew. Grieving the expectations that you had for the next week, month, year. Can lead to depression and anxiety.
Scanxiety
Anxiety looking towards treatment and upcoming scans. Very present during treatment and also after. Scanxiety can last even when in remission, because even following treatment there are appointments monthly or every three months and 6 months. I will talk more about managing anxiety in a bit.
Uncertainty and feeling out of control
Cancer is pretty much the epitome of feeling out of control. There is so much uncertainty in what the future holds, and how treatment will look like.
Post Treatment
Uncertainty and feeling out of control still there, as well as everything else I just mentioned.
Doctors, friends, family expect you to go back to normal life, but that is impossible. You are left with the “now what” feeling, and the emotional toll of what you just went through hits. This is completely normal. A lot of people who have gone through cancer and are considered survivors feel abnormal or feel that they are crazy for feeling emotional weight post-treatment, while everyone around you is telling you that you should be fine and going back to normal life. This is not abnormal, and is actually quite typical.
There is also the fear of recurrence that is incredibly triggering and can intensify anxiety and depression.
Long-Term Treatment and End of Life
Oftentimes if you will be in long term treatment, that means that the cancer is metastatic. Metastatic cancer is a stage 4 diagnosis, and means that the cancer has spread from its place of origin. This does not necessarily mean that the cancer is actively spreading, but can mean that there is actually no evidence of disease and you have to continue long-term treatments to keep it that way. There is also a high rate of recurrence with metastatic disease. This in itself comes with so many varying emotions,and overwhelming uncertainty.
With end of life and long term care, some get help from home health nurses, palliative care, or hospice care. An important note is that palliative care does not necessarily mean end of life. Palliative care just means a team that helps with someone who has a serious illness. Palliative care is a great choice to have regular support for the person with cancer and the individual’s loved ones. Hospice care is more for end of life, and to help the individual with a serious illness be comfortable while declining. Hospice care is meant for those who are not undergoing any more treatment for their illness. Hospice care does not necessarily mean that the person with the illness will decline immediately, I know a caregiver who’s loved one has been in hospice care for almost two years now.
As you can see, in all stages of physical illness there is a need for mental health care.
Therapy treatment
Therapy treatment can include various modalities of treatment such as cognitive behavioral therapy for negative thinking, grief therapy, mindfulness to lower stress and anxiety levels, acceptance and commitment therapy for radical acceptance of the present situation, existentialism to confront mortality and meaning in life, and more.
Do not have to have a preexisting mental health concern, cancer is a transformative experience and it is so helpful to get support.
Something that I have found really fascinating is that therapists are scared of treatment people affected by cancer. Of course is it necessary to not treat someone whos presenting issue is out of your scope or competency of care, but treating cancer is really not scary! These clients present with big life change, emotions, anxiety, and depression- same as every client. There are some great webinars, workshops, and programs out there that help mental health professionals strengthen skills of dealing with cancer and grief. I recommend to research those. To all mental health professionals: do not shy away from working with individuals impacted by cancer or other serious illness. We need more practitioners who are proficient in the field of psycho-oncology.
In addition to an individual counselor, people with cancer and caregivers can find support from hospitals, non-profit organizations, clinics, and treatment centers.
*Link: What do I tell the kids https://www.youtube.com/watch?v=aN854MAnL4k
