Journey of Cancer through Psycho Oncology

Jaitri Mandal

Psycho-oncologist
4BaseCare

The World Health Organization (WHO) estimates that by 2030 cancer incidence will increase by 40% in high-income countries and more than 80% in low-income countries. The elevation of cancer rates over the last decade created a significant psychosocial burden on patients and caregivers. These increasing prevalence rates can be linked to lifestyle changes, increased tensions, and lack of social support.

To address psychosocial concerns, psycho-oncological services have been integrated into cancer care by routinely measuring distress among cancer patients and providing need-based interventions. Integrating psycho-oncological services into cancer care helps to maximize cancer treatment outcomes, improved adherence to treatment, a better quality of life, and adaptive coping strategies for patients and caregivers.

Emotional Challenges and their Impact
Patients and their loved ones go through immense emotional changes, disturbances, and confusion from the time of diagnosis through the treatment processes.

Initial stages of diagnosis:
The moment an individual is diagnosed with cancer the emotions experienced are:

• Immediate emotion: ‘why me?’.
• Experience Denial and Anger: “I can never get cancer. We should go for a second opinion’.
• Goes to self-doubt: if a cancer diagnosis is because of any sin, or if it’s a punishment from God.
• Patients start experiencing hopelessness, fear of uncertainty, and death, which make them more vulnerable to irrational negative thoughts. During this phase, adaptive coping is required for the entire family to deal with psychological distress effectively, for better treatment decision making, adherence, and treatment efficacy for cancer patients.

Moreover, with respect to the Indian context, 54% of caregivers do not disclose the diagnosis to patients⁽¹⁾. Because family members believe that being aware of a diagnosis can severely affect a patient’s psychological well-being. But recent findings suggested that complete disclosure of cancer diagnosis resulted in reduced anxiety and depression. In addition, the intensity, and consistent burden of fears, worry about treatment, health hazards and psychological trauma associated with cancer caregiving can affect caregivers’ well-being. Such distress, if ignored, can result in a ‘caregiver burden’. During this phase, adaptive coping is required for the patient and family to deal with psychological distress effectively, for better treatment decision making, adherence, and treatment efficacy for cancer patients.

During treatment: Patients start experiencing reduced appetite due to nausea, vomiting (Chemotherapy-Induced Nausea and Vomiting), lack of taste; disturbed and late-onset of sleep, the onset of dreams; cancer-related fatigue, and chronic physical pain which is often elevated by psychological pain or distress. The plethora of Psychosocial concerns including lack of financial resources for treatment, transportation; disruptions in work and family life make their cancer journey even more difficult.

Children diagnosed with cancer are forced to skip their regular classes, face gaps in their academic years, low performance in exams, fatigue, and not being able to play with friends and siblings result in severe distress, self-isolation, and stubborn behavior.

Psychosocial distress: Cancer treatment accompanies physical concerns, emotional distress like depression, anxiety, adjustment issues, and religious or spiritual concerns. Stigma related to self, public/social, false social and cultural associations of cancer, and fear of spreading cancer increase the intensity of Distress which needs to be dealt with carefully by the Psycho-oncologist. The level of distress can be measured by the NCCN Distress Thermometer. Studies show that the majority (60.3%) of patients are found to experience moderate to high levels of emotional distress⁽²⁾ during treatment, where depression and anxiety have been experienced by 38 percent and 36 percent of cancer patients consequently ⁽³⁾.

Post-treatment: Fear of relapse, severe body image issues, psycho-sexual concerns, etc can take a toll on patients’ mental wellbeing.
The apt psycho-oncological service for patients and caregivers can optimize the management of cancer symptoms and treatment side effects to reduce distress and other major psychosocial concerns.

Psycho-oncology plays a very significant role in holistic cancer care treatment at every stage. From breaking the diagnosis to handling emotional turmoil during and post-treatment; from Palliative counseling to celebrating cancer survivorship psycho-oncologists help the cancer patients, survivors, and caregivers to manage distress, denial, anger, depression, anxiety, and multiple adjustment issues. Hence, the need for psycho-oncology is beyond doubt. Consistent long-term follow-up can improve the overall quality of life, loss to follow-up and abandonment in treatment, adherence to treatment and medication, and better quality of death.

References:

1. Chittem, M., Norman, P., & Harris, P. R. (2013). Relationships between perceived diagnostic disclosure, patient characteristics, psychological distress, and illness perceptions in Indian cancer patients. Psycho‐oncology, 22(6), 1375-1380.
2. Veeraiah, S., Kayser, K., & Sudhakar, R. (2022). Psychosocial factors influencing distress among cancer patients in South India. Journal of Psychosocial Oncology Research and Practice, 4(1), e067.
3. Shankar, A., Dracham, C., Ghoshal, S., & Grover, S. (2016). Prevalence of depression and anxiety disorder in cancer patients: An institutional experience. Indian journal of cancer, 53(3), 432.