A cancer diagnosis brings a wealth of psychological challenges. In fact, adults living with cancer have a six-time higher risk for psychological disability than those not living with cancer. Patients and families have to deal with not only the physical stress to their lives and potential livelihoods, but also with family dynamics and changes in their sense of self and future.
Cancer patients also must make numerous decisions while they are in an extremely emotional state. They must decide what treatments to pursue, both initially and over the long term, how to cope with treatment side effects, how to deal with disability and maintain an independent identity, and how to maintain quality of life.
Depression and anxiety are common diagnoses associated with these challenges, yet, despite all of this, social or emotional support is offered in less than half of cancer patients’ care.
Behavioral Health Problems Exacerbate Physical Health Problems
When cancer patients are not treated for their behavioral health issues, it can negatively impact health outcomes by affecting their ability to make sound medical decisions, by decreasing the chances of them seeking and adhering to treatment, and by affecting their immune systems and ability to fight off cancer.
Behavioral health problems can extend over time. For example, after a breast cancer diagnosis, most patients undergo recommended surgery. However, following surgery, many patients are advised to go on hormonal regimes that can be toxic and difficult to endure. Depression and anxiety can undermine adherence to those regimens.
At a physiological level, healing can be delayed or impaired, making patients less likely to reenter society and more likely to experience relapse and recurrences. For example, cellular and molecular processes can be negatively influenced by untreated behavioral disorders in cancer patients, which can lead to the cancer’s progression.
Importantly, this connection can also work conversely, meaning psychological treatment has been found to improve underlying biological status. A compelling example of this was shown by Thornton, et.al., (2009) who used a psychological intervention to alleviate symptoms of depression among cancer patients and reduce the presence of inflammatory markers found in the body. This is important because inflammatory markers are an indicator of the stress that is being placed on a person’s immune system. Since mental health issues are also associated with smoking and other unhealthy behaviors, behavioral health problems appear to contribute to worse health outcomes for cancer patients and survivors.
Overcoming Stigma and Challenges
Cancer has been the big “C” from the time people became aware of it. More than any other disease, patients fear it and suffer tremendous concerns about the social impact for them and their families when people learn that they have a cancer diagnosis. Further, cancer doesn’t go away. Survivorship and late effects last well after the initial diagnosis, even for early stage cancers. In fact, for a third of cancer patients, distress persists more than a year after their cancer diagnosis and comes in the forms of worrying about the future, feeling lonely or isolated, and financial concerns—to name a few. In addition, there is a very real insurance threat to the individual from having a so-called “pre-existing” condition such as cancer.
Patients should take note of any behavioral health problems such as anxiety or stress just as they do with physical side effects. Patients should communicate these problems with their care team, as well as important others in their lives such as significant others, family, or friends. Behavioral health should have equal weight with physical health as it is important patients are able to cope with their treatment and maintain their quality of life. Knowing that behavioral health issues can have a significant impact on physical health and their response to treatment may motivate patients to place equal value on both physical and behavioral health.
I have seen first-hand how financial distress can impact the health and lives of individuals and families. Patients must be able to access the medical treatments they need, regardless of their ability to pay. That is one of the reasons I'm proud to be associated with the HealthWell Foundation, which offers a Cancer-Related Behavioral Health Fund, specifically for treatment-related behavioral health issues in cancer. The Fund provides financial assistance to individuals with a diagnosis of cancer to help with cost-shares (deductibles, coinsurances and copayments) for covered services rendered by behavioral health clinicians.
About the Author
Suzanne M. Miller, PhD, is Professor of Cancer Prevention and Control and Director of Patient Empowerment and Health Decision Making at Fox Chase Cancer Center (FCCC). Dr. MillerHealthWell Foundationthe Society of Behavioral MedicineNew Jersey Health Care Quality Institutealso serves as Editor-in-Chief for one of SBM’s flagship journals, Translational Behavioral Medicine
About the HealthWell Foundation
A nationally recognized, independent non-profit organization founded in 2003, the HealthWell Foundation has served as a safety net across over 70 disease areas for more than 500,000 underinsured patients. Since its inception, HealthWell has provided over $1.6 billion in grant support to access life-changing medical treatments patients otherwise would not be able to afford. HealthWell provides financial assistance to adults and children facing medical hardship resulting from gaps in their insurance that cause out-of-pocket medical expenses to escalate rapidly. HealthWell assists with the treatment-related cost-sharing obligations of these patients. HealthWell ranked 33rd on the 2019 Forbes list of the 100 Largest U.S. Charitiesits 100 percent fundraising efficiency. For more information, visit www.HealthWellFoundation.org.