Benefits of Psycho-Oncology

Transcript

00:00 --> 00:03Funding for Yale Cancer Answers is
00:03 --> 00:06provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:11Yale Cancer Answers features
00:11 --> 00:13the latest information on cancer
00:13 --> 00:15care by welcoming oncologists and
00:15 --> 00:17specialists who are on the forefront
00:17 --> 00:19of the battle to fight cancer.
00:19 --> 00:21This week it's a conversation about
00:21 --> 00:24Psycho Oncology with Doctor Shannon Mazur.
00:24 --> 00:26Dr. Mazur is an assistant professor of
00:26 --> 00:28psychiatry at the Yale School of Medicine,
00:28 --> 00:30where Doctor Chagpar is a professor
00:30 --> 00:32of surgical oncology.
00:33 --> 00:34So Shannon, maybe we can start
00:34 --> 00:36off by you telling us a little
00:36 --> 00:38bit more about yourself and what it is you do?
00:40 --> 00:42Sure, I'm currently working
00:42 --> 00:44as a psycho oncologist at the Cancer
00:44 --> 00:47Center and my background got me here.
00:47 --> 00:50I have always been interested in medicine
00:50 --> 00:53and human interactions from a young
00:53 --> 00:54age and at some point along the way,
00:54 --> 00:56I got heavily involved in bioethics and
00:56 --> 00:58it led to me having a masters degree
00:58 --> 01:01in bioethics and then taught in the
01:01 --> 01:02field for quite a few years before
01:02 --> 01:04actually going to medical school.
01:04 --> 01:06And when I was involved in bioethics,
01:06 --> 01:08that led to a deep interest in
01:08 --> 01:11end of life care and some of the
01:11 --> 01:13issues that come with end of life
01:13 --> 01:15care and inevitably Hospice care,
01:15 --> 01:16palliative care,
01:16 --> 01:20and how we handle people who are seriously
01:20 --> 01:23ill and all of my work along the way
01:23 --> 01:26led to me becoming a psychiatrist,
01:26 --> 01:28going through medical school,
01:28 --> 01:30and then eventually doing a fellowship
01:30 --> 01:32within consult medicine for psychiatry
01:32 --> 01:34and following up with that,
01:34 --> 01:37working specifically with
01:37 --> 01:40cancer patients and psychiatry.
01:40 --> 01:42The field of psycho oncology is
01:42 --> 01:46where I reside now and have both
01:46 --> 01:48work that is inpatient and outpatient
01:48 --> 01:51work and psychology can be thought
01:51 --> 01:53of as working within the hospital.
01:53 --> 01:55And also there's aspects to it that
01:55 --> 01:57are done as an outpatient and the
01:57 --> 01:59continuity of care that can come with
01:59 --> 02:02those that are not currently hospitalized.
02:02 --> 02:04So, let's pick up on that
02:04 --> 02:06conversation at that point.
02:06 --> 02:07So for many of
02:07 --> 02:09the people in our audience,
02:09 --> 02:11we may not be completely familiar
02:11 --> 02:14with the field of psycho oncology.
02:14 --> 02:16Many of us know about medical
02:16 --> 02:18oncology or surgical oncology,
02:18 --> 02:19radiation oncology,
02:19 --> 02:22what exactly is psycho oncology?
02:23 --> 02:26So Psycho Oncology first came about
02:26 --> 02:29around the 1970s in Western countries and
02:29 --> 02:31in Western culture and came about that
02:31 --> 02:34there used to be cancer as a diagnosis,
02:34 --> 02:37was kind of a stigma, it
02:37 --> 02:39wasn't talked about as much.
02:39 --> 02:42And there became this movement within the
02:42 --> 02:441970s where patients were starting
02:44 --> 02:47to have more conversations about it and
02:47 --> 02:50integrating in more social aspects
02:50 --> 02:53into their care and really not having
02:53 --> 02:56what was once deemed just as
02:56 --> 02:59this death sentence and able to
02:59 --> 03:02talk more about it amongst providers,
03:02 --> 03:03society, family members.
03:03 --> 03:05And so the the field of Psycho
03:05 --> 03:07Oncology first started to get its
03:07 --> 03:09roots around that time in the 1970s
03:09 --> 03:12and then kind of sprang from there.
03:12 --> 03:14So it is a relatively new field,
03:14 --> 03:17but even more so I would say in the
03:17 --> 03:19last 20 years has started to become
03:19 --> 03:22integrated into most of the larger cancer
03:22 --> 03:25hospitals because there became this
03:25 --> 03:28knowledge that within the field
03:28 --> 03:31of psychology that the main 2 aspects
03:31 --> 03:34is that it's studying the impact of
03:34 --> 03:36behavior and psychosocial factors on
03:36 --> 03:39cancer and cancer morbidity and mortality.
03:39 --> 03:41And also the flip side of that,
03:41 --> 03:43which is how psychological
03:43 --> 03:45influences can influence cancer.
03:45 --> 03:47So seeing both how behavior
03:47 --> 03:48influences cancer,
03:48 --> 03:50but how cancer influences our
03:50 --> 03:52behavior and our mental.
03:52 --> 03:54Psycho oncology
03:54 --> 03:57kind of integrates in both
03:57 --> 04:01aspects of that showing that beyond just
04:01 --> 04:03the medical treatment there's
04:03 --> 04:06this whole other aspect to cancer
04:06 --> 04:08care and treatment that we need to be
04:08 --> 04:11examining and to bring in as part of a
04:11 --> 04:13holistic approach to cancer.
04:13 --> 04:16We know that depending
04:16 --> 04:17upon what source you look at
04:17 --> 04:19and what what research paper you read,
04:19 --> 04:22the kind of common number that is most
04:22 --> 04:25commonly seen is that about 35% of patients
04:25 --> 04:27who have cancer diagnosis will
04:27 --> 04:30at some point have a psychiatric
04:30 --> 04:33disorder or diagnosis within the
04:33 --> 04:35trajectory of their treatment.
04:35 --> 04:37So whether that's at the
04:37 --> 04:38beginning and whether that's through
04:38 --> 04:40the treatment or transitioning through
04:40 --> 04:42survivorship and end of life care,
04:42 --> 04:45but about 35% and I almost think that
04:45 --> 04:47that is somewhat of a low number,
04:47 --> 04:49but that's really kind of getting
04:49 --> 04:51to those who meet the actual
04:51 --> 04:53kind of disorder diagnosis and we
04:53 --> 04:56see that this number continues to
04:56 --> 04:59increase in the sense that we have
04:59 --> 05:01medical progress showing
05:01 --> 05:03more survivors being able
05:03 --> 05:05to survive through the cancer and
05:05 --> 05:07longer periods of time.
05:07 --> 05:08And then also just the fact that
05:08 --> 05:10we see that increased life
05:10 --> 05:12expectancy leading to higher numbers
05:12 --> 05:14of cancer patients in general.
05:14 --> 05:17So this number has continued to grow
05:17 --> 05:19and is becoming as I mentioned
05:19 --> 05:21kind of more integrated into many
05:21 --> 05:24of the larger cancer hospitals.
05:24 --> 05:26So that's interesting.
05:26 --> 05:2935% of cancer survivors will
05:29 --> 05:32have a psychiatric diagnosis.
05:32 --> 05:34Certainly, as you pointed out,
05:34 --> 05:37the impact of cancer can be
05:37 --> 05:39quite significant in terms of
05:39 --> 05:41the patient's mental health.
05:41 --> 05:43I mean, certainly I think many of
05:43 --> 05:45our listeners can imagine that
05:45 --> 05:47if given a diagnosis of cancer,
05:47 --> 05:52one may face anxiety or depression,
05:52 --> 05:55but that may be more so attributed
05:55 --> 05:58to the diagnosis itself and
05:58 --> 06:01being able to cope rather
06:01 --> 06:04than a disorder of
06:04 --> 06:06transmitters in your brain.
06:06 --> 06:09Can you talk a little bit more
06:09 --> 06:11about the diagnosis that's made
06:11 --> 06:14in these 35% of cancer survivors
06:14 --> 06:16and whether that's a transient
06:17 --> 06:19thing or whether there actually
06:19 --> 06:21is an impact on neurotransmitters
06:21 --> 06:23that needs to be dealt with in
06:23 --> 06:26a pharmacologic manner.
06:26 --> 06:29That's a great question and I think
06:29 --> 06:31it's a multifold answer and part of
06:31 --> 06:34that is that we obviously within that
06:34 --> 06:3635% there are patients who have already
06:36 --> 06:38had pre-existing mental health issues.
06:38 --> 06:41So somebody who's struggled with anxiety
06:41 --> 06:43or depression throughout their entire life
06:43 --> 06:45they're included in that 35%.
06:45 --> 06:48So we know there are people who whether
06:48 --> 06:50it was kind of already genetically
06:50 --> 06:53predisposed or had
06:53 --> 06:55an organic presentation throughout
06:55 --> 06:57their life that will also
06:57 --> 07:00either have a worsening of their
07:00 --> 07:02symptoms or just a continuation of their
07:02 --> 07:04symptoms through their cancer diagnosis.
07:04 --> 07:07But the other side of that is what I
07:07 --> 07:09think you're getting at is there's
07:09 --> 07:12a large percentage of
07:12 --> 07:14this population that has
07:14 --> 07:15no prior psychiatric history,
07:15 --> 07:17has never seen a psychiatrist or
07:17 --> 07:19a therapist that never considered
07:19 --> 07:21themselves to struggle with anxiety
07:21 --> 07:24or depression who are now in this
07:24 --> 07:26situation with cancer and finding that
07:26 --> 07:28they're starting to have some of those
07:28 --> 07:30symptoms and so we can look at it
07:30 --> 07:33in an acute aspect and then
07:33 --> 07:35also kind of looking at the more
07:35 --> 07:37long haul and changes
07:37 --> 07:40that may come and so acutely many
07:40 --> 07:42patients of course have an
07:42 --> 07:45adjustment to finding out
07:45 --> 07:48a cancer diagnosis, it can be very shocking,
07:48 --> 07:49it can be very distressing and can bring
07:49 --> 07:51up a whole lot of emotions and
07:51 --> 07:53that's to be expected from anybody.
07:53 --> 07:55And so that doesn't necessarily mean
07:55 --> 07:57that you have a a mental health issue
07:57 --> 08:00or that there is need for
08:00 --> 08:01acquisition or intervention,
08:01 --> 08:04it just means that quite frankly you're
08:04 --> 00:-01kind of normal and that's
08:06 --> 08:09to be expected with having such a large
08:09 --> 08:12diagnosis or revelation happen.
08:12 --> 08:14But what some patients will have
08:14 --> 08:16is that this will then continue on.
08:16 --> 08:17It's not just that kind of initial
08:17 --> 08:19shock or that initial adjustment and
08:19 --> 08:21it can actually lead to what we
08:21 --> 08:23would then qualify as an adjustment
08:23 --> 08:25disorder and that would
08:25 --> 08:27mean that it would be a continued
08:27 --> 08:30presence of the symptoms whether that
08:30 --> 08:33is depression or anxiety or
08:33 --> 08:35other symptoms that it could come
08:35 --> 08:38with it leading to it now
08:38 --> 08:40interfering with their ability
08:40 --> 08:43either to have quality of life,
08:43 --> 08:44to attend appointments,
08:44 --> 08:46to go about their daily life to the
08:46 --> 08:48point where it's actually interfering
08:48 --> 08:50with their ability to function
08:50 --> 08:51as they had been from a
08:51 --> 08:53mental health standpoint.
08:53 --> 08:55Of course there's going to be physical
08:55 --> 08:58effects from the cancer or cancer treatments
08:58 --> 09:00that are also weighing in there but
09:00 --> 09:02focusing more on the
09:02 --> 09:03impact that their mental health
09:03 --> 09:05is at that point having on them.
09:05 --> 09:09Now there are also different types of
09:09 --> 09:13cancers that can lead to changes in
09:13 --> 09:16the more neuronal you know serotonergic,
09:16 --> 09:18hormonal impacts as well.
09:18 --> 09:22So that can actually cause
09:22 --> 09:23an organic change in the body
09:23 --> 09:25that would lead to this.
09:25 --> 09:26So not just necessarily their
09:26 --> 09:29adjustment to it but rather
09:29 --> 09:30something that is a direct
09:30 --> 09:33result from having the cancer.
09:33 --> 09:34So for instance,
09:34 --> 09:36obviously within a certain type of
09:36 --> 09:38brain tumor or neurologic tumors,
09:38 --> 09:41there can be changes in personality
09:41 --> 09:42leading to either depression or anger
09:42 --> 09:44or anxiety that is actually from
09:44 --> 09:46a physical change that has occurred
09:46 --> 09:48in the body due to the cancer.
09:48 --> 09:52There can also be changes that
09:52 --> 09:54occur due to treatments and so
09:54 --> 09:56for instance tamoxifen and some
09:56 --> 09:58of the aromatase inhibitors,
09:58 --> 10:00some of the treatments that we use
10:00 --> 10:02for breast cancer are known to cause
10:02 --> 10:04these changes within
10:04 --> 10:06women that can lead to anxiety,
10:06 --> 10:06depression,
10:06 --> 10:07agitation, insomnia, are
10:07 --> 10:10some of the symptoms we start to see.
10:11 --> 10:13It's multifold in the sense
10:13 --> 10:16that 35% includes people who
10:16 --> 10:18have already had prior diagnosis,
10:18 --> 10:20patients who are just having a hard
10:20 --> 10:21time adjusting to the diagnosis
10:21 --> 10:23and then patients who have actually
10:23 --> 10:25had some sort of physical change
10:25 --> 10:26in their body whether that be
10:26 --> 10:29due to the cancer itself or due
10:29 --> 10:30to the treatments that
10:30 --> 10:32lead to some of their symptoms.
10:34 --> 10:35And I would imagine that your
10:35 --> 10:38approach in terms of treatment
10:38 --> 10:41is different between all of those groups.
10:41 --> 10:44So there may be differences in
10:44 --> 10:47how you approach somebody who is
10:47 --> 10:49struggling with mental health issues,
10:49 --> 10:52who's has brain metastases,
10:52 --> 10:57or an actual physiologic
10:57 --> 11:00anatomic issue versus somebody who
11:00 --> 11:04is just really struggling with
11:04 --> 11:06the diagnosis and trying to
11:06 --> 11:09come to terms with that and trying
11:09 --> 11:11to deal with the emotions that
11:11 --> 11:14come with the diagnosis of cancer.
11:14 --> 11:16Can you talk a little bit
11:16 --> 11:18about how your approach may be similar
11:18 --> 11:20or different in
11:20 --> 11:21different groups of patients?
11:22 --> 11:23Absolutely. Yeah.
11:23 --> 11:25You're absolutely correct there.
11:25 --> 11:27There's different factors that come
11:27 --> 11:28into play with each person right.
11:28 --> 11:31So it's definitely not a
11:31 --> 11:32cookie cutter experience that
11:32 --> 11:34you know there's many different
11:34 --> 11:36factors that lead to how a patient reacts and
11:36 --> 11:38how we're going to approach treating
11:38 --> 11:40a patient and what sort of needs
11:40 --> 11:41the patient may have and you touched
11:41 --> 11:43on kind of one of the big things which
11:43 --> 11:47is obviously the type of cancer.
11:47 --> 11:50The difference between having a brain
11:50 --> 11:53tumor versus having lung cancer,
11:53 --> 11:54and what that means for
11:54 --> 11:56their presentation from a mental
11:56 --> 11:57health perspective.
11:57 --> 11:59But there's other factors that also
11:59 --> 12:01play into that, some biological
12:01 --> 12:04and some kind of situational.
12:04 --> 12:06So the biological ones could be
12:06 --> 12:08you know family history of having
12:08 --> 12:10a psychiatric illness before and
12:10 --> 12:11how that might affect them.
12:11 --> 12:13We use that sometimes when we're
12:13 --> 12:15trying to select what type of
12:15 --> 12:17medications might be helpful.
12:18 --> 12:20If a family member had success
12:20 --> 12:23on one type of medication,
12:23 --> 12:24there's research and data
12:24 --> 12:26to show that there there may be
12:26 --> 12:27a link to them having a benefit
12:27 --> 12:29from that medication as well.
12:29 --> 12:31So we might start with that
12:31 --> 12:32medication and those who have
12:32 --> 12:34kind of prior psychiatric history
12:34 --> 12:36or are predisposed to having
12:36 --> 12:38worsening symptoms unfortunately.
12:38 --> 12:40So we would treat those
12:40 --> 12:42patients with that in mind as well and
12:42 --> 12:44then a huge part of it can also come
12:44 --> 12:46with where they are in their life.
12:46 --> 12:49What their age is and
12:49 --> 12:51what their functioning was
12:51 --> 12:54prior to having this diagnosis and
12:54 --> 12:57how that impacts them with their
12:57 --> 12:59kind of mental state of either
12:59 --> 13:01acceptance or difficulty with
13:01 --> 13:03coping with the diagnosis.
13:03 --> 13:05And some of that can also be
13:05 --> 13:07what stage of cancer they're at.
13:07 --> 13:10So if somebody who finds out that they
13:10 --> 13:12have advanced cancer and is already
13:12 --> 13:14you know stage four and treatment
13:14 --> 13:17options are very limited or not at all,
13:17 --> 13:18will have a
13:18 --> 13:20much different
13:20 --> 13:22impact of how we're going to treat
13:22 --> 13:23them versus somebody who's in
13:23 --> 13:25earlier stages has a lot of options
13:25 --> 13:27who are really looking to try
13:27 --> 13:29the long haul of hopefully many,
13:29 --> 13:31many years ahead of them versus
13:31 --> 13:33acutely stabilizing them.
13:33 --> 13:36It sounds like it's a very
13:36 --> 13:39complex field, psycho oncology and
13:39 --> 13:42one that we still need to unpack.
13:42 --> 13:44So we're going to dive further into
13:44 --> 13:47this whole issue right after we take
13:47 --> 13:49a short break for a medical minute.
13:49 --> 13:51Please stay tuned to learn more
13:51 --> 13:53about the benefits of Psycho Oncology
13:53 --> 13:55with my guest Doctor Shannon Mazur.
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15:09 --> 15:11You're listening to Connecticut public radio.
15:12 --> 15:14Welcome back to Yale Cancer Answers.
15:14 --> 15:16This is Doctor Anees Chagpar and
15:16 --> 15:18I'm joined tonight by my guest,
15:18 --> 15:19Doctor Shannon Mazur.
15:19 --> 15:22We're discussing the benefits of Psycho
15:22 --> 15:24oncology and right before the break,
15:24 --> 15:26Shannon had mentioned that about
15:26 --> 15:2835% of cancer survivors have some
15:28 --> 15:31sort of a mental health diagnosis,
15:31 --> 15:34whether that was a pre-existing diagnosis,
15:34 --> 15:36whether that was, you know,
15:36 --> 15:39adjustment disorder from just having
15:39 --> 15:42difficulty getting over the concept of
15:42 --> 15:47cancer, or whether there is actually
15:47 --> 15:49a functional anatomic impairment
15:49 --> 15:52in patients with brain tumors or
15:52 --> 15:55metastases or issues with treatment
15:55 --> 15:57that could affect the brain.
15:57 --> 15:58So Shannon,
15:58 --> 16:01you had mentioned that Psycho
16:01 --> 16:03Oncology is relatively new field,
16:03 --> 16:06started in about the 1970s,
16:06 --> 16:08you know when I think about
16:08 --> 16:10the number of people who are
16:10 --> 16:12diagnosed with cancer every day,
16:12 --> 16:13everywhere,
16:13 --> 16:15all over the country,
16:15 --> 16:17you can't help but imagine that
16:17 --> 16:18many of those patients are
16:18 --> 16:20struggling with the diagnosis,
16:20 --> 16:22and it may or may not actually reach
16:22 --> 16:24the level of an adjustment disorder.
16:24 --> 16:27But many of these patients may not be
16:27 --> 16:30near a dedicated psycho oncologist.
16:30 --> 16:33Are there things that
16:33 --> 16:36you would advise patients or their
16:36 --> 16:38family members to do in terms of
16:38 --> 16:41helpful hints to try to get over
16:41 --> 16:44the adjustment to that diagnosis?
16:44 --> 16:46That's a great question and you know
16:46 --> 16:48hopefully most places do at least
16:48 --> 16:50have a connection to a social worker.
16:50 --> 16:52So the first thing is I would say
16:52 --> 16:54speak up because you're not
16:54 --> 16:56alone and you're not the first person
16:56 --> 16:58going through cancer treatments that
16:58 --> 17:00have had these sort of reactions.
17:00 --> 17:02It is very normal.
17:02 --> 17:04And that's one thing I really try
17:04 --> 17:06to express to anybody that I meet is
17:06 --> 17:09that if you've never had this problem
17:09 --> 17:11before doesn't mean that this diagnosis
17:11 --> 17:13doesn't rocked your world
17:13 --> 17:15in a sense and so to speak up and
17:15 --> 17:17to discuss that either with your
17:17 --> 17:19oncologist or with your primary care
17:19 --> 17:21provider or if you are able
17:21 --> 17:23to get connected with a social worker
17:23 --> 17:25because they can hopefully help
17:25 --> 17:27direct you to resources if needed.
17:27 --> 17:30And we do kind of think of this
17:30 --> 17:32as in a pyramid in the sense that
17:32 --> 17:34everybody's most likely going to have
17:34 --> 17:37some reaction to the diagnosis and so
17:37 --> 17:39that's kind of the large
17:39 --> 17:42end of the pyramid and where everybody
17:42 --> 17:44has this discussion with their
17:44 --> 17:46oncology provider and is able
17:46 --> 17:48to have some processing and we
17:48 --> 17:50realize that as you move
17:50 --> 17:52along there might be some that need
17:52 --> 17:54to talk to a social workers and then
17:55 --> 17:57if that's not enough maybe getting
17:57 --> 17:59connected to group therapies.
17:59 --> 18:01Because of the pandemic there are many
18:01 --> 18:04group therapies that are out there
18:04 --> 18:06either through your hospital system
18:06 --> 18:09or oncology provider or kind of
18:09 --> 18:11just in general people can join.
18:14 --> 18:16Getting to the point of actually
18:16 --> 18:18needing a psychologist or some type
18:18 --> 18:19of therapist or counselor to be
18:19 --> 18:21able to discuss their issues
18:21 --> 18:23and then thinking kind of at the
18:23 --> 18:25top of that pyramid would be getting
18:25 --> 18:26actually to the psychiatrist.
18:26 --> 18:28So somebody that would actually
18:28 --> 18:30need medication management to try
18:31 --> 18:32to help with their
18:32 --> 18:34symptoms that they're having.
18:34 --> 18:38So the first is always just speak up,
18:38 --> 18:39communicate whether that's just
18:39 --> 18:41with your provider or with your
18:41 --> 18:43family members because trying to
18:43 --> 18:46go through this in isolation is
18:46 --> 18:49difficult if not impossible and so
18:49 --> 18:52there are other resources available.
18:52 --> 18:54But then also realizing that there
18:54 --> 18:57are ways to kind of work through this
18:57 --> 18:59ladder if you will to get to
18:59 --> 19:01the level of need or assistance
19:01 --> 19:04that you actually need.
19:04 --> 19:07Great points in terms of
19:07 --> 19:09actually speaking up because even if
19:09 --> 19:12you can't access a psycho oncologist
19:12 --> 19:14right from the get go you know having
19:14 --> 19:16somebody to talk to your family
19:16 --> 19:18doctor and nurse navigator or social
19:18 --> 19:21work or somebody they can often help
19:21 --> 19:24and or escalate as the case may be.
19:24 --> 19:27Before the break you
19:27 --> 19:30had mentioned kind of two aspects
19:30 --> 19:31of Psycho Oncology.
19:31 --> 19:35The first is how cancer affects behavior,
19:35 --> 19:38it affects mental health and
19:38 --> 19:40we've kind of dived into that a bit,
19:40 --> 19:42but the other is
19:42 --> 19:46how mental health
19:46 --> 19:48can affect cancer.
19:48 --> 19:50Can you talk a little bit more about that?
19:51 --> 19:54Absolutely. So we know that
19:54 --> 19:56within mental health
19:56 --> 19:58that can lead to changes in our behavior,
19:58 --> 20:00changes in our social interactions,
20:00 --> 20:04changes in the way we're able to
20:04 --> 20:06kind of process and work through life.
20:06 --> 20:09And so when somebody's in
20:09 --> 20:11mental distress or mentally
20:11 --> 20:14unwell that can impact their
20:14 --> 20:16ability to follow through with items
20:16 --> 20:19that are for their cancer treatment.
20:19 --> 20:21So in other words if somebody is too
20:21 --> 20:23anxious and and suffering from very
20:23 --> 20:26severe anxiety and not able to
20:26 --> 20:28make it to their appointments because
20:28 --> 20:30they're too panicked at the thought of
20:30 --> 20:32going to the appointments or leaving
20:32 --> 20:34their house and therefore
20:34 --> 20:36they don't follow up with their
20:36 --> 20:38treatments and they're not able
20:40 --> 20:43to get recommended treatments or show up for
20:43 --> 20:45the radiation or whatnot,
20:45 --> 20:48the same aspect could be with depression.
20:48 --> 20:51If somebody is having such severe
20:51 --> 20:53depression that they're not able to get
20:53 --> 20:56out of bed to try to eat some food,
20:56 --> 20:57to try to stay hydrated,
20:57 --> 21:00to be able to you know,
21:00 --> 21:01again go to their appointments,
21:01 --> 21:03things like that,
21:03 --> 21:06we find that those
21:06 --> 21:08psychological factors then end up
21:08 --> 21:12having an impact on your oncological
21:13 --> 21:16prognosis if you're not able to take the medications,
21:16 --> 21:17if you're not able to show up
21:17 --> 21:18to the appointments,
21:18 --> 21:20if you're not able to participate
21:20 --> 21:22in care planning you're gonna
21:22 --> 21:24have worse prognosis with your cancer
21:24 --> 21:26and that is something
21:26 --> 21:29that we know and we have been
21:29 --> 21:32able to kind of study and see
21:32 --> 21:35that there can be an increase
21:37 --> 21:41in longer survival,
21:41 --> 21:44better rates of compliance,
21:44 --> 21:47better prognosis if we're able to
21:47 --> 21:49have a more steady mental health.
21:51 --> 21:53And you mentioned and I think
21:53 --> 21:55it seems to be common sense that
21:55 --> 21:58there are patients who have a
21:58 --> 22:00pre-existing diagnosis of mental
22:00 --> 22:03health issues who may also get cancer.
22:03 --> 22:06What proportion of cancer patients
22:06 --> 22:11already have a mental health diagnosis?
22:11 --> 22:13And so that's another one
22:13 --> 22:16of those that's kind of up for
22:16 --> 22:17debate depending upon which resource
22:17 --> 22:19and data you're looking at.
22:19 --> 22:23But we say that about 1/4 of
22:23 --> 22:26all patients in America will have a
22:26 --> 22:28mental health disorder at some point.
22:28 --> 22:30And so if you want to think
22:30 --> 22:34of that within kind of that 35%
22:34 --> 22:36it is a little
22:36 --> 22:38bit of a convoluted way to look at
22:38 --> 22:40it but I would say the
22:40 --> 22:43majority of patients might have had
22:43 --> 22:46some history of either some mild anxiety
22:46 --> 22:50or depression and that gets
22:50 --> 22:52exacerbated through the diagnosis.
22:52 --> 22:54But if they and unfortunately
22:54 --> 22:57we also have a lot of patients
22:57 --> 22:59who had undiagnosed
22:59 --> 23:01psychological problems that had been
23:01 --> 23:02there throughout their life as well.
23:02 --> 23:04So it's kind of hard to give
23:04 --> 23:05you a specific number.
23:05 --> 23:07But I would say,
23:07 --> 23:09I personally in my clinic kind of
23:09 --> 23:12see half and half and I think
23:12 --> 23:14that might be somewhat standard
23:14 --> 23:16to kind of realize that you already
23:16 --> 23:18have about 1/4 of the population
23:18 --> 23:20that already has it.
23:20 --> 23:22That there is no direct correlation to
23:22 --> 23:25saying that just because you had a
23:25 --> 23:27pre-existing mental health condition
23:27 --> 23:29that you were more susceptible to
23:29 --> 23:31having a cancer diagnosis,
23:31 --> 23:33but certainly if you
23:33 --> 23:35have a mental health diagnosis,
23:35 --> 23:41say schizophrenia or a different disorder,
23:41 --> 23:43bipolar, et cetera,
23:43 --> 23:47it may really affect you in terms of
23:47 --> 23:49getting through the cancer journey.
23:49 --> 23:52I mean it's hard enough for
23:52 --> 23:53people without that diagnosis,
23:53 --> 23:56but then it just adds in an
23:56 --> 23:58extra layer of complexity.
23:58 --> 23:59Can you talk a little bit more
23:59 --> 24:02about that and how you may or may
24:02 --> 24:04not interact with the patients
24:04 --> 24:06already established healthcare team
24:06 --> 24:09in terms of their mental health,
24:09 --> 24:11their psychiatrists, etcetera.
24:11 --> 24:13Yeah, one of the biggest problems
24:13 --> 24:16is it comes with the
24:16 --> 24:18follow up and being able to have them
24:18 --> 24:20connected to consistent treatments
24:20 --> 24:22because if they're not established
24:22 --> 24:26within a kind of a stabilized on
24:26 --> 24:28medications or with a stable living
24:28 --> 24:30environment then unfortunately,
24:30 --> 24:32once they're discharged to have
24:32 --> 24:34follow up for for their therapies
24:34 --> 24:36and treatments it's very hard
24:36 --> 24:38to have them kind of come back.
24:38 --> 24:41So we do see a significant number of
24:41 --> 24:44patients with what we would consider
24:44 --> 24:47serious mental health issues as you're
24:47 --> 24:49mentioning the schizophrenia kind of this,
24:49 --> 24:52the psychotic spectrum having a much harder
24:52 --> 24:55time with the follow up and the close care.
24:55 --> 24:58And so there are efforts that are put in to
24:58 --> 25:01try to help stabilize, making sure that
25:01 --> 25:03rides are set up ahead of time
25:03 --> 25:06trying to get them into a stable
25:06 --> 25:09living situation if they are
25:09 --> 25:12unhoused or if they're not already
25:12 --> 25:15connected to a psychiatrist or an
25:15 --> 25:17outpatient treatment facility.
25:17 --> 25:20Making sure that we can try to get them
25:20 --> 25:21stabilized on psychiatric medications.
25:21 --> 25:24Because we find that if we're
25:24 --> 25:26able to get some of their symptoms,
25:26 --> 25:27mental health symptoms,
25:27 --> 25:29better under control,
25:29 --> 25:30then they will have better
25:30 --> 25:31outcomes with their
25:31 --> 25:32cancer treatments and have better
25:32 --> 25:35follow through and so looking at
25:35 --> 25:37what's the best medication
25:37 --> 25:39regimen for them to make it so that
25:39 --> 25:41they will remain on their medications
25:41 --> 25:43and try to have follow up.
25:47 --> 25:50It can make their cancer treatment
25:50 --> 25:52difficult in the sense of making
25:52 --> 25:53sure that follow up is probably
25:53 --> 25:55one of the biggest factors.
25:55 --> 25:57But we do use that kind of
25:57 --> 25:59collaborative care approach to
25:59 --> 26:01really get as many people
26:01 --> 26:02involved as possible.
26:02 --> 26:04When we think of the collaborative
26:04 --> 26:06care approach within Psycho Oncology,
26:06 --> 26:07really kind of getting social work involved.
26:07 --> 26:10The psychologist involved,
26:10 --> 26:12the advanced practice providers,
26:12 --> 26:14having the direct
26:14 --> 26:17communication with the oncology team,
26:17 --> 26:18streamlining communication,
26:18 --> 26:20simplifying for the patient as much
26:20 --> 26:23as possible and trying to get
26:23 --> 26:25wrap around care for the patients who
26:25 --> 26:28unfortunately sometimes come in unhoused,
26:28 --> 26:28uninsured,
26:28 --> 26:30not having financial resources
26:30 --> 26:32and seeing what we can do to help.
26:32 --> 26:34To help that patient population.
26:35 --> 26:38You know, the other question that
26:38 --> 26:42comes up is there's a lot of
26:42 --> 26:44stigma around mental health diagnosis.
26:44 --> 26:48And, I wonder whether
26:48 --> 26:52you get pushback from patients and
26:52 --> 26:55their families saying, you know
26:55 --> 26:58I really don't need a psychiatrist.
26:58 --> 27:01I'm not crazy. I'm just,
27:01 --> 27:03you know, I have cancer.
27:03 --> 27:08And how does the stigma of a mental
27:08 --> 27:10health diagnosis affect patients
27:10 --> 27:12who are going through cancer,
27:12 --> 27:15patients who may need psycho
27:15 --> 27:16oncology services
27:19 --> 27:22and their reentry or continued existence
27:22 --> 27:25in society with the stigma
27:25 --> 27:27that sometimes is associated
27:27 --> 27:29with mental health diagnosis.
27:30 --> 27:34Yeah, unfortunately that is very true.
27:34 --> 27:36We see it time and time again and
27:36 --> 27:39and that stigma is still there
27:39 --> 27:41and I think we're making some
27:41 --> 27:42great strides within society.
27:42 --> 27:45But it absolutely comes up time and
27:45 --> 27:48time again and I think the biggest
27:48 --> 27:50impact it has is delayed care.
27:50 --> 27:53Patients will kind of fight or
27:53 --> 27:55put off being connected to a
27:55 --> 27:57psychiatrist or psychologist until
27:58 --> 28:00there's a point where
28:00 --> 28:02intervening where somebody has
28:02 --> 28:03to intervene and that may
28:03 --> 28:05come when they're hospitalized.
28:05 --> 28:07I do get connected to patients
28:07 --> 28:09frequently when they're in the
28:09 --> 28:10hospital because the distress
28:10 --> 28:12becomes kind of paramount to them
28:12 --> 28:13needing to get connected to me.
28:13 --> 28:16But I think the biggest problem
28:16 --> 28:18is there are ways to help and
28:18 --> 28:20it's not speaking
28:20 --> 28:22up or not accepting that care delays
28:22 --> 28:25that and many of the medications
28:25 --> 28:27do take several weeks to take
28:27 --> 28:29effect and so just kind of continues
28:29 --> 28:31to push off getting the care
28:31 --> 28:32that could be helpful for them.
28:33 --> 28:35Doctor Shannon Mazur is an
28:35 --> 28:36assistant professor of psychiatry
28:36 --> 28:38at the Yale School of Medicine.
28:39 --> 28:41If you have questions,
28:41 --> 28:43the address is canceranswers@yale.edu,
28:43 --> 28:45and past editions of the program
28:45 --> 28:48are available in audio and written
28:48 --> 28:49form at yalecancercenter.org.
28:49 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public Radio.
28:55 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

Information

Benefits of Psycho-Oncology with guest Dr. Shannon Mazur March 19, 2023 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095