Coping with a Diagnosis of Cancer

Mark Crooks, Coping with a Diagnosis of
Cancer
September 5, 2010Welcome to Yale Cancer Center Answers with Dr. Ed Chu and
Dr. Francine Foss, I am Bruce Barber.  Dr. Chu is Deputy
Director and Chief of Medical Oncology at Yale Cancer Center and
Dr. Foss is a Professor of Medical Oncology and Dermatology
specializing in the treatment of lymphomas.  If you would like
to join the conversation, you can contact the doctors
directly.  The address is canceranswers@yale.edu and
the phone number is 1888-234-4YCC.  This evening, I will be
sitting in for Ed and France and I am joined by Mary Crooks. 
Mary is a Licensed Clinical Social Worker in the Head and Neck
Cancer Program at Yale and she joins me this evening to talk about
support for cancer patients.Barber
 Mary, welcome to Yale Cancer Center Answers. Let's get started by
discussing how you got interested in this field?Crooks
That brings me way back, Bruce, to when I was in high school
actually. Back then people could work as a nurse's aide at a very
young age, and I was a nurse's aide at a local nursing home. From
there I went to college and decided that social work was really for
me.  Initially, I was introduced to social work courses at
Cedar Crest College in Allentown, Pennsylvania.  I had a
fabulous opportunity for internship when I was a senior in college
and I worked with senior citizens who were possibly abused or
neglected, and at that point I realized working with seniors and
trying to have them open up and talk about what was really going on
with them, develop a rapport, I could then lead them to seeking
help, having their needs met, and empowering them to reach out to
the community and get the support they needed.  After doing
that internship, I was lucky to land a job with the State of
Connecticut working for the Department of Income Maintenance where
again, we were able to meet peoples' needs and that was a great
experience because it let me know the resources in the
community.Barber
 Let's jump forward to where you are now.Crooks
I have had the opportunity to work at Yale-New Haven Hospital for
over 7 years in the oncology department and I got to that area of
working with oncology patients and their families because I did
have past hospice experience and working with patients previously
with cancer in the community, and so working at Yale I have been
able to help the patients, who are inpatient, navigate and
negotiate the hospital system and learn about their disease and
learn how they work within the hospital as far as the hospital
system, meeting the doctors, meeting the nurses, and what their
disease means to them.Barber
 It must be very overwhelming for someone to get a cancer
diagnosis, and you must be of great help to them?Crooks
Thank you, I like to think so. Meeting people at a time that is so
challenging for them, a3:37 into mp3 file 
http://yalecancercenter.org/podcast/sept0510-cancer-answers-crooks.mp3
 time where they least expect to be diagnosed with cancer or any
ailment of any type, and how they in turn need to take stock, learn
about the diagnosis, and I reach out to them.Barber
 What's usually the first reaction?Crooks
The first reaction people usually have is shock, disbelief that
this is happening to them.Barber
 How do you get them to work through that, what do you find really
empowers a patient once they get over that initial shock?Crooks
When they have gotten over the initial shock, they are usually able
to talk about it.  I can give them a safe environment, a time
where they can just speak with me, sit down in a quite environment
and share more about their thoughts and their feelings related to
their new diagnosis.Barber
 Do you find that is it set up now so that you are able to spend
time with them before they have to go home and go back into the
world, or is it something that is a gradual process where you want
to give them a little information at first, let them process it,
and then let them come back and see you.Crooks
I take my cues from the patient themselves, so if they are
hesitant, or if they are quiet, or if I sense that they are not
ready to talk at this moment, I wait until the next time they come
in to see the doctor.  We have a fabulous out-patient
treatment area where they meet the doctor on multiple occasions to
be treated or for the consult purposes, so I will visit them again
on their next appointment.Barber
 I would imagine the emotional aspect is important to deal with
first, but then there will be a lot of logistics, won't there, that
you can also help with?Crooks
The patient will reach out and will share what is of concern to
them.  They do that by me asking open ended questions, like
how you are feeling today?  What is going on for you?  Is
there anything else you would like to ask me? And they will ask
what is on their mind usually that day and based upon what they
share with me, I will respond accordingly.Barber
 This has got to be very difficult for their family as well. 
What kind of advice do you give patients regarding how to bring
this news to their family and help their family deal with it as
well?Crooks
I encourage them to be open and honest with their family, and also
to be patient with their family because sometimes they have this
information ahead of time, before they share it with their family,
and they have had time to mull it over and to process it
themselves.  So, when they first approach their family, I let
them know that the family members may react with shock or anger or
denial, 7:05 into mp3 file 
http://yalecancercenter.org/podcast/sept0510-cancer-answers-crooks.mp3
 and let them know to be patient with their family member, but to
be open and honest in their communication as well.Barber
 How about at work?  I would imagine that all of a sudden you
have got this cancer diagnosis, it is probably difficult to know
how much to share with people at work, and who to tell. What advice
do you give for that?Crooks
I also encourage them to be open and honest with their manager or
their boss, because more often than not, the manager or boss will
be empathetic, understanding, and will be able to guide them in
their work activities.Barber
 And what else?Crooks
When they receive the support from others around them that usually
helps them cope better and go through the day and receive support
and feel that support, and it gives them extra energy to move
forward and to deal with and face their concerns.Barber
 You work with patients with head and neck cancers, what are the
things that these patients are dealing with just being out and
living their lives?Crooks
Head and neck cancers are unique in that oftentimes you can see it
when you look at person.  You will often see the result of
surgery or the result of radiation treatment, and their face or
their neck will show signs of that treatment for a period of time,
and it's difficult for people when they are out facing the
community and facing people, particularly people they don't know,
and they are concerned about how people are going to react to
them.  They look at them funny.  They may feel that
others are judging them based upon their appearance and it's hard
for them to face the world that way versus if you have cancer in
another part of the body, a part of the body that is often covered
with clothing, and people might not be aware, so this is
particularly difficult when we think of head and neck cancer.Barber
 What strategies do you advise them to use, to again just be open
about it?Crooks
Yes, absolutely.  The patient needs to work on how they are
going to relate to others and how they want to respond to
others.  How do they feel comfortable?  If they want to
pass over it so to speak or have a very short limited conversation
with someone, that's fine.  If they want to elaborate on their
situation, tell about their diagnosis, tell about their treatment,
that's fine too.  It's for them to find what they are most
comfortable with, giving more or less information based upon their
needs.10:36 into mp3 file 
http://yalecancercenter.org/podcast/sept0510-cancer-answers-crooks.mp3Barber
 And do you find that it varies widely from patient to patient, or
are there some things that are fairly common?Crooks
I find it varies widely from patient to patient because we are all
individuals, Bruce, and we all relate to others in our own unique
ways with our own unique personality. We need to honor those ways
and honor that personality and go forward and be comfortable in who
we are relating to.Barber
 How are patients referred to you?Crooks
Patients are referred to me as a consult service by the doctor, and
specific to the head and neck cancer area, the oncologist or the
surgeon would refer a patient to me who they feel has expressed the
need, an emotional need, a social need, a need that the other
interdisciplinary team members are not equipped to address.  A
need such as concerns about finances, concerns about relationship
issues, concerns possibly with their relationship with God and
others around them.Barber
 These are all very important issues and I would like to speak with
you some more about them.  Let's take a quick break for a
medical minute and then come back to speak some more about support
for cancer patients with Mary Crooks.Barber
 Welcome back, we are speaking with Mary Crooks about support for
cancer patients. Mary, take me through your average day.  Are
you working at Smilow Cancer Hospital?Crooks
Yes, I am. A typical day starts out early, I arrive at work around
7 because I need to be on time for our early morning disciplinary
rounds.  They begin at 7:30, and the interdisciplinary team
includes the doctor, the nurse, our care coordinator, which is also
considered the discharge planner, and14:03 into mp3 file 
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 residents and internists.  And what we do in our early
morning rounds is we go from room to room to check on each
individual patient on the floor, the hematology/oncology floor at
Smilow Cancer Hospital and the team goes in to see the patient to
determine what their needs are for the day and the doctor reports
what the treatment plan will be.  When I go into the room in
the morning with the team, I am assessing just by observation how
the person may be coping that day or feeling emotionally.  If
I sense that the person is stressed in any manner, I will make a
mental note to return later at the end of completion of rounds to
check in with that person and see how they are feeling.Barber
 So, after you have done your rounds, is there then a meeting of
the team?Crooks
Yes, the meeting of the team happens first thing in the morning
with the completion of seeing each patient.  We do a little
check in at the time when we are seeing each patient, prior to
going into the room and prior to coming out of the room.Barber
 What do those meetings entail?Crooks
The meetings entail the doctors sharing the medical information,
test results, and setting up, again as I said, what the plan of
treatment will be for that day.  At that moment in time, if
there is what we call a psychosocial concern, I raise it at that
time and let the team know what I am thinking about for my plan for
the day with that particular patient.Barber
 Then you will go back in and see that patient if you feel it's
important to speak with the patient?Crooks
Absolutely, I will go back in, I will see the patient and I will
determine if they had any unmet needs or  any concerns that
they did not have a chance to voice to the team earlier, and then
what I will do is I will report back to the team later that day,
usually by phone call or if I see them on the floor later when they
are visiting the patient, and that is how we keep the communication
open and let the patient and family members know that we are
working in their best interest and serving them.Barber
 Sometimes do the patients not want to talk about it?Crooks
Yes, sometimes the particular patient does not want to talk about
what is upsetting them or what is concerning them, so I sense that
based upon cues they give me, usually nonverbal cues but sometimes
verbal cues, and I will approach them sometimes that same day or
the next day based upon how they are feeling and the cues I am
getting from them.17:24 into mp3 file 
http://yalecancercenter.org/podcast/sept0510-cancer-answers-crooks.mp3Barber
 In head and neck cancer, what kind of side effects are they facing
and how do you help them deal with the side effects of their
treatment?Crooks
The side effects they are facing could be a whole range of side
effects, based mostly upon the treatment they received.  Most
head and neck cancer patients receive both radiation therapy and
chemotherapy.  Based upon the treatment they received, they
will have certain symptoms. Symptoms that we often see with
radiation therapy, depending upon where it is directed on the head
or on the neck, can affect the person's swallowing.  It can
affect a person's speech.  It can affect their skin, so what I
do is when I meet with the individual patient, by my communication
to them I give them permission to be able to talk about these
symptoms openly and honestly and to be able to address the feelings
they may have about these symptoms.Barber
 What are some of the techniques you use to get through these
difficult times?Crooks
The technique that I often use is to let them know, through my
nonverbal and verbal actions, that they can open up, that they can
feel safe with me, that I understand not as a person who has had a
head and neck cancer, but as a person who has worked with many head
and neck cancer patients.  I let them know that other people
have expressed their concerns to me and that I know that these
concerns often exist; they may or may not exist for them, but that
I know that these are common concerns that others have shared.Barber
 Are there actual techniques they can use such as say guided
imagery to mentally cope with what they are going through?Crooks
Absolutely, there are many techniques that some people already
employ themselves, and they are not aware of it.  Some people
actually have routines that they do, at home or they do it at work
to reduce stress.  Some of those routines are listening to
music, exercising, or meditating.  Some people are not used to
thinking about what their routines are or the natural ways they
employ to reduce stress.  I talk to them about that and we
review how they have dealt with stress in the past and then based
upon what they share with me, I ask them questions and I say to
them, I heard you say to me that you have exercised to reduce
stress or you listen to music to reduce stress.  So we go back
to the techniques that they are most familiar with first and
foremost, then if they are interested in learning new techniques,
based upon what they share with me, I will introduce those to
them.  There are many different techniques one can use to
relax and I ask them which one's they think they would like to try
and we start off with something simple.Barber
 Give me a couple of examples.  Give me your top favorite
relaxation techniques.Crooks
The easiest and the most simple, and one that people can relate to
often, is just simply breathing. 21:52 into mp3 file 
http://yalecancercenter.org/podcast/sept0510-cancer-answers-crooks.mp3We all breathe, obviously, and we all take it for granted, we
are not aware of it.  We do not pay attention to our breathes
and one way that a person can relax very quickly is just simply
breathing in through the nose and then out through the nose, and to
be mindful as they are doing that they are breathing in from a
space in their abdomen, breathing up through their chest, and then
hold the breath for a minute and then breathe out, again all the
way down to their abdomen.  And this is a very very simple
relaxation technique that I practice with them and I encourage them
to try that and then once they have mastered that, we can look at
other techniques.Barber
 Are there support groups available?Crooks
Yes, absolutely at Smilow Cancer Hospital we have multiple oncology
support groups.  Some are disease based, such as the head and
neck cancer support group, there is a multiple myeloma group, and
we have other support groups that are more generally based such as
a patient and family support group that meets at the
hospital.  We have another patient and family support group
that meets at the Shoreline for people who live out that way. 
It is easier for them to get to.  We have a brain tumor
support group, and I encourage people to try support groups, see if
they like it and they are open ended groups, so you can come as you
wish and if you miss a meeting or two that is fine, you can always
come back.Barber
 And I would imagine that is very powerful for a lot of people to
know, and you alluded to this earlier, that they are not alone in
this.Crooks
Absolutely, people when they come to support groups often talk
about the other people in the group and how they know exactly what
they are going through, and they are right.  All of us medical
professionals, unless we have had cancer ourselves, we do not
exactly know what the other person is feeling.  We can imagine
it, we can be empathetic, but we do not know exactly.  The
people in the support group know exactly how it feels to have
cancer, and how it feels to have the treatment that they have
received.Barber
 I think the thing with cancer is it is something that we all worry
about.  If we are a cancer survivor we have dealt with it, if
not, it is certainly something that is there.  What would you
say to someone who has not dealt with cancer, but is thinking about
the possibility that they might one day hear that diagnosis?Crooks
We all worry about certain things and we can become anxious about
something.  Certainly many people are anxious about the
economy and fear of loss of jobs, many people can be anxious about
receiving a diagnosis, and not knowing how that would be for them
and how they will respond to it.  I think that when we think
of our loved ones and we think of the people around us who
truly25:23 into mp3 file 
http://yalecancercenter.org/podcast/sept0510-cancer-answers-crooks.mp3care about us and who are there for us, we have a built in
support system, people who we can lean on if we are ever
diagnosed.  A lot of things can happen in life and life is
filled with adversity and one thing we know about is that there
will be changes in our lives and when that happens we need to know
who is there for us, who we can reach out to, who we can lean on
and call and speak with to share our concerns.Barber
 That is a wonderful way to close, to underline how important it is
for all of us to have strong relationships in our lives.Crooks
Absolutely, the theme here is a strong relationships in our lives,
building relationships with our loved ones and keeping them strong,
building relationships with the doctors, the nurses, people we come
in contact with when we are ill, and remembering to keep open
communication with everyone who touches our lives, everyone who we
work with in our day-to-day living.Barber
 Mary Crooks is a Licensed Clinical Social Worker in the Head and
Neck Cancer Program at Yale.If you have questions or would like to share your comments,
visit yalecancecenter.org where you can also subscribe to our pod
cast and find written transcripts of past programs.  I am
Bruce Barber and you are listening to the WNPR Health Forum on the
Connecticut Public Broadcasting Network.