In an interview with Pharmacy Times at the American Society of Clinical Oncology (ASCO) 2022 Annual Meeting, Bruce Feinberg, DO, vice president and chief medical officer at Cardinal Health Specialty Solutions, discussed how a cancer diagnosis and treatment can impact patients’ mental health.
How does a cancer diagnosis and the following treatment impact mental health?
Bruce Feinberg, DO: It probably is not a reach for most people to think that when you hear the words “You have cancer,” that it’s a shock to your system. And it’s a shock to your system in very emotional ways. The first thing you’re thinking about is, am I going to live? Or am I going to die? How much time do I have to live? How much will I suffer? There are a few crises that people have to deal with—loss of life, loss of home, loss of job—and cancer diagnosis is right up there, on the 5 most significant crises that someone has to deal with. And even more so than most other chronic disabling diseases, once you get past cancer and that element of immediate risk and loss of life potential, you start to think about loss of eyesight and blindness. And that would happen, obviously, from things like macular degeneration. So, it is a huge, huge shake up to an individual and all the people around them, which has so many layers. Inability to talk about it from friends and family, not knowing what to say, how to say it, and then the layers of anxiety that often lead to depression. And you’re layering onto that, then, all the physical things that happen to people in the course of their treatment. So, it’s, it’s kind of unique in the severity. Kind of a PTSD-generating event, even for those who are going on to be survivors.
How can mental health care be incorporated in oncology treatment in community settings?
Bruce Feinberg, DO: So, one of the problems we have is we think about the complexity of cancer, and often a cancer patient has seen their primary care doctor, who referred them to a specialist, who maybe then did a biopsy, then referred them to a medical oncologist, [and] they might also need surgical intervention from a surgical oncologist, there could be radiation from radiation oncologist, and possibly some disabling from that would require other types of specialists to be involved. And then you layer on that, once the patient is finally kind of in the path and progress of cancer treatment, more doctors, like getting mental health care and doing that with the psychologist, psychiatrist. And often, it’s just the straw on the camel’s back. I can’t see one more doctor, I can’t afford one more doctor, I can’t take that time out and go to one more place. So, the fragmentation of our system makes it problematic. And you would think that would be better in an academic or hospital environment, but only if you’re inpatient with all those individuals coming to see you in one location, which isn’t the case. Almost all cancer care is outpatient. So, the problem exists in the community, it exists in academia. And it’s a difficult problem to solve, because of the complexity and the nature of the disease. Optimally, whatever you can do at site of care, at the time of cancer treatment would be best to that degree. Many cancer programs are incorporating social workers, psychologists, trying to bring that care within the system. But there are problems, again, that have to do with operationalizing it: How does it get paid for? How much gets paid? Can you afford to staff that personnel, given the reimbursement, and then again, that patient and family willingness to want to engage in one more thing? Because it’s not like, at that point, if there was a pill, can I just take that pill, but there isn’t the pill. And so, counseling is a complex process that takes time. And so, it is sometimes again, just one thing too many for patients, and often for the system to be able to manage. That’s not ideally the way you want it to be, but a reality.
What mental health symptoms should health providers watch for in patients with cancer?
Bruce Feinberg, DO: So, you could argue that it would almost be inconceivable with a diagnosis of a potentially terminal disease, not to have a severe emotional reaction. So, do you need to wait for a symptom? Or actually, is it best to understand that this is going to upset the applecart of your mind and something needs to be done preemptively, proactively, and not wait. The symptoms are difficult from the standpoint of so many things, again, happening to that individual physically and mentally and emotionally—loss of sleep, changing eating habits, interpersonal relationships and the impact it is having on them. And you could assume that all those things are going to happen. So, I think it’s really more going in with the understanding that this would be a normal human response, to have this kind of mental crisis. And be proactive, be preemptive and not think about it as “I’m looking for something.”