Psycho-oncology: The Overlooked Mental Health Crisis in Cancer Care

Psycho-oncology in Cancer Care

Receiving a cancer diagnosis marks the beginning of a long winding journey. Beyond the immediate physical implications, the emotional and psychological toll can be overwhelming. The initial shock of such news often gives way to a flood of emotions, leaving individuals feeling engulfed and isolated. Despite the careful and detailed treatment plans crafted by medical professionals, there is a glaring gap in addressing the psychological well-being of patients. This oversight, unfortunately, is not an anomaly but a widespread issue in our healthcare system.

The World Health Organization (WHO) has projected a stark increase in cancer cases, estimating over 35 million new diagnoses annually by 2050. This alarming figure represents a 77% rise from the 20 million cases reported in 2022. Such statistics expose the reality that approximately one in five people will face cancer at some point in their lives.

Given these daunting numbers, it is evident that cancer care must evolve to become more holistic. This means not only focusing on the physical aspects of the disease but also incorporating comprehensive psychological support. Integrating psycho-oncology and psycho-oncologists into medical teams is a critical step toward this goal. These specialists can provide essential emotional and mental health support, helping patients navigate the complex and often overwhelming emotional journey that accompanies a cancer diagnosis.

Psychological Impact of a Cancer Diagnosis

Cancer patients, survivors, and their caregivers face a deep and often overlooked struggle: the emotional challenges that accompany a cancer diagnosis. For patients, the initial shock brings acute anxiety, a looming fear of mortality, and an overwhelming uncertainty about the future. According to a study by Hartung et al. (2017), cancer patients are over five times more likely to experience depressive symptoms compared to the general population. This stark reality highlights the intense emotional toll that cancer inflicts.

As patients grapple with daily hardships and physical challenges, they find themselves in a relentless emotional battle, feeling disconnected from their former selves. The lack of adequate psychosocial support only deepens this emotional distress and sense of isolation. Moreover, the losses in physical function, reproductive ability, financial roles, and intimacy contribute to significant emotional pain, compounding the difficulties faced by those living with cancer.

Caregivers, often the unsung heroes in this journey, bear the immense burden of managing the patient's condition. They navigate familial conflicts, balance caregiving with other life stressors, and endure a rollercoaster of emotions—worry, frustration, sadness, guilt, and the exhaustion from constant vigilance. This emotional turmoil often goes unrecognised, yet it is critical to acknowledge and address the psychological needs of caregivers to ensure their well-being.

Even after treatment ends, survivors continue to grapple with emotional repercussions. While emotional adjustment typically improves within the first two years post-treatment, many survivors harbour persistent fears of cancer recurrence and a heightened sense of vulnerability. Their emotional well-being can be disrupted by news of other people's cancer diagnoses, follow-up appointments, and reminders of their own treatment, leading to symptoms akin to post-traumatic stress. 

This broad spectrum of emotional turmoil stresses the urgent need for comprehensive psychosocial support to be integrated into cancer care. Patients, survivors, and caregivers alike require a holistic approach to their emotional and mental health to navigate the complexities of a cancer diagnosis and its aftermath effectively. 

The Crucial Role of Psycho-Oncologists in Cancer Care

Psycho-oncologists are critical in supporting the mental health of individuals navigating the cancer journey. These specialists help patients develop a growth mindset through targeted interventions, transforming the perception of cancer from a catastrophic event into an opportunity for personal development. By fostering a sense of empowerment, psycho-oncologists encourage patients to view their bodies as capable and resilient.

For survivors, psycho-oncologists aid in fostering Post-Traumatic Growth (PTG), a concept introduced by Tedeschi and Calhoun in 1996, which refers to positive psychological changes resulting from struggling with challenging life circumstances. PTG can significantly enhance social resources, personal resources, and coping skills across various life domains, enabling cancer survivors to lead fulfilling lives despite their experiences.

On a larger scale, the inclusion of psycho-oncology in standard care protocols recognises the interconnectedness of mental and physical health, potentially leading to more efficient use of healthcare resources and improved long-term outcomes. As John Diamond famously said, "Cancer is a word, not a sentence." Psycho-oncologists play a crucial role in helping patients and their loved ones embrace this perspective, transforming the cancer journey from one of fear and despair to one of growth, resilience, and hope.

Psycho-oncologists also play a crucial role in developing essential psychological resources such as resilience, optimism, emotional intelligence, and grit among patients, survivors, and caregivers. One notable intervention is Positive Psychology Interventions (PPIs) like HOPE-IN, which combines cognitive, affective, and behavioural techniques to increase levels of hope and decrease psychological distress among cancer patients. 

Another effective program is the Stress Management and Resiliency Training (SMART) program. Participants, including caregivers and survivors, have shown significant improvements in resilience, perceived stress, anxiety, and overall quality of life through this training. Other successful PPIs include mindfulness-based interventions, empowerment programs, group therapy, and meaning-making interventions. These programs collectively contribute to enhancing the psychological well-being of individuals affected by cancer.

Barriers in Psycho-oncology

Despite their vital role in cancer care, psycho-oncologists face numerous challenges in implementing effective interventions. These include professional burnout, compassion fatigue, and the emotional toll of patient deaths. Securing adequate funding remains a huge hurdle, compounded by a lack of clarity regarding their role within healthcare teams. 

Ethical concerns, such as maintaining patient confidentiality, also present ongoing challenges. Furthermore, psycho-oncologists often struggle with insufficient institutional support and social stigma surrounding both cancer and mental health issues. 

To advance the field of psycho-oncology, several key areas need attention. First, increasing the training and education of more psycho-oncologists is essential to meet the growing demand for mental health support in cancer care. Expanding specialised programs and certifications to integrate psycho-oncology into medical and psychology training, coupled with adequate institutional support, is imperative.

Incorporating and expanding research into Positive Psychology Interventions (PPIs) is also critical. By enhancing the evidence base, healthcare providers can better understand the most effective strategies for improving patient outcomes. Standardising the integration of psycho-oncological services and PPIs into cancer treatment protocols ensures all patients have access to these vital services.

Fostering stronger interdisciplinary collaboration and leveraging digital health technologies can extend the reach of psycho-oncological services, particularly in underserved areas. Developing culturally sensitive approaches, such as language-specific counselling services that respect cultural beliefs and values, is essential to making psycho-oncology more inclusive.

Moreover, raising awareness about the importance of psycho-oncology and reducing social stigma around cancer and mental health is crucial. Public health campaigns and educational initiatives can help normalise seeking psychological support during cancer treatment. By focusing on these areas, the field of psycho-oncology can continue to evolve and improve, ultimately enhancing the quality of life for cancer patients, survivors, and their caregivers.

Dr Garima Rajan is an Assistant Professor of Psychology at FLAME University, Pune and Dishita Swaika is an Alumna of the university.

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