Body and mind combined in cancer care

Gathering Around Cancer, virtual meeting, 5-6 November 2020

The meeting heard from Dr Helen Greally, National Clinical Lead in Psycho-Oncology at the National Cancer Control Programme (NCCP), and Director of Psychology and Support Services at Cancer Care West, who delivered a talk titled ‘Psychological needs of cancer patients and the status of psycho-oncology services in Ireland: Towards an integrated service’. Cancer Care West is a charity that provides community-based psychological supports for cancer patients and their families in the West of Ireland. Dr Greally told the meeting that, with regard to the psychological needs of cancer patients, “there have been remarkable advances in early detection and treatment in multiple types of cancers, but we also know that at the same time, approximately 50 per cent of all cancer patients experience anxiety following diagnosis. That is from a very recent study conducted in 2019.”

She told the conference that the advances in physiological treatments have not been matched by the achievements in providing high-quality care in the psychological and social realms following a cancer diagnosis. “We know from speaking with cancer patients that many of them highlight the fact that their cancer care providers do not really understand their psychosocial needs and fail to recognise and adequately address the emotional stress [of these patients] and were unaware of, or did not refer them to, the appropriate resources,” she said. “One of the challenges we face is that it often happens in cancer support services that when patients do eventually arrive at a psychologist or cancer support centre, they say things like, ‘we did not know these services were available’. That is a very difficult hurdle to overcome and we really want to highlight the fact that psychosocial support should be an integral part of quality cancer care services.” A cancer diagnosis also exacerbates pre-existing problems such as anxiety and depression, said Dr Greally, and can be a cause for panic in many patients. She offered an example of a patient who was required to wear a thermoplastic mask, causing serious levels of anxiety and distress, to the point where she was unable to receive her treatment, despite being administered a sedative.

However, after two sessions of psychological support, the patient was capable of wearing the mask and receiving her treatment. “So there are very practical ways that psychological support can help with a patient’s cancer treatment,” said Dr Greally. She added: “Fear of recurrence is a very common issue for a lot of people and while it is fairly normal, it can really strangle someone in terms of being able to cope with their lives, because they get so caught up in watching for every ache and pain… relationship difficulties are also a very common outcome for a lot of people and reintegration in going back to work is also a big issue for a lot of them, and obviously also issues like fatigue, as people are not able to work at the same level as they did previously.” Disease progression also causes significant psychological issues and trauma and families suffer with the obvious bereavement issues and the stressors associated with a prolonged disease course.

“The NCCP has published a needs assessment of cancer patients and that was very instructive in terms of what patients are saying to us,” said Dr Greally. “We really need to do an effective assessment with every cancer patient and support them in their journey through cancer. It’s not a one-size-fits-all approach; different kinds of patients need different supports… there are very specific interventions that can be used to help people to cope with their cancer.” She also highlighted the importance of survivorship programmes and these are being increasingly offered to people with long-term cancer and she stressed the advantages of peer support. “We need a very clearly-defined referral pathway for psychosocial services,” said Dr Greally. “A lot of patients identify the time when they have finished their active treatment as the most stressful time, because they feel that idea of ‘who is going to take care of me now?’ That can be a tremendous stressor for a cancer patient.”