Distress: The 6th vital sign in Cancer is experienced by a majority (60.3%) of cancer patients ranging from moderate to high level ⁽¹⁾, whereas depression and anxiety are faced by 38% and 36% of cancer patients consequently ⁽²⁾ Psycho-oncologist designs counseling sessions after assessing the level of distress, anxiety, and depression by using standardized instruments.

Factors influencing distress:
Physical symptoms, Psychological concerns- depression, anxiety, Adjustment issues, Social Concerns: stigma, family issues, lack of financial resources for treatment or transportation; disruptions in work and family life, Spiritual and Existential concerns.

Factors influencing depression:

• Disease-related factors like Site of cancer – head and neck, breast, oropharyngeal; chronic pain, disease severity, disability, and metabolic factors.
• Patient-related factors like- maladaptive coping styles, Lack of social support, younger age, financial struggle, history of psychiatric illness or suicide attempt, recent losses, and negative outlook on life. Iatrogenic causes like chemotherapy, Disfiguring surgery & Body image issues: e.g Mastectomy or Breast conservation, insertion of Ryle’s tube, stoma bags, and repeated diagnostic procedures increase depression.

Factors influencing anxiety: Diagnosis itself and stage of cancer diagnosis, health condition (disturbed sleep, pain, fatigue), illness perception by others and self, real and anticipated side effects (nausea and vomiting, hair loss), thoughts associated with duration and treatment protocol, pre and post-procedure phase, fear of death and financial loss are major factors of increased anxiety. Breathlessness, muscle pain, dizziness, palpitation, and panic attack are common symptoms of anxiety noted in cancer patients.

Delirium: Around 88% of terminally ill cancer patients can develop delirium (acute confusional state). It can be both Hypoactive (withdrawn, quiet, sleepy, and no expression of distress) and Hyperactive (restlessness, agitation, and aggressiveness). Apart from Pharmacological therapy Psycho-oncologists incorporate multiple non-pharmacological interventions to handle delirium such as:

1. Interaction with the patient about the day, date, and time orientation.
2. Switch off the lights and open the curtains and windows during the daytime.
3. Scheduling a proper time to sleep at night.
4. Stopping the patient to sleep in the morning, rather engaging more in communication with the caregiver and sitting in bed.
5. Reading books, newspapers, or playing music for the patient.
6. Inviting family members for better communication with the patient. Showing recent and old photographs.

Psychosexual dysfunctions: Patients and caregivers are often embarrassed to discuss sex and physical intimacy during and post-cancer treatment. Effect of treatment (chemotherapy, surgery, radiation, hormonal therapy) can cause pain during intercourse, changes in body image, and fatigue resulting in a lack of interest in sexual excitement, activity, and satisfaction. Studies reported that after cancer out of 60% of patients with sexual disfunction only 25% of patients seek health professional support for the same ⁽³⁾. In Psycho-oncological counseling, therapists probe into the above issues to address anxiety and fear related to myths and misconceptions, encourage non-performance touching, partner’s support and explore their sexual preferences.

Palliative and End-of-life care:
For end-of-life care patients Psycho-oncologists play a very significant role in facilitating the process of acceptance in handling pain, symptoms management, and gradually death. Patients start experiencing severe sleep disturbance, distress, fear of death, loss of autonomy, and loss of dignity. Though counseling psycho-oncologists help the patients to achieve a Good Death ⁽⁴⁾.

The role of Psycho-oncology

Psycho-oncologist plays a major role in objectively assessing psychological concerns among cancer patients and providing need-based counseling sessions. Behavioral interventions, Acceptance and Commitment therapy, and sleep hygiene techniques are considered effective psycho-oncological interventions to handle the above concerns. Psycho-oncologists design therapy sessions including caregivers for consistent motivation and reinforcement for effective cognitive, and behavioral changes and adaptive coping for cancer patients.

Commonly used Psychosocial Intervention used for Cancer Patients and Caregivers:

Psycho-oncology services include periodically monitoring patients’ and caregivers’ distress and taking care of their well-being for better adherence and health outcomes for cancer patients. Psycho oncologists explore the reason for non-disclosing diagnosis, discuss disclosure options with caregivers and help them in developing skills while disclosing cancer diagnosis to patients and managing their emotions effectively.

Psycho-oncologists generally use Relaxation techniques (Autogenic Relaxation Guided Imagery), Thought to monitor, challenging maladaptive thoughts/feelings, identifying consequences of actions, brainstorming, and cost-benefit analysis to identify possible solutions for effective management of anxiety symptoms among cancer patients.

Regarding managing depression, psycho-oncological interventions can range from supportive counseling, and need-based psychoeducation to intensive Cognitive Behavioural Therapy (CBT) and organizing Support group meetings.

During and even after Post-treatment Cancer patients and Caregivers experience a plethora of psychological concerns. Systematic distress assessment in regular intervals and need-based interventions play a significant role in maximizing cancer treatment outcomes, improved adherence to treatment, a better quality of life, and adaptive coping strategies for patients and caregivers.

References:

1. Veeraiah, S., Kayser, K., & Sudhakar, R. (2022). Psychosocial factors influencing distress among cancer patients in South India. Journal of Psychosocial Oncology Research and Practice, 4(1), e067.
2. Shankar, A., Dracham, C., Ghoshal, S., & Grover, S. (2016). Prevalence of depression and anxiety disorder in cancer patients: An institutional experience. Indian journal of cancer, 53(3), 432.
3. Schover, L. R. (2019). Sexual quality of life in men and women after cancer. Climacteric, 22(6), 553-557.
4. Bovero, A., Gottardo, F., Botto, R., Tosi, C., Selvatico, M., & Torta, R. (2020). Definition of a good death, attitudes toward death, and feelings of interconnectedness among people taking care of terminally ill patients with cancer: an exploratory study. American Journal of Hospice and Palliative Medicine®, 37(5), 343-349.