Cancer patients and survivors had a lot to deal with before the COVID-19 pandemic began. Now, the stress of coping with a chronic condition and the threat of catching the infectious respiratory illness is creating additional anxiety for patients handling both.
Psychiatrist Scott Irwin, MD, Ph.D., director of the Patient and Family Support Program at Cedars-Sinai Cancer and professor of Psychiatry and Behavioral Neurosciences, addresses the top mental health concerns of cancer patients and survivors and offers advice about how to handle them.
Q: What are the mental health needs of cancer patients during normal times – when there is no global health crisis?
A: Cancer patients often feel anxious about their future, how their treatments will impact their lives, therapy side effects, and they worry that their cancer will return or get worse. Depression, insomnia and psychological symptoms from cancer or its treatments also are common.
Q: What are cancer patients dealing with now, with the additional stress of COVID-19?
A: Many patients are dealing with increased anxiety. Also, many cancer patients are older and/or have compromised immune systems, so they are at higher risk for negative outcomes of the new virus. They're worried about leaving home and possibly exposing themselves to COVID-19 and other infections. Additionally, some patients already suffer from depression, which may now be intensified as their sense of hopelessness possibly worsens.
Q: Should cancer patients skip their psychotherapy treatments to avoid exposure to COVID-19 at medical centers?
A: No. It's even more important now to continue mental health treatment during this anxiety-producing time. Chronic stress can affect your body, thoughts and feelings. It can trigger inflammation in the body, causing insomnia, fatigue, headaches and depression. It also can cause irritability, lack of motivation and feelings of being overwhelmed. Most patients, however, can continue treatment via telemedicine from the comfort and protection of home.
Q: What advice do you have for cancer patients who are feeling anxious or worried in the current health crisis?
A: One of the easiest ways they can reduce stress and anxiety is to limit exposure to things that trigger anxiety. Staying informed is important, but it's also important to set boundaries for how much news you consume about the COVID-19 pandemic. Also:
- Get health information about COVID-19 from reliable sources, beginning with your oncologist. Cedars-Sinai has compiled information specifically for cancer patients. Also, the World Health Organization and the Centers for Disease Control and Prevention are great resources that update their information regularly, along with the Los Angeles County Department of Public Health. Remember to limit check-ins and discussions with others to one or two times a day to avoid ramping up your anxiety.
- Do a reality check: How do your anxious thoughts differ from information provided by experts?
- Practice relaxation techniques, such as deep breathing, meditation, yoga or tai chi.
- Talk to others – mental health professionals, family or friends – about your feelings and worrisome thoughts. Keeping those feelings inside can lead to more serious physical and mental health consequences.
- Eat healthfully. Get advice from a nutritionist about which foods are best for you.
- Exercise. People being treated for cancer often reduce their activity levels, which can intensify anxiety and depression. The more you walk around, even at home, the better. Check with your physician before engaging in more rigorous activities. It is better to exercise to feel better than to wait to feel better to exercise.
- Get a good night's sleep. Seek help if you are having trouble sleeping.
- Practice good hand hygiene and keep your distance from others: Wash your hands frequently, avoid touching items people may have touched and wear a mask in public.
- Use social media to maintain a sense of connection even though you're not seeing each other in person. For example, share meals, celebrate special occasions, play cards and board games together and read books to grandkids via videoconferencing.
Q: What can family members, friends and caregivers do to help ease cancer patients' anxiety and depression during the COVID-19 crisis?
A: Be sensitive to their needs and wants. Ask them what help they need and are comfortable with. Don't assume they want or need the help you're offering or any help. Cancer patients may not want people calling or coming over. On the other hand, they may need extra help with feelings of anxiety and isolation or getting food and supplies during this current health crisis. Try not to add to their stress and anxiety by sharing your own anxieties with them.
Q: Are the mental health needs of patients with chronic conditions such as heart disease, hypertension and diabetes similar to those of cancer patients?
A: Yes, with an exception: Many patients with chronic diseases other than cancer may not be facing imminent mortality in the same way some cancer patients are. They also may not have illnesses that leave them immune-compromised. However, they do have underlying medical conditions that put them in the same higher-risk category as cancer patients, and all of us have heightened worries and concerns during this trying time.
Q: What mental health services are available at Cedars-Sinai Cancer?
A: The Cedars-Sinai Cancer Patient and Family Support team is here to help patients navigate these stressful times. We have three psychiatrists, four palliative medicine doctors, four dietitians, 11 social workers, a rehabilitation specialist and two chaplains across our four cancer care sites. Patients getting care at any of our outpatient cancer locations may access these services. Staff is available daily from every discipline to support our patients. Patients can visit these experts in person – if they're already at the medical center for cancer treatments – or by phone or video. Most of our patients already are taking advantage of these remote-care options.
Additionally, the program offers a comprehensive array of classes and groups through our Wellness, Resilience and Survivorship Programs, many of which patients can now access remotely. They include Cancer Exercise Recovery, Gentle Yoga for Wellness, and Emerging from the Haze programs, among others.
Q: What mental health resources are available for cancer patients outside of Cedars-Sinai?
A: Support is available from the National Cancer Institute, the American Cancer Society, Cancer.Net and the Cancer Support Community, among others.
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Cedars-Sinai Medical Center is a non-profit, tertiary 886-bed hospital and multi-specialty academic health science center located in the Mid-City West area of Los Angeles, California. Part of the Cedars-Sinai Health System, the hospital employs a staff of over 2,000 physicians and 10,000 employees.
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