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Benefits of Psycho-Oncology
Transcript
- 00:00 --> 00:03Funding for Yale Cancer Answers is
- 00:03 --> 00:06provided by Smilow Cancer Hospital.
- 00:06 --> 00:08Welcome to Yale Cancer Answers
- 00:08 --> 00:10with Doctor Anees Chagpar.
- 00:10 --> 00:11Yale Cancer Answers features
- 00:11 --> 00:13the latest information on cancer
- 00:13 --> 00:15care by welcoming oncologists and
- 00:15 --> 00:17specialists who are on the forefront
- 00:17 --> 00:19of the battle to fight cancer.
- 00:19 --> 00:21This week it's a conversation about
- 00:21 --> 00:24Psycho Oncology with Doctor Shannon Mazur.
- 00:24 --> 00:26Dr. Mazur is an assistant professor of
- 00:26 --> 00:28psychiatry at the Yale School of Medicine,
- 00:28 --> 00:30where Doctor Chagpar is a professor
- 00:30 --> 00:32of surgical oncology.
- 00:33 --> 00:34So Shannon, maybe we can start
- 00:34 --> 00:36off by you telling us a little
- 00:36 --> 00:38bit more about yourself and what it is you do?
- 00:40 --> 00:42Sure, I'm currently working
- 00:42 --> 00:44as a psycho oncologist at the Cancer
- 00:44 --> 00:47Center and my background got me here.
- 00:47 --> 00:50I have always been interested in medicine
- 00:50 --> 00:53and human interactions from a young
- 00:53 --> 00:54age and at some point along the way,
- 00:54 --> 00:56I got heavily involved in bioethics and
- 00:56 --> 00:58it led to me having a masters degree
- 00:58 --> 01:01in bioethics and then taught in the
- 01:01 --> 01:02field for quite a few years before
- 01:02 --> 01:04actually going to medical school.
- 01:04 --> 01:06And when I was involved in bioethics,
- 01:06 --> 01:08that led to a deep interest in
- 01:08 --> 01:11end of life care and some of the
- 01:11 --> 01:13issues that come with end of life
- 01:13 --> 01:15care and inevitably Hospice care,
- 01:15 --> 01:16palliative care,
- 01:16 --> 01:20and how we handle people who are seriously
- 01:20 --> 01:23ill and all of my work along the way
- 01:23 --> 01:26led to me becoming a psychiatrist,
- 01:26 --> 01:28going through medical school,
- 01:28 --> 01:30and then eventually doing a fellowship
- 01:30 --> 01:32within consult medicine for psychiatry
- 01:32 --> 01:34and following up with that,
- 01:34 --> 01:37working specifically with
- 01:37 --> 01:40cancer patients and psychiatry.
- 01:40 --> 01:42The field of psycho oncology is
- 01:42 --> 01:46where I reside now and have both
- 01:46 --> 01:48work that is inpatient and outpatient
- 01:48 --> 01:51work and psychology can be thought
- 01:51 --> 01:53of as working within the hospital.
- 01:53 --> 01:55And also there's aspects to it that
- 01:55 --> 01:57are done as an outpatient and the
- 01:57 --> 01:59continuity of care that can come with
- 01:59 --> 02:02those that are not currently hospitalized.
- 02:02 --> 02:04So, let's pick up on that
- 02:04 --> 02:06conversation at that point.
- 02:06 --> 02:07So for many of
- 02:07 --> 02:09the people in our audience,
- 02:09 --> 02:11we may not be completely familiar
- 02:11 --> 02:14with the field of psycho oncology.
- 02:14 --> 02:16Many of us know about medical
- 02:16 --> 02:18oncology or surgical oncology,
- 02:18 --> 02:19radiation oncology,
- 02:19 --> 02:22what exactly is psycho oncology?
- 02:23 --> 02:26So Psycho Oncology first came about
- 02:26 --> 02:29around the 1970s in Western countries and
- 02:29 --> 02:31in Western culture and came about that
- 02:31 --> 02:34there used to be cancer as a diagnosis,
- 02:34 --> 02:37was kind of a stigma, it
- 02:37 --> 02:39wasn't talked about as much.
- 02:39 --> 02:42And there became this movement within the
- 02:42 --> 02:441970s where patients were starting
- 02:44 --> 02:47to have more conversations about it and
- 02:47 --> 02:50integrating in more social aspects
- 02:50 --> 02:53into their care and really not having
- 02:53 --> 02:56what was once deemed just as
- 02:56 --> 02:59this death sentence and able to
- 02:59 --> 03:02talk more about it amongst providers,
- 03:02 --> 03:03society, family members.
- 03:03 --> 03:05And so the the field of Psycho
- 03:05 --> 03:07Oncology first started to get its
- 03:07 --> 03:09roots around that time in the 1970s
- 03:09 --> 03:12and then kind of sprang from there.
- 03:12 --> 03:14So it is a relatively new field,
- 03:14 --> 03:17but even more so I would say in the
- 03:17 --> 03:19last 20 years has started to become
- 03:19 --> 03:22integrated into most of the larger cancer
- 03:22 --> 03:25hospitals because there became this
- 03:25 --> 03:28knowledge that within the field
- 03:28 --> 03:31of psychology that the main 2 aspects
- 03:31 --> 03:34is that it's studying the impact of
- 03:34 --> 03:36behavior and psychosocial factors on
- 03:36 --> 03:39cancer and cancer morbidity and mortality.
- 03:39 --> 03:41And also the flip side of that,
- 03:41 --> 03:43which is how psychological
- 03:43 --> 03:45influences can influence cancer.
- 03:45 --> 03:47So seeing both how behavior
- 03:47 --> 03:48influences cancer,
- 03:48 --> 03:50but how cancer influences our
- 03:50 --> 03:52behavior and our mental.
- 03:52 --> 03:54Psycho oncology
- 03:54 --> 03:57kind of integrates in both
- 03:57 --> 04:01aspects of that showing that beyond just
- 04:01 --> 04:03the medical treatment there's
- 04:03 --> 04:06this whole other aspect to cancer
- 04:06 --> 04:08care and treatment that we need to be
- 04:08 --> 04:11examining and to bring in as part of a
- 04:11 --> 04:13holistic approach to cancer.
- 04:13 --> 04:16We know that depending
- 04:16 --> 04:17upon what source you look at
- 04:17 --> 04:19and what what research paper you read,
- 04:19 --> 04:22the kind of common number that is most
- 04:22 --> 04:25commonly seen is that about 35% of patients
- 04:25 --> 04:27who have cancer diagnosis will
- 04:27 --> 04:30at some point have a psychiatric
- 04:30 --> 04:33disorder or diagnosis within the
- 04:33 --> 04:35trajectory of their treatment.
- 04:35 --> 04:37So whether that's at the
- 04:37 --> 04:38beginning and whether that's through
- 04:38 --> 04:40the treatment or transitioning through
- 04:40 --> 04:42survivorship and end of life care,
- 04:42 --> 04:45but about 35% and I almost think that
- 04:45 --> 04:47that is somewhat of a low number,
- 04:47 --> 04:49but that's really kind of getting
- 04:49 --> 04:51to those who meet the actual
- 04:51 --> 04:53kind of disorder diagnosis and we
- 04:53 --> 04:56see that this number continues to
- 04:56 --> 04:59increase in the sense that we have
- 04:59 --> 05:01medical progress showing
- 05:01 --> 05:03more survivors being able
- 05:03 --> 05:05to survive through the cancer and
- 05:05 --> 05:07longer periods of time.
- 05:07 --> 05:08And then also just the fact that
- 05:08 --> 05:10we see that increased life
- 05:10 --> 05:12expectancy leading to higher numbers
- 05:12 --> 05:14of cancer patients in general.
- 05:14 --> 05:17So this number has continued to grow
- 05:17 --> 05:19and is becoming as I mentioned
- 05:19 --> 05:21kind of more integrated into many
- 05:21 --> 05:24of the larger cancer hospitals.
- 05:24 --> 05:26So that's interesting.
- 05:26 --> 05:2935% of cancer survivors will
- 05:29 --> 05:32have a psychiatric diagnosis.
- 05:32 --> 05:34Certainly, as you pointed out,
- 05:34 --> 05:37the impact of cancer can be
- 05:37 --> 05:39quite significant in terms of
- 05:39 --> 05:41the patient's mental health.
- 05:41 --> 05:43I mean, certainly I think many of
- 05:43 --> 05:45our listeners can imagine that
- 05:45 --> 05:47if given a diagnosis of cancer,
- 05:47 --> 05:52one may face anxiety or depression,
- 05:52 --> 05:55but that may be more so attributed
- 05:55 --> 05:58to the diagnosis itself and
- 05:58 --> 06:01being able to cope rather
- 06:01 --> 06:04than a disorder of
- 06:04 --> 06:06transmitters in your brain.
- 06:06 --> 06:09Can you talk a little bit more
- 06:09 --> 06:11about the diagnosis that's made
- 06:11 --> 06:14in these 35% of cancer survivors
- 06:14 --> 06:16and whether that's a transient
- 06:17 --> 06:19thing or whether there actually
- 06:19 --> 06:21is an impact on neurotransmitters
- 06:21 --> 06:23that needs to be dealt with in
- 06:23 --> 06:26a pharmacologic manner.
- 06:26 --> 06:29That's a great question and I think
- 06:29 --> 06:31it's a multifold answer and part of
- 06:31 --> 06:34that is that we obviously within that
- 06:34 --> 06:3635% there are patients who have already
- 06:36 --> 06:38had pre-existing mental health issues.
- 06:38 --> 06:41So somebody who's struggled with anxiety
- 06:41 --> 06:43or depression throughout their entire life
- 06:43 --> 06:45they're included in that 35%.
- 06:45 --> 06:48So we know there are people who whether
- 06:48 --> 06:50it was kind of already genetically
- 06:50 --> 06:53predisposed or had
- 06:53 --> 06:55an organic presentation throughout
- 06:55 --> 06:57their life that will also
- 06:57 --> 07:00either have a worsening of their
- 07:00 --> 07:02symptoms or just a continuation of their
- 07:02 --> 07:04symptoms through their cancer diagnosis.
- 07:04 --> 07:07But the other side of that is what I
- 07:07 --> 07:09think you're getting at is there's
- 07:09 --> 07:12a large percentage of
- 07:12 --> 07:14this population that has
- 07:14 --> 07:15no prior psychiatric history,
- 07:15 --> 07:17has never seen a psychiatrist or
- 07:17 --> 07:19a therapist that never considered
- 07:19 --> 07:21themselves to struggle with anxiety
- 07:21 --> 07:24or depression who are now in this
- 07:24 --> 07:26situation with cancer and finding that
- 07:26 --> 07:28they're starting to have some of those
- 07:28 --> 07:30symptoms and so we can look at it
- 07:30 --> 07:33in an acute aspect and then
- 07:33 --> 07:35also kind of looking at the more
- 07:35 --> 07:37long haul and changes
- 07:37 --> 07:40that may come and so acutely many
- 07:40 --> 07:42patients of course have an
- 07:42 --> 07:45adjustment to finding out
- 07:45 --> 07:48a cancer diagnosis, it can be very shocking,
- 07:48 --> 07:49it can be very distressing and can bring
- 07:49 --> 07:51up a whole lot of emotions and
- 07:51 --> 07:53that's to be expected from anybody.
- 07:53 --> 07:55And so that doesn't necessarily mean
- 07:55 --> 07:57that you have a a mental health issue
- 07:57 --> 08:00or that there is need for
- 08:00 --> 08:01acquisition or intervention,
- 08:01 --> 08:04it just means that quite frankly you're
- 08:04 --> 00:-01kind of normal and that's
- 08:06 --> 08:09to be expected with having such a large
- 08:09 --> 08:12diagnosis or revelation happen.
- 08:12 --> 08:14But what some patients will have
- 08:14 --> 08:16is that this will then continue on.
- 08:16 --> 08:17It's not just that kind of initial
- 08:17 --> 08:19shock or that initial adjustment and
- 08:19 --> 08:21it can actually lead to what we
- 08:21 --> 08:23would then qualify as an adjustment
- 08:23 --> 08:25disorder and that would
- 08:25 --> 08:27mean that it would be a continued
- 08:27 --> 08:30presence of the symptoms whether that
- 08:30 --> 08:33is depression or anxiety or
- 08:33 --> 08:35other symptoms that it could come
- 08:35 --> 08:38with it leading to it now
- 08:38 --> 08:40interfering with their ability
- 08:40 --> 08:43either to have quality of life,
- 08:43 --> 08:44to attend appointments,
- 08:44 --> 08:46to go about their daily life to the
- 08:46 --> 08:48point where it's actually interfering
- 08:48 --> 08:50with their ability to function
- 08:50 --> 08:51as they had been from a
- 08:51 --> 08:53mental health standpoint.
- 08:53 --> 08:55Of course there's going to be physical
- 08:55 --> 08:58effects from the cancer or cancer treatments
- 08:58 --> 09:00that are also weighing in there but
- 09:00 --> 09:02focusing more on the
- 09:02 --> 09:03impact that their mental health
- 09:03 --> 09:05is at that point having on them.
- 09:05 --> 09:09Now there are also different types of
- 09:09 --> 09:13cancers that can lead to changes in
- 09:13 --> 09:16the more neuronal you know serotonergic,
- 09:16 --> 09:18hormonal impacts as well.
- 09:18 --> 09:22So that can actually cause
- 09:22 --> 09:23an organic change in the body
- 09:23 --> 09:25that would lead to this.
- 09:25 --> 09:26So not just necessarily their
- 09:26 --> 09:29adjustment to it but rather
- 09:29 --> 09:30something that is a direct
- 09:30 --> 09:33result from having the cancer.
- 09:33 --> 09:34So for instance,
- 09:34 --> 09:36obviously within a certain type of
- 09:36 --> 09:38brain tumor or neurologic tumors,
- 09:38 --> 09:41there can be changes in personality
- 09:41 --> 09:42leading to either depression or anger
- 09:42 --> 09:44or anxiety that is actually from
- 09:44 --> 09:46a physical change that has occurred
- 09:46 --> 09:48in the body due to the cancer.
- 09:48 --> 09:52There can also be changes that
- 09:52 --> 09:54occur due to treatments and so
- 09:54 --> 09:56for instance tamoxifen and some
- 09:56 --> 09:58of the aromatase inhibitors,
- 09:58 --> 10:00some of the treatments that we use
- 10:00 --> 10:02for breast cancer are known to cause
- 10:02 --> 10:04these changes within
- 10:04 --> 10:06women that can lead to anxiety,
- 10:06 --> 10:06depression,
- 10:06 --> 10:07agitation, insomnia, are
- 10:07 --> 10:10some of the symptoms we start to see.
- 10:11 --> 10:13It's multifold in the sense
- 10:13 --> 10:16that 35% includes people who
- 10:16 --> 10:18have already had prior diagnosis,
- 10:18 --> 10:20patients who are just having a hard
- 10:20 --> 10:21time adjusting to the diagnosis
- 10:21 --> 10:23and then patients who have actually
- 10:23 --> 10:25had some sort of physical change
- 10:25 --> 10:26in their body whether that be
- 10:26 --> 10:29due to the cancer itself or due
- 10:29 --> 10:30to the treatments that
- 10:30 --> 10:32lead to some of their symptoms.
- 10:34 --> 10:35And I would imagine that your
- 10:35 --> 10:38approach in terms of treatment
- 10:38 --> 10:41is different between all of those groups.
- 10:41 --> 10:44So there may be differences in
- 10:44 --> 10:47how you approach somebody who is
- 10:47 --> 10:49struggling with mental health issues,
- 10:49 --> 10:52who's has brain metastases,
- 10:52 --> 10:57or an actual physiologic
- 10:57 --> 11:00anatomic issue versus somebody who
- 11:00 --> 11:04is just really struggling with
- 11:04 --> 11:06the diagnosis and trying to
- 11:06 --> 11:09come to terms with that and trying
- 11:09 --> 11:11to deal with the emotions that
- 11:11 --> 11:14come with the diagnosis of cancer.
- 11:14 --> 11:16Can you talk a little bit
- 11:16 --> 11:18about how your approach may be similar
- 11:18 --> 11:20or different in
- 11:20 --> 11:21different groups of patients?
- 11:22 --> 11:23Absolutely. Yeah.
- 11:23 --> 11:25You're absolutely correct there.
- 11:25 --> 11:27There's different factors that come
- 11:27 --> 11:28into play with each person right.
- 11:28 --> 11:31So it's definitely not a
- 11:31 --> 11:32cookie cutter experience that
- 11:32 --> 11:34you know there's many different
- 11:34 --> 11:36factors that lead to how a patient reacts and
- 11:36 --> 11:38how we're going to approach treating
- 11:38 --> 11:40a patient and what sort of needs
- 11:40 --> 11:41the patient may have and you touched
- 11:41 --> 11:43on kind of one of the big things which
- 11:43 --> 11:47is obviously the type of cancer.
- 11:47 --> 11:50The difference between having a brain
- 11:50 --> 11:53tumor versus having lung cancer,
- 11:53 --> 11:54and what that means for
- 11:54 --> 11:56their presentation from a mental
- 11:56 --> 11:57health perspective.
- 11:57 --> 11:59But there's other factors that also
- 11:59 --> 12:01play into that, some biological
- 12:01 --> 12:04and some kind of situational.
- 12:04 --> 12:06So the biological ones could be
- 12:06 --> 12:08you know family history of having
- 12:08 --> 12:10a psychiatric illness before and
- 12:10 --> 12:11how that might affect them.
- 12:11 --> 12:13We use that sometimes when we're
- 12:13 --> 12:15trying to select what type of
- 12:15 --> 12:17medications might be helpful.
- 12:18 --> 12:20If a family member had success
- 12:20 --> 12:23on one type of medication,
- 12:23 --> 12:24there's research and data
- 12:24 --> 12:26to show that there there may be
- 12:26 --> 12:27a link to them having a benefit
- 12:27 --> 12:29from that medication as well.
- 12:29 --> 12:31So we might start with that
- 12:31 --> 12:32medication and those who have
- 12:32 --> 12:34kind of prior psychiatric history
- 12:34 --> 12:36or are predisposed to having
- 12:36 --> 12:38worsening symptoms unfortunately.
- 12:38 --> 12:40So we would treat those
- 12:40 --> 12:42patients with that in mind as well and
- 12:42 --> 12:44then a huge part of it can also come
- 12:44 --> 12:46with where they are in their life.
- 12:46 --> 12:49What their age is and
- 12:49 --> 12:51what their functioning was
- 12:51 --> 12:54prior to having this diagnosis and
- 12:54 --> 12:57how that impacts them with their
- 12:57 --> 12:59kind of mental state of either
- 12:59 --> 13:01acceptance or difficulty with
- 13:01 --> 13:03coping with the diagnosis.
- 13:03 --> 13:05And some of that can also be
- 13:05 --> 13:07what stage of cancer they're at.
- 13:07 --> 13:10So if somebody who finds out that they
- 13:10 --> 13:12have advanced cancer and is already
- 13:12 --> 13:14you know stage four and treatment
- 13:14 --> 13:17options are very limited or not at all,
- 13:17 --> 13:18will have a
- 13:18 --> 13:20much different
- 13:20 --> 13:22impact of how we're going to treat
- 13:22 --> 13:23them versus somebody who's in
- 13:23 --> 13:25earlier stages has a lot of options
- 13:25 --> 13:27who are really looking to try
- 13:27 --> 13:29the long haul of hopefully many,
- 13:29 --> 13:31many years ahead of them versus
- 13:31 --> 13:33acutely stabilizing them.
- 13:33 --> 13:36It sounds like it's a very
- 13:36 --> 13:39complex field, psycho oncology and
- 13:39 --> 13:42one that we still need to unpack.
- 13:42 --> 13:44So we're going to dive further into
- 13:44 --> 13:47this whole issue right after we take
- 13:47 --> 13:49a short break for a medical minute.
- 13:49 --> 13:51Please stay tuned to learn more
- 13:51 --> 13:53about the benefits of Psycho Oncology
- 13:53 --> 13:55with my guest Doctor Shannon Mazur.
- 13:56 --> 13:58Funding for Yale Cancer Answers comes
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- 14:10 --> 14:13Smilowcancerhospital.org.
- 14:13 --> 14:16Over 230,000 Americans will be
- 14:16 --> 14:18diagnosed with lung cancer this year,
- 14:18 --> 14:20and in Connecticut alone there
- 14:20 --> 14:23will be over 2700 new cases.
- 14:23 --> 14:25More than 85% of lung cancer
- 14:25 --> 14:27diagnosis are related to smoking,
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- 14:30 --> 14:32can significantly reduce your risk
- 14:32 --> 14:34of developing lung cancer each day.
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- 14:37 --> 14:39thanks to increased access to advanced
- 14:39 --> 14:41therapies and specialized care.
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- 14:44 --> 14:45lung cancer survivors more hope
- 14:45 --> 14:47than they have ever had before.
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- 15:08 --> 15:09at yalecancercenter.org.
- 15:09 --> 15:11You're listening to Connecticut public radio.
- 15:12 --> 15:14Welcome back to Yale Cancer Answers.
- 15:14 --> 15:16This is Doctor Anees Chagpar and
- 15:16 --> 15:18I'm joined tonight by my guest,
- 15:18 --> 15:19Doctor Shannon Mazur.
- 15:19 --> 15:22We're discussing the benefits of Psycho
- 15:22 --> 15:24oncology and right before the break,
- 15:24 --> 15:26Shannon had mentioned that about
- 15:26 --> 15:2835% of cancer survivors have some
- 15:28 --> 15:31sort of a mental health diagnosis,
- 15:31 --> 15:34whether that was a pre-existing diagnosis,
- 15:34 --> 15:36whether that was, you know,
- 15:36 --> 15:39adjustment disorder from just having
- 15:39 --> 15:42difficulty getting over the concept of
- 15:42 --> 15:47cancer, or whether there is actually
- 15:47 --> 15:49a functional anatomic impairment
- 15:49 --> 15:52in patients with brain tumors or
- 15:52 --> 15:55metastases or issues with treatment
- 15:55 --> 15:57that could affect the brain.
- 15:57 --> 15:58So Shannon,
- 15:58 --> 16:01you had mentioned that Psycho
- 16:01 --> 16:03Oncology is relatively new field,
- 16:03 --> 16:06started in about the 1970s,
- 16:06 --> 16:08you know when I think about
- 16:08 --> 16:10the number of people who are
- 16:10 --> 16:12diagnosed with cancer every day,
- 16:12 --> 16:13everywhere,
- 16:13 --> 16:15all over the country,
- 16:15 --> 16:17you can't help but imagine that
- 16:17 --> 16:18many of those patients are
- 16:18 --> 16:20struggling with the diagnosis,
- 16:20 --> 16:22and it may or may not actually reach
- 16:22 --> 16:24the level of an adjustment disorder.
- 16:24 --> 16:27But many of these patients may not be
- 16:27 --> 16:30near a dedicated psycho oncologist.
- 16:30 --> 16:33Are there things that
- 16:33 --> 16:36you would advise patients or their
- 16:36 --> 16:38family members to do in terms of
- 16:38 --> 16:41helpful hints to try to get over
- 16:41 --> 16:44the adjustment to that diagnosis?
- 16:44 --> 16:46That's a great question and you know
- 16:46 --> 16:48hopefully most places do at least
- 16:48 --> 16:50have a connection to a social worker.
- 16:50 --> 16:52So the first thing is I would say
- 16:52 --> 16:54speak up because you're not
- 16:54 --> 16:56alone and you're not the first person
- 16:56 --> 16:58going through cancer treatments that
- 16:58 --> 17:00have had these sort of reactions.
- 17:00 --> 17:02It is very normal.
- 17:02 --> 17:04And that's one thing I really try
- 17:04 --> 17:06to express to anybody that I meet is
- 17:06 --> 17:09that if you've never had this problem
- 17:09 --> 17:11before doesn't mean that this diagnosis
- 17:11 --> 17:13doesn't rocked your world
- 17:13 --> 17:15in a sense and so to speak up and
- 17:15 --> 17:17to discuss that either with your
- 17:17 --> 17:19oncologist or with your primary care
- 17:19 --> 17:21provider or if you are able
- 17:21 --> 17:23to get connected with a social worker
- 17:23 --> 17:25because they can hopefully help
- 17:25 --> 17:27direct you to resources if needed.
- 17:27 --> 17:30And we do kind of think of this
- 17:30 --> 17:32as in a pyramid in the sense that
- 17:32 --> 17:34everybody's most likely going to have
- 17:34 --> 17:37some reaction to the diagnosis and so
- 17:37 --> 17:39that's kind of the large
- 17:39 --> 17:42end of the pyramid and where everybody
- 17:42 --> 17:44has this discussion with their
- 17:44 --> 17:46oncology provider and is able
- 17:46 --> 17:48to have some processing and we
- 17:48 --> 17:50realize that as you move
- 17:50 --> 17:52along there might be some that need
- 17:52 --> 17:54to talk to a social workers and then
- 17:55 --> 17:57if that's not enough maybe getting
- 17:57 --> 17:59connected to group therapies.
- 17:59 --> 18:01Because of the pandemic there are many
- 18:01 --> 18:04group therapies that are out there
- 18:04 --> 18:06either through your hospital system
- 18:06 --> 18:09or oncology provider or kind of
- 18:09 --> 18:11just in general people can join.
- 18:14 --> 18:16Getting to the point of actually
- 18:16 --> 18:18needing a psychologist or some type
- 18:18 --> 18:19of therapist or counselor to be
- 18:19 --> 18:21able to discuss their issues
- 18:21 --> 18:23and then thinking kind of at the
- 18:23 --> 18:25top of that pyramid would be getting
- 18:25 --> 18:26actually to the psychiatrist.
- 18:26 --> 18:28So somebody that would actually
- 18:28 --> 18:30need medication management to try
- 18:31 --> 18:32to help with their
- 18:32 --> 18:34symptoms that they're having.
- 18:34 --> 18:38So the first is always just speak up,
- 18:38 --> 18:39communicate whether that's just
- 18:39 --> 18:41with your provider or with your
- 18:41 --> 18:43family members because trying to
- 18:43 --> 18:46go through this in isolation is
- 18:46 --> 18:49difficult if not impossible and so
- 18:49 --> 18:52there are other resources available.
- 18:52 --> 18:54But then also realizing that there
- 18:54 --> 18:57are ways to kind of work through this
- 18:57 --> 18:59ladder if you will to get to
- 18:59 --> 19:01the level of need or assistance
- 19:01 --> 19:04that you actually need.
- 19:04 --> 19:07Great points in terms of
- 19:07 --> 19:09actually speaking up because even if
- 19:09 --> 19:12you can't access a psycho oncologist
- 19:12 --> 19:14right from the get go you know having
- 19:14 --> 19:16somebody to talk to your family
- 19:16 --> 19:18doctor and nurse navigator or social
- 19:18 --> 19:21work or somebody they can often help
- 19:21 --> 19:24and or escalate as the case may be.
- 19:24 --> 19:27Before the break you
- 19:27 --> 19:30had mentioned kind of two aspects
- 19:30 --> 19:31of Psycho Oncology.
- 19:31 --> 19:35The first is how cancer affects behavior,
- 19:35 --> 19:38it affects mental health and
- 19:38 --> 19:40we've kind of dived into that a bit,
- 19:40 --> 19:42but the other is
- 19:42 --> 19:46how mental health
- 19:46 --> 19:48can affect cancer.
- 19:48 --> 19:50Can you talk a little bit more about that?
- 19:51 --> 19:54Absolutely. So we know that
- 19:54 --> 19:56within mental health
- 19:56 --> 19:58that can lead to changes in our behavior,
- 19:58 --> 20:00changes in our social interactions,
- 20:00 --> 20:04changes in the way we're able to
- 20:04 --> 20:06kind of process and work through life.
- 20:06 --> 20:09And so when somebody's in
- 20:09 --> 20:11mental distress or mentally
- 20:11 --> 20:14unwell that can impact their
- 20:14 --> 20:16ability to follow through with items
- 20:16 --> 20:19that are for their cancer treatment.
- 20:19 --> 20:21So in other words if somebody is too
- 20:21 --> 20:23anxious and and suffering from very
- 20:23 --> 20:26severe anxiety and not able to
- 20:26 --> 20:28make it to their appointments because
- 20:28 --> 20:30they're too panicked at the thought of
- 20:30 --> 20:32going to the appointments or leaving
- 20:32 --> 20:34their house and therefore
- 20:34 --> 20:36they don't follow up with their
- 20:36 --> 20:38treatments and they're not able
- 20:40 --> 20:43to get recommended treatments or show up for
- 20:43 --> 20:45the radiation or whatnot,
- 20:45 --> 20:48the same aspect could be with depression.
- 20:48 --> 20:51If somebody is having such severe
- 20:51 --> 20:53depression that they're not able to get
- 20:53 --> 20:56out of bed to try to eat some food,
- 20:56 --> 20:57to try to stay hydrated,
- 20:57 --> 21:00to be able to you know,
- 21:00 --> 21:01again go to their appointments,
- 21:01 --> 21:03things like that,
- 21:03 --> 21:06we find that those
- 21:06 --> 21:08psychological factors then end up
- 21:08 --> 21:12having an impact on your oncological
- 21:13 --> 21:16prognosis if you're not able to take the medications,
- 21:16 --> 21:17if you're not able to show up
- 21:17 --> 21:18to the appointments,
- 21:18 --> 21:20if you're not able to participate
- 21:20 --> 21:22in care planning you're gonna
- 21:22 --> 21:24have worse prognosis with your cancer
- 21:24 --> 21:26and that is something
- 21:26 --> 21:29that we know and we have been
- 21:29 --> 21:32able to kind of study and see
- 21:32 --> 21:35that there can be an increase
- 21:37 --> 21:41in longer survival,
- 21:41 --> 21:44better rates of compliance,
- 21:44 --> 21:47better prognosis if we're able to
- 21:47 --> 21:49have a more steady mental health.
- 21:51 --> 21:53And you mentioned and I think
- 21:53 --> 21:55it seems to be common sense that
- 21:55 --> 21:58there are patients who have a
- 21:58 --> 22:00pre-existing diagnosis of mental
- 22:00 --> 22:03health issues who may also get cancer.
- 22:03 --> 22:06What proportion of cancer patients
- 22:06 --> 22:11already have a mental health diagnosis?
- 22:11 --> 22:13And so that's another one
- 22:13 --> 22:16of those that's kind of up for
- 22:16 --> 22:17debate depending upon which resource
- 22:17 --> 22:19and data you're looking at.
- 22:19 --> 22:23But we say that about 1/4 of
- 22:23 --> 22:26all patients in America will have a
- 22:26 --> 22:28mental health disorder at some point.
- 22:28 --> 22:30And so if you want to think
- 22:30 --> 22:34of that within kind of that 35%
- 22:34 --> 22:36it is a little
- 22:36 --> 22:38bit of a convoluted way to look at
- 22:38 --> 22:40it but I would say the
- 22:40 --> 22:43majority of patients might have had
- 22:43 --> 22:46some history of either some mild anxiety
- 22:46 --> 22:50or depression and that gets
- 22:50 --> 22:52exacerbated through the diagnosis.
- 22:52 --> 22:54But if they and unfortunately
- 22:54 --> 22:57we also have a lot of patients
- 22:57 --> 22:59who had undiagnosed
- 22:59 --> 23:01psychological problems that had been
- 23:01 --> 23:02there throughout their life as well.
- 23:02 --> 23:04So it's kind of hard to give
- 23:04 --> 23:05you a specific number.
- 23:05 --> 23:07But I would say,
- 23:07 --> 23:09I personally in my clinic kind of
- 23:09 --> 23:12see half and half and I think
- 23:12 --> 23:14that might be somewhat standard
- 23:14 --> 23:16to kind of realize that you already
- 23:16 --> 23:18have about 1/4 of the population
- 23:18 --> 23:20that already has it.
- 23:20 --> 23:22That there is no direct correlation to
- 23:22 --> 23:25saying that just because you had a
- 23:25 --> 23:27pre-existing mental health condition
- 23:27 --> 23:29that you were more susceptible to
- 23:29 --> 23:31having a cancer diagnosis,
- 23:31 --> 23:33but certainly if you
- 23:33 --> 23:35have a mental health diagnosis,
- 23:35 --> 23:41say schizophrenia or a different disorder,
- 23:41 --> 23:43bipolar, et cetera,
- 23:43 --> 23:47it may really affect you in terms of
- 23:47 --> 23:49getting through the cancer journey.
- 23:49 --> 23:52I mean it's hard enough for
- 23:52 --> 23:53people without that diagnosis,
- 23:53 --> 23:56but then it just adds in an
- 23:56 --> 23:58extra layer of complexity.
- 23:58 --> 23:59Can you talk a little bit more
- 23:59 --> 24:02about that and how you may or may
- 24:02 --> 24:04not interact with the patients
- 24:04 --> 24:06already established healthcare team
- 24:06 --> 24:09in terms of their mental health,
- 24:09 --> 24:11their psychiatrists, etcetera.
- 24:11 --> 24:13Yeah, one of the biggest problems
- 24:13 --> 24:16is it comes with the
- 24:16 --> 24:18follow up and being able to have them
- 24:18 --> 24:20connected to consistent treatments
- 24:20 --> 24:22because if they're not established
- 24:22 --> 24:26within a kind of a stabilized on
- 24:26 --> 24:28medications or with a stable living
- 24:28 --> 24:30environment then unfortunately,
- 24:30 --> 24:32once they're discharged to have
- 24:32 --> 24:34follow up for for their therapies
- 24:34 --> 24:36and treatments it's very hard
- 24:36 --> 24:38to have them kind of come back.
- 24:38 --> 24:41So we do see a significant number of
- 24:41 --> 24:44patients with what we would consider
- 24:44 --> 24:47serious mental health issues as you're
- 24:47 --> 24:49mentioning the schizophrenia kind of this,
- 24:49 --> 24:52the psychotic spectrum having a much harder
- 24:52 --> 24:55time with the follow up and the close care.
- 24:55 --> 24:58And so there are efforts that are put in to
- 24:58 --> 25:01try to help stabilize, making sure that
- 25:01 --> 25:03rides are set up ahead of time
- 25:03 --> 25:06trying to get them into a stable
- 25:06 --> 25:09living situation if they are
- 25:09 --> 25:12unhoused or if they're not already
- 25:12 --> 25:15connected to a psychiatrist or an
- 25:15 --> 25:17outpatient treatment facility.
- 25:17 --> 25:20Making sure that we can try to get them
- 25:20 --> 25:21stabilized on psychiatric medications.
- 25:21 --> 25:24Because we find that if we're
- 25:24 --> 25:26able to get some of their symptoms,
- 25:26 --> 25:27mental health symptoms,
- 25:27 --> 25:29better under control,
- 25:29 --> 25:30then they will have better
- 25:30 --> 25:31outcomes with their
- 25:31 --> 25:32cancer treatments and have better
- 25:32 --> 25:35follow through and so looking at
- 25:35 --> 25:37what's the best medication
- 25:37 --> 25:39regimen for them to make it so that
- 25:39 --> 25:41they will remain on their medications
- 25:41 --> 25:43and try to have follow up.
- 25:47 --> 25:50It can make their cancer treatment
- 25:50 --> 25:52difficult in the sense of making
- 25:52 --> 25:53sure that follow up is probably
- 25:53 --> 25:55one of the biggest factors.
- 25:55 --> 25:57But we do use that kind of
- 25:57 --> 25:59collaborative care approach to
- 25:59 --> 26:01really get as many people
- 26:01 --> 26:02involved as possible.
- 26:02 --> 26:04When we think of the collaborative
- 26:04 --> 26:06care approach within Psycho Oncology,
- 26:06 --> 26:07really kind of getting social work involved.
- 26:07 --> 26:10The psychologist involved,
- 26:10 --> 26:12the advanced practice providers,
- 26:12 --> 26:14having the direct
- 26:14 --> 26:17communication with the oncology team,
- 26:17 --> 26:18streamlining communication,
- 26:18 --> 26:20simplifying for the patient as much
- 26:20 --> 26:23as possible and trying to get
- 26:23 --> 26:25wrap around care for the patients who
- 26:25 --> 26:28unfortunately sometimes come in unhoused,
- 26:28 --> 26:28uninsured,
- 26:28 --> 26:30not having financial resources
- 26:30 --> 26:32and seeing what we can do to help.
- 26:32 --> 26:34To help that patient population.
- 26:35 --> 26:38You know, the other question that
- 26:38 --> 26:42comes up is there's a lot of
- 26:42 --> 26:44stigma around mental health diagnosis.
- 26:44 --> 26:48And, I wonder whether
- 26:48 --> 26:52you get pushback from patients and
- 26:52 --> 26:55their families saying, you know
- 26:55 --> 26:58I really don't need a psychiatrist.
- 26:58 --> 27:01I'm not crazy. I'm just,
- 27:01 --> 27:03you know, I have cancer.
- 27:03 --> 27:08And how does the stigma of a mental
- 27:08 --> 27:10health diagnosis affect patients
- 27:10 --> 27:12who are going through cancer,
- 27:12 --> 27:15patients who may need psycho
- 27:15 --> 27:16oncology services
- 27:19 --> 27:22and their reentry or continued existence
- 27:22 --> 27:25in society with the stigma
- 27:25 --> 27:27that sometimes is associated
- 27:27 --> 27:29with mental health diagnosis.
- 27:30 --> 27:34Yeah, unfortunately that is very true.
- 27:34 --> 27:36We see it time and time again and
- 27:36 --> 27:39and that stigma is still there
- 27:39 --> 27:41and I think we're making some
- 27:41 --> 27:42great strides within society.
- 27:42 --> 27:45But it absolutely comes up time and
- 27:45 --> 27:48time again and I think the biggest
- 27:48 --> 27:50impact it has is delayed care.
- 27:50 --> 27:53Patients will kind of fight or
- 27:53 --> 27:55put off being connected to a
- 27:55 --> 27:57psychiatrist or psychologist until
- 27:58 --> 28:00there's a point where
- 28:00 --> 28:02intervening where somebody has
- 28:02 --> 28:03to intervene and that may
- 28:03 --> 28:05come when they're hospitalized.
- 28:05 --> 28:07I do get connected to patients
- 28:07 --> 28:09frequently when they're in the
- 28:09 --> 28:10hospital because the distress
- 28:10 --> 28:12becomes kind of paramount to them
- 28:12 --> 28:13needing to get connected to me.
- 28:13 --> 28:16But I think the biggest problem
- 28:16 --> 28:18is there are ways to help and
- 28:18 --> 28:20it's not speaking
- 28:20 --> 28:22up or not accepting that care delays
- 28:22 --> 28:25that and many of the medications
- 28:25 --> 28:27do take several weeks to take
- 28:27 --> 28:29effect and so just kind of continues
- 28:29 --> 28:31to push off getting the care
- 28:31 --> 28:32that could be helpful for them.
- 28:33 --> 28:35Doctor Shannon Mazur is an
- 28:35 --> 28:36assistant professor of psychiatry
- 28:36 --> 28:38at the Yale School of Medicine.
- 28:39 --> 28:41If you have questions,
- 28:41 --> 28:43the address is canceranswers@yale.edu,
- 28:43 --> 28:45and past editions of the program
- 28:45 --> 28:48are available in audio and written
- 28:48 --> 28:49form at yalecancercenter.org.
- 28:49 --> 28:51We hope you'll join us next week to
- 28:51 --> 28:53learn more about the fight against
- 28:53 --> 28:55cancer here on Connecticut Public Radio.
- 28:55 --> 28:57Funding for Yale Cancer Answers is
- 28:57 --> 29:00provided by Smilow Cancer Hospital.
Information
Benefits of Psycho-Oncology with guest Dr. Shannon Mazur
March 19, 2023
Yale Cancer Center
visit: http://www.yalecancercenter.org
email: canceranswers@yale.edu
call: 203-785-4095
ID
9698Guests
Dr. Shannon MazurTo Cite
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