Cancer patients face a dual battle that extends far beyond their physical diagnosis, as psychological and emotional challenges can significantly impact their treatment outcomes and recovery. Boris M. Kiselev, MD, a consult liaison psychiatrist at Atrium Health Carolinas Medical Center and assistant professor in the Psycho-Oncology Program at Atrium Health Levine Cancer Institute, emphasizes that integrating psychological care is essential for comprehensive cancer treatment.
Critical Role in Treatment Adherence
The severity of psychological distress directly influences the level of psycho-oncology intervention required. "For some patients with high levels of distress, psycho-oncology can play a central role," Kiselev explains. "At some point, a high level of those types of concerns will interfere with a patient's ability to receive treatment."
By addressing psychological symptoms directly, clinicians not only improve patients' quality of life but also enhance their ability to receive necessary medical care during and after treatment. This dual benefit underscores the medical necessity of psychological support in oncology settings.
Standardized Screening and Referral Guidelines
Major cancer organizations have recognized the importance of psychological screening. The American Cancer Society Commission on Cancer guidelines, along with the American Society of Clinical Oncology and other professional organizations, recommend that every cancer patient be screened for distress. When needs are identified, patients should receive appropriate referrals to services that best match their requirements, whether individual or group psychotherapy, peer support, or inpatient psychiatric treatment.
Patients with social concerns such as transportation, housing, or food insecurity should be connected with dedicated social workers to address these barriers to care. The goal is to integrate psycho-oncology care into the broader cancer treatment framework, enabling collaboration between psychological providers and oncology teams.
Evidence-Based Treatment Approaches
While antidepressants have a well-established role supported by clinical guidelines, effective psycho-oncology employs a comprehensive toolkit of interventions. Mindfulness-based stress reduction, administered in group or individual settings, has demonstrated efficacy for anxiety and depression in cancer patients through randomized controlled trials.
Music therapy and relaxation interventions show moderate quality evidence for effectiveness. Exercise interventions, supported by the American College of Sports Medicine Physical Activity Guidelines for adults with cancer, help with anxiety, depression, sleep, and fatigue. Integrative approaches including Tai Chi and acupuncture have lower quality evidence but have been studied and are available through robust integrative oncology departments.
Medical Comorbidity Considerations
Clinicians must consider underlying medical conditions that may contribute to psychiatric symptoms. For patients receiving immunotherapy, endocrinopathies could be contributing factors to psychological distress. Sleep disorders also require evaluation as potential contributors to mental health symptoms.
Psychotherapy as a Foundation
Psychotherapy serves as a foundational intervention that helps patients process their cancer experience, learn coping techniques, and develop insight. "The great thing about psychotherapy is that even after they complete the psychotherapy treatment that they're doing, they'll have those tools that they can take with them afterwards that will continue to be helpful to them in a longitudinal way," Kiselev notes.
Unique Challenges in Survivorship
The psychological challenges for cancer survivors can be even more impactful than during active treatment. The adjustment to life after cancer resembles a grief process, as survivors process losses including their previous physical health, work capacity, financial stability, and sometimes relationships.
Survivors often experience chronic symptoms such as pain, neuropathy, or other treatment complications. Fear of recurrence can be particularly disabling, making psychotherapy and other psycho-oncology interventions crucial during the survivorship phase.
The integration of psycho-oncology into comprehensive cancer care represents a paradigm shift toward treating the whole person rather than just the disease, with evidence supporting its role in improving both psychological well-being and treatment outcomes.
