Cancer Series: Emotional help and a new "normal"
December 5, 2011 1:05 p.m.
Dr. Wayne Bardwell, president of the American Psycho-social Oncology Society, and Associate Professor of Psychiatry, Moores UCSD Cancer Center
Peggy Pico, KPBS Science and Technology Reporter
CAVANAUGH: This is KPBS Midday Edition. I'm Maureen Cavanaugh. Cancer is not a psychological condition. It is, of course, a physical ills. But for years, counseling and emotional therapy for cancer patients was therefore thought to be something of a family and friends matter. That's not the case any longer. Psychologists are now trained in cancer counseling, helping patients deal with the emotional challenges of the disease, the treatment, and of patients' new normal. Peggy Pico joins us to share her personal experiences with living with cancer. Welcome back.
PICO: It's good to be here.
CAVANAUGH: And doctor Wayne Bardwell is also here, president of the American psychosocial oncology society, and associate professor of psychiatry at Moores Cancer Center. Welcome to the show.
BARDWELL: Happy to be here.
CAVANAUGH: You are a cancer psychologist. Can you tell us what that means and how your work differs from what we know as standard therapy?
BARDWELL: Sure. As you mentioned, it is a relatively new field. But it's a field where the psychologist is trained in and focuses on the issues that cancer patients face during their cancer journey. From the point of diagnosis or sometimes even before the official diagnosis is received, and through the process of treatment, and also assisting the patient through the process of moving into what we call a survivorship phase.
CAVANAUGH: This is perhaps a question you cannot answer, doctor, but why is this new? It would seem so logical to provide that kind of professional counseling support for people who receive a diagnosis of a serious illness like cancer.
BARDWELL: It does seem surprising. By being new, I don't want to say that the counselling hasn't occurred previously, but this is more of a specialized profession nowadays and departments within cancer centers that are designated to what they like to call treating the patient around the tumor.
CAVANAUGH: When you have this diagnose, and when you are dealing with the understanding that you have this life-changing condition, can it lead to a mental illness or a psychological disorder?
CAVANAUGH: Well, look, if you look at cancer as a stressor, whenever we experience stressors in our lives, it can bring up difficulties or issues that we have. Part of being human is to not be completely perfect and complete. If you experience the stress of cancer, it can bring up anxiety, depression, and insomnia and fatigue as well.
CAVANAUGH: Peggy, you've been so honest and forthright with us in sharing this journey. And I'm wondering, what are some of the emotional impacts that you've dealt with?
PICO: I anticipated this right from the beginning. So I went to a cancer therapist from the very beginning, from the moment I was diagnosed. It helped me immensely. Some of the emotional things that happened to me were -- some of it was linked to physical things from the chemotherapy. Feeling emotionally out of control at times, inability to sleep, that was a big one. The fatigue, probably the biggest one for me, and my therapist would attest to this. I had a mental battle with chemo. Ef time I got it I got six treatments. I would proclaim and was serious that I wasn't going to do it again because I mentally couldn't wrap my mind around the fact that I was putting these very toxic chemicals into my body to make me feel better! And it certainly wasn't making me feel better, but in the end, it would make me better. And I couldn't -- couldn't navigate through that without my therapist who said, all right, don't commit to all eight. How about in a few days we talk? And how about the next one? And how about the next one? And able to walk me through my physical treatments that I needed to survive. So I credit my therapist for saving my life on equal if not more than my oncologist and my surgeon.
CAVANAUGH: Doctor Bardwell, since cancer patients have similar problem, not the same problems, but similar problems in dealing with treatment and dealing with the diagnose and so forth, how do you stop this from becoming a one size fits all therapy?
BARDWELL: That's a very important question, yeah, because a therapy that's tailored to the individual needs is going to be the most beneficial therapy. What we find is that different patients have different reactions. People react to a diagnosis differently. Part of it has to do with the individual's personality or their experience with dealing with adversity in the past. Some people have more resources to draw upon than others. But it's important to get a sense of what is meaningful to the patient, what is important to them, and then direct the therapy to those issues.
CAVANAUGH: I see. Now, we have heard a great deal about how ONE'S psychological outlook determines the outcome of your treatment, and even survival rate. Do we have statistics, doctor, that actually make us aware that this actually does happen? That it does haveap impact?
BARDWELL: It's a very important area of research these days, trying to understand how psychological factors can have an impact on survival or longevity. We know in a practical way, when people are experiencing heightened psychological distress that it's more difficult for them to adhere to treatment, and some may choose not to do treatment. Other people at the opposite extreme may take their own life. So that's a very practical way that psychological factors can impact longevity and survival. There are studies that have shown that people who have had significant depression in the past and developed a propound depression after their diagnose, that may have an impact on their longevity.
CAVANAUGH: There's a flip side to that, where you're told if you're depressed that you're making your illness worse? Isn't that more of a burden that some patients should have to go through?
PICO: Yeah. So I am pretty natural he a positive person. So people would come up to me and say you have such a positive attitude, and that's going to help you live longer. Oh, really! Except on those days when I'm not being very positive. So the burden -- I didn't feel a burden because I felt like I'm going to be how I'm going to be. The way I put it, it was like a fall day. The weather overall was pretty good, you might get a rainstorm or a blustery day, and as long as you go up to that and say hey! I'm having a bad day. Leave me alone, that's -- the positive attitude, it didn't put pressure on it. And having the therapist help me with that, because
I think my therapist was the one who fold me you could have noncancer day. You could just say to somebody, we're not talking about cancer today! And move on. So I didn't feel pressure, but certainly I think if you allow yourself to say, yeah, I'm pretty much overall positive but there's going to be bad days.
CAVANAUGH: I haved are, doctor, of people who have cancer who become almost terrified of having any kind of a negative thought at all. Do you deal with that in your therapy?
BARDWELL: Absolutely. A number of us call that the tyranny of positive thinking. We would all like to feel optimistic and positive at all times. Unfortunately life is not like that. And I think people need to feel safe in whatever feeling they have. Sometimes family and friend of their fears will impose their anxieties on the patient and want them to perk up. But the patient gets to be however they are in that moment, in the therapy process.
CAVANAUGH: So for your friends and family, you would want to put on sometimes, at least, a face. Everything's okay, I'm doing just great, when the reality is I'm not doing too great, and I need to talk to somebody like a professional about this
BARDWELL: Yes, even in the midst of a crowd, one can feel lonely if ONE'S feelings have to be kept hidden. And we want to find balance in that. If a person spends a good deal of their time in those negative feelings, we want to be careful to figure out what that's about, and possibly use some other techniques to help them move out of it. In general, I want people to feel as authentic as they can be in the moment.
CAVANAUGH: I want to talk more about the treatment of cancer Tuesday precipitating some feelings of emotional distress. You were just talking to us about the fact that the chemo for you was as much of an emotional battle as it was a physical one. What other aspects of cancer treatment do people struggle with?
BARDWELL: Well, it's -- there are various times in the cancer process when people have feelings that, arise. A key point is diagnose, another time is during the process of treatment, then also in the transition to what we call survivorship. It's not uncommon for people to struggle at various times with depression, fear and anxiety about their possibility of survival. During the treatment process in particular, it's not uncommon for people to experience fatigue and insomnia as well. And then in this process of transitioning to survivorship, it's not uncommon for patients to kind of grit their teeth and get through the treatment process. They have all of their family and friends around supporting them, and then all of a sudden, they're done with it, their support system breathes a sigh of relief, and they're left with all these feelings.
CAVANAUGH: Yeah, that's when you break down and all your strength that you've been using for such a long time needs a boost because you used it up, right?
BARDWELL: Exactly right.
CAVANAUGH: Besides talking, besides being able to express your opinions, what kinds of treatments do -- options do you offer for your counseling patients?
BARDWELL: There are a variety that involve some very databased psychology interventions, and also some alternative and complimentary techniques. Individual therapy is warranted and helpful for many patients. We also offer a variety of group therapy programsat the Moors UCSD center. They include a gentle yoga group for cancer patients. We have I group for care givers. We have groups for various types of cancer. A group for Spanish speaking patients who have cancer. And we also offer mindfulness classes, meditation classes, and other techniques that are ways of helping the individual deal with the stress. And I think most importantly, they give them a sense of control over a process that feels very much out of their control.
CAVANAUGH: Have you taken advantage of the classes?
PICO: I did. The gentle I don't go was great because you are so fatigued, and the specialty classes that deal with cancer patients where eye regular gym or regular person, I didn't trust them. I didn't want them going through, that I might after two poses just fall over tired. And I did, and it was very good to have somebody who specialized in cancer in relation to these types of things.
CAVANAUGH: I know that there are some cancer patients who are given mood stabilizing drugs like tranquilizers or other drugsing. Have you tried any of that?
PICO: I ended uptaking for my nausea and vomiting, so if an oncologist is listening, one of the side effects to one of these drug was that it was a sedative. I continued to have difficulty sleeping through the night due to the drugs, the steroids, all sorts of things. If you're not getting the good nightee sleep and already compromised, that's what I took. But other than that, I didn't take anything else.
CAVANAUGH: Do you think that's a good idea for people who are going through this stress induced by a cancer diagnose and treatments to put them on as I say a mood stabilizer?
BARDWELL: I think we need to look at pharmaceuticals as another resource available to patient business and they're appropriate for some and not others. Certainly people who are dealing with severe depression, at the extreme, if there are suicidal thoughts for example, or if the person is unable to function in their life and carry through with treatment, I think medications combined with psychotherapy are the best approach for handling that. On a short term bases we can use antianxiety medications that can calm the person down if thirds requirement anxiety is out of control. We try to give them behavioral techniques they can use to control anxiety.
CAVANAUGH: You use a term that a lot of people who deal with cancer use, called the new normal. What does that mean?
PICO: I wish I knew! I'm just facing it right now. I heard it from my therapist when I first got diagnosed. You have a new preserve. For me, cancer has given me a new perspective on life. There's the people who say, I couldn't change a thing because I learned so much! No, I think I could have learned it winning the hotry or something. But since I have it, I'm learning a lot, and I'm transitioning into it now, these thoughts about, wow, I just survived this. What does this mean? I can't just go back to my life as it was before. The no, sire of my life as it was before won't exist again for me. Everything has changed on my perspective as what's important, what's not, how I deal with things, everything has change the the. And I'm still getting my sea legs on that. But I know it's out there, all I know for me, the new normal for me means everything has changed. And will my new normal life will be very different from my old one.
CAVANAUGH: It sounds as if cancer counseling is reality an essential part of cancer treatment. Is it a probable to get insurance companies to pay for this support?
BARDWELL: That's another good question. There are more and more limited resources within health insurance, and people are trying to control costs in many ways. One is to carve out mental healthcare so it's handled only by a particular group within town. So there are some excellent therapists in those groups. But it's not as likely that they're going to have the expertise at working with cancer patients or other illnesses. And cancer doesn't realize some people don't have insurance or funds available. There are a number of people who don't have insurance coverage and who may have problems that are even more significant than others who do because of the socioeconomic differences.
CAVANAUGH: Exactly. So it would be -- is it available for people who don't have insurance at all?
BARDWELL: Well, we do our best to not turn away any of power patients from the care that we can provide. UCSD has one of the few comprehensive cancer centers in the nation, one of 40. And part of that treatment is insuring as I said earlier that we treat the patient around the tumor, that means providing support to the patient and the family.
PICO: I was going to say my insurance company said, oh, yes, we'll cover it, but we're not going to cover a cancer specialist. They wanted me to go to a traditional therapist. And I didn't feel that was significant. So yeah, sometimes you may have to argue with them a little bit.
CAVANAUGH: Why not make it more difficult, right?
PICO: Why not! Part of the challenge.
CAVANAUGH: I've been speaking with doctor Wayne bardwell, and Peggy Pico. Thank you so much.
PICO: Thank you.
BARDWELL: Thank you.