Behavioral Health Brief: Examining the Psychosocial Implications of Mental Health and Cancer Care
By Brittany J. Nwachuku, EdD, LCSW, LISW, OSW-C
Social Work Today
Vol. 22 No. 1 P. 8

Diagnosis and treatment of malignant diseases can impact the lives of many, including patients, relatives, and their families. However, a cancer diagnosis can create a greater sense of anxiety than other illnesses for which the prognosis is often much poorer.

Cancer can disrupt all aspects of a person’s daily life, including family dynamics, work, and finances. The stress that can come with a cancer diagnosis can be quite complex and overwhelming and have psychological effects that can last for years. According to 2018 research by Singer, approximately one-third of all cancer patients suffer from a comorbid mental health condition that requires additional support from a multidisciplinary oncology team, including social workers. Many patients derive critical support from significant others to develop resilience against the multiple predicators of stress and to facilitate problem-solving strategies in relation to the demands of their illness.

Evidence suggests that a patient’s initial response to a cancer diagnosis is significantly influenced by preexisting psychosocial factors that patients bring to their cancer experience. It is common for an individual to go through an array of emotions during this process. According to Singer, one might experience shock, hopelessness, depression, anxiety, anger, fear, and anticipation. For some patients, there are economic, social, and medical deprivations, as well as tough life decisions that need to be made regarding their health.

In addition, psychosocial problems such as severe depression and anxiety that emerged from an initial diagnosis and treatment may resurface should the disease recur. This amplifies the need for a comprehensive psychosocial history at initial assessment. As social workers, it is imperative to understand that not everyone has the necessary support to deal with cancer while also grappling with the psychological and mental health implications that such news can bring.

Making a Connection
There has been increasing recognition of emotional, physical, and social well-being in patients with a severe mental health diagnosis. However, little is known about the effects of a cancer diagnosis coupled with a mental health diagnosis. About 1 in 3 people diagnosed with cancer experience mental and emotional distress such as depression and anxiety disorders. Research indicates that psychiatric disorders in cancer patients are generally undertreated, although appropriate treatment and support can improve overall quality of life and be key to ensuring longer survivorship.

There are higher rates of mental health disorders among certain cancer patients, most notably lung and breast cancer patients. Researchers have found that this is due in part to the specific challenges of treating these patients, including concurrent medical conditions, drug interactions, lack of capacity, and difficulties in coping with the treatment regimen as a result of psychiatric symptoms.

In addition, patients with a dual diagnosis are more likely to have comorbidities resulting in higher incidence of postoperative complications and higher cancer fatality rates. Many individuals, not just those with psychiatric history, have fears associated with a cancer diagnosis and the required treatment. To promote and practice effective psychosocial care, it is essential for social workers to assist with explaining the diagnosis and treatments.

The Role of Social Workers
Social workers are trained to teach, socialize, and equip individuals to overcome adversity and empower themselves throughout the cancer journey. When people have difficulty asking for assistance, issues that are ordinarily manageable can go unaddressed and eventually require further care.

Social workers are also aware of the value their services provide and the positive impact they have on the well-being of both individuals and families. They must utilize their skills to foster a culture that encourages patients to receive assistance and helps eliminate any perceived stigma about receiving social work services.

Practice Tips
The following social work practice implications should be considered when assisting patients through mental health and cancer care:

Introduce social work services early and follow up often in the cancer journey. Social workers remain key to bridging the gap between physical and mental health. The primary role of social work in oncology settings is to assist patients in developing a healthy psychosocial plan by identifying their coping abilities and their physical, family, social, and spiritual needs. They must also provide support and connect them to the appropriate internal and external resources. Essentially, social workers can help alleviate the many tensions patients may experience during the cancer journey.

All cancer patients need emotional support, ranging from orientation to the disease to in-depth counseling. Approximately 80% of families require emotional counseling, while 30% of patients in the first few weeks of consultation are provided with palliative care counseling due to the advanced stage of their disease. Social workers can utilize psychosocial variables to construct patient profiles that can help predict which patients likely will effectively adapt to their diagnosis and treatment and which ones may find it difficult to adjust.

Techniques such as psychosocial screening can be utilized to quickly identify patients who may experience higher levels of distress. Previous prevalence studies of psychological distress indicate that 25% to 30% of all newly diagnosed and recurrent patients experience significantly elevated levels of emotional distress, while as many as 47% have a psychiatric diagnosis.

Introducing social work services early in the process allows patients to be counseled about the possible emotional, behavioral, and psychological impacts cancer can have on them and others in their lives. Making patients aware of resources can help alleviate stressors that can be barriers to their care.

Work collaboratively with the health care team to bridge social work with the medical model. It is the duty of social workers to protect the well-being of their clients, an obligation that requires them to be patient advocates. With the number of individuals diagnosed with cancer and mental illness on the rise, the use of social workers in health care settings is crucial. Vulnerable, marginalized patients can feel misunderstood or unheard due to verbal communication and behaviors that are often misinterpreted by helping professionals.

Social workers can be an asset to the myriad of medical professionals who are involved in patient care. Medical professionals focus solely on the medical model of health care, which includes an individual’s medical history, test results, symptoms, and treatment. However, as a multidisciplinary team member, social workers can help to decrease miscommunication by thoroughly and correctly communicating the client’s behavioral and social symptoms to the medical team to help resolve social and behavioral problems that may influence overall cancer care.

In essence, social workers can change the physician-centered approach to a patient-centered approach.

Encourage and support help through peer groups. Social workers should foster a sense of community and support not only for patients but also for the profession. Social work is not performed in a vacuum. In most health settings, the number of available social workers is limited. It is important that the profession utilizes peer groups and other organizations to encourage and empower each other.

Build a network within your department, community, or even the state level to stay connected to other social workers and to stay current on the changes that are continually happening within the client and patient populations. The Association of Oncology Social Work and your local chapter of the National Association of Oncology Social Workers are just two of the many resources available to social workers who wish to stay abreast of changes throughout the profession.

In addition, brainstorm with colleagues to develop strategies to assist cancer patients navigating through mental illness. Determine and define the role social workers play in providing adequate support and resources to those in need.

— Brittany J. Nwachuku, EdD, LCSW, LISW, OSW-C, is an assistant professor at Slippery Rock University.

Resources
Holland, J. C. (2003). American Cancer Society Award lecture. Psychological care of patients: Psycho-oncology contribution. Journal of Clinical Oncology, 21(Suppl 23), 253s–265s.

Howard, L., Barley, E., Davies, E., Rigg, A., Lempp, H., Rose, D., Taylor, D., & Thornicroft, G. (2010). Cancer diagnosis in people with severe mental illness: Practical and ethical issues. The Lancet, 11(1), 797-804.

Nelson, R. (2007). Psychiatric disorders common in patients with advanced cancer. http://www.medscape.com/viewarticle/563028

Parast, S., & Allaii, B. (2014). The role of social work in health care system. Journal of Social Science for Policy Implications, 2(2), 59-68.

Singer, S. (2018). Psychosocial impact of cancer. Recent Results in Cancer Research, 197, 1-11.

Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-Oncology, 10(1), 19-28.