Distress in People With Cancer

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Counseling services you may need

The kind of problems you have and your level of distress will help decide what services can best help you.

Social work

In most places, the social worker is the “first responder,” and the first support person you may see. When the cancer care team wants to refer you to someone for your distress, a social worker will see you and find out whether your distress falls into the area of psychosocial or practical problems.

Psychosocial problems. The word “psychosocial” combines psychological, or mental, health with social conditions or aspects. Some psychosocial problems are:

  • Trouble adjusting to illness
  • Family and social isolation
  • Family conflict
  • Problems with treatment decisions
  • Concern about the quality of life
  • Problems adjusting to changes in care
  • Making decisions for future medical care (advance directives)
  • Abuse or neglect in the home
  • Trouble coping or problems communicating
  • Changes in how you think and feel about your body and your sexual self
  • Grief problems
  • End-of-life issues
  • Cultural concerns
  • Caregiver issues or the need to prepare for caregiving and set up caregiver support

Social workers work with patients and families with psychosocial problems by:

  • Teaching patients and families
  • Offering support and education group sessions for patients and families
  • Giving you resource lists and finding community resources where you can get needed help
  • Counseling patients and families about relationships and grief

The above options work best when the distress level is fairly low (4 or less).

If the problems are more severe, patient and family counseling or psychotherapy may be used. Patients and/or families or loved ones may also be referred to psychosocial or psychiatric treatment or pastoral counseling, and certain problems may involve sexual or grief counseling. The social worker may offer community resources that can help families and loved ones with serious issues, such as organizations that help women who are abused at home.

At this level, social workers teach you how to approach and resolve the problem in the way that works best for you. There are also times when the social worker must speak up for the patient who has no close family, or refer a family member to protective services if there is neglect at home. All patients are taught about how to better cope with their illness.

In some places, the social worker is the only resource and handles all practical, psychosocial, and psychological problems. These services are usually covered as part of your total care. Social workers also know a lot about community resources, so that along with counseling, they can connect you to other sources of help nearby.

Practical problems. These can range from day-to-day needs, such as food and clothing, to professional needs, such as job issues. Listed here are some of the more common practical problems that a social worker can help you and your family or loved one manage:

  • Illness-related concerns (for example, how to get to treatment every day, how to pay for parking, or where to stay for out-of-town overnight hospital visits)
  • Financial concerns
  • Job concerns
  • School concerns
  • Food costs and preparation
  • Help with daily activities
  • Cultural or language differences (culture or language not the same as those around you)
  • Finding help for family and caregivers

For practical problems that are causing only mild distress, the social worker might use patient and family education, suggest support group sessions, and offer resources. For more severe distress due to practical problems, social workers provide patient and family counseling. They may also be able to link people to community agencies, teach problem-solving approaches, help you get needed care, and offer education and support group sessions.

Mental health

Mental health services are used to evaluate and treat distress that is moderate to severe (4 or more on the distress scale). This distress may be caused by other emotional or psychiatric problems the person had before cancer was found. Some problems that can make it harder to cope include:

  • Major depression
  • Dementia
  • Anxiety
  • Panic attacks
  • Mood disorders
  • Personality disorders
  • Adjustment disorders
  • Substance abuse

All of these may be worsened by the distress of cancer.

Most of the time, mental health services are provided by psychologists, psychiatric nurses, psychiatric social workers, and psychiatrists. Oncology nurses and social workers are often very skilled and experienced in these areas as well. Ideally, one of these professionals is a member of your cancer care team.

Mental health professionals use a range of counseling and therapy approaches to help you cope. They often start by helping you figure out what has worked well for you in the past. They will respect your coping style and try to help you strengthen it. They can help you understand how past problems or experiences may be making it harder to deal with cancer. They may also teach you techniques like relaxation and meditation to help control distress.

Costs. Mental health services are not free as a part of your medical cancer care, but they are usually covered in part by health insurance. Call your health insurance company to find out which professional services are covered and the dollar amount it will cover. An increasing number of cities and towns have free support groups sponsored by local hospitals, religious organizations, or cancer advocacy groups such as the American Cancer Society.

Medicines. Usually, psychologists and social workers work with psychiatrists who can prescribe medicines to help manage distress. Sometimes a drug is needed to reduce distress related to cancer, or distress caused by a medicine to treat cancer or another serious symptom. For example, steroids (like prednisone or Decadron®) may cause mood swings. Opioid pain medicines (like morphine or fentanyl) in higher doses can cause confused thinking. Medicines may be needed to counter these symptoms.

Medicines to treat depression (anti-depressants) or to treat anxiety (anti-anxiety medicines) are options that may reduce distress and help with poor sleep and appetite. Many patients fear taking these medicines – “I will be a zombie” or “I will get addicted.” These concerns are often exaggerated, much like the unreasonable fear some people have of taking narcotics for cancer pain. Many people also fear that seeing a psychiatrist means they are “crazy” or “weak.” But like other mental health professionals, psychiatrists can help reduce severe distress through counseling and helping choose the best medicines.

Remember that your mental health is as important as your physical health, so work with your cancer care team to get all the care you need.

Pastoral services

In a time of crisis (like when you, a family member, or a loved one has cancer), many people prefer to talk with a person from their spiritual or religious group. Today, many clergy have training in pastoral counseling for people with cancer. They are often available to the cancer care team and will see patients who do not have their own clergy or religious counselor.

Pastoral services are important because finding out you have cancer can lead to a crisis of faith or belief. Some people may question the purpose of their life or wonder why God “gave” them cancer. Others may feel that God is punishing them or that God has left them. Still others may use their religious and spiritual resources as a means to cope with their illness and help them sort through these kinds of questions.

The clergy may help you address any of these symptoms or concerns:

  • Grief
  • Concerns about death and the afterlife
  • Conflicted or challenged belief systems
  • Loss of faith
  • Concerns about the meaning or purpose of life
  • Concerns about the relationship with a higher power or God
  • Isolation from the religious community
  • Guilt
  • Hopelessness
  • Conflict between beliefs and recommended treatment
  • Need for certain types of rituals

Special issues

Some situations call for special skills. Examples are grief counseling and sexual counseling.

The Association for Death Education and Counseling is useful for grief counseling. They have many resources for people who are looking for help or who wish to offer support to someone who is coping with a loss.

The American Association of Sex Educators, Counselors, and Therapists can help you find a specially trained expert in sexual counseling and sex therapy. See the section called “To learn more” for contact information for these 2 groups.

Choosing the right counselor

When you wish to see a counselor, it is important to find one who has had some training and experience in taking care of people with cancer. Your cancer care team is the best way to get names of counselors in your area. Another resource, the American Psychosocial Oncology Society (APOS), can connect you to someone within 2 business days through their toll-free service at 1-866-276-7443. They will help you find a qualified professional in your area who can counsel people with cancer. If you see a counselor and do not feel comfortable or safe talking with that person, call APOS and ask for other names.


Last Medical Review: 03/09/2012
Last Revised: 03/09/2012