Psycho-Oncology

Psycho-oncology is an integrated subspecialty bringing cancer care and aspects of mental health in a close interwoven bond. The comprehensive and holistic cancer care framework is made wholesome only with the inclusion of psycho-Oncology. Individuals face different challenges at various stages during their lifetime. Amongst them all, receiving any diagnosis related to physical or mental health concerns, especially the ones that are long-term and chronic conditions, can have a significant impact on one’s overall ways of living. One such challenge is a cancer diagnosis. Over the past decades, despite the advancement in treatment modalities, receiving a cancer diagnosis, thoughts around it, and conversations related to treatment are still considered to be debilitating. The range varies from exhausting side effects associated with treatment to maintaining overall health which deepens the distress.

Holistic Multidisciplinary care 

Right from the time of diagnosis, the treatment processes, recovery, and beyond survivorship, one undergoes waves of experiences in the physical, psychological, social, and spiritual aspects of their life. To address the full spectrum of needs of the patients, a multidisciplinary approach is a must. Psycho-oncology is one of the most integral components of it. It is an intersection of Oncology, Cancer Genetics, Psychology, Psychiatry, and research working in collaboration to not just provide compassionate and comprehensive treatment at present but continuously work to enhance the quality of overall treatment in the years to come. In the growing field of psycho-Oncology, the epitome is in providing dignity care to all. Following the Bio-Psycho-Social approach, psycho-oncology aims to address all domains of an individual's life and integrate holistically through the period of cancer treatment and beyond. The nature and purpose of the field is not just to help individuals navigate through cancer treatment by bringing acceptance towards changes and challenges but also to find and rediscover their meaning and purpose.

Therapeutic Interventions

Individuals dealing with cancer (across all age groups) experience a wide range of emotional and psychological concerns. Their mental health and decision-making abilities are significantly impacted due to the loss of touch with their regular life routines, exhaustive treatment procedures, frequent pricks and pains, hospital visits, uncertainties through the treatment, and fears related to mortality. While the doctors, nurses, and other clinical practitioners take care of the patient’s physical health, Psycho-Oncologists ensure to address concerns related to psychological well-being. Patients often find themselves stuck in the spiral of negative thinking. Often the act of dwelling in the past and unpleasant anticipation about the future can make patients experience mood disturbances and feelings of exhaustion and helplessness. 

• Supportive Counseling: It can provide a comfortable space for patients to express their concerns in a non-judgmental environment. Empathetic active listening, emotional support, and validation of their feelings reduce their overall distress. 

• Mindfulness-based approaches: Thesecan help patients focus more on the present situation, controlling the controllable can help them build a more grounded mindset. 

• Solution-focused and cognitive-behavioral-based approaches: These can help patients improve their decision-making abilities, and replace unhelpful beliefs with realistic approaches. Alongside the therapeutic approaches, regular assessment of distress is a must. It can help provide an idea regarding the major areas of concern to be addressed at respective times. 

• Distress assessment: It can be conducted using the Distress Thermometer by the National Comprehensive Cancer Network (NCCN). The thermometer comprises major themes of our life aspects including physical, emotional, social, practical, spiritual, and religious domains of our life. While addressing psychological concerns, the field actively supports the multi-cultural approach. The psycho-oncologists need to have an understanding of all the cultures around the globe. This not only helps them build a better rapport with the patient from their respective cultures and backgrounds but also helps in addressing their concerns better. 

• Psycho-education and Support groups: Supportive counseling often needs to be complimented by the psycho-education and support groups. Psycho-educating patients about the mind-body connection, and the psychological impact of cancer treatment can help build better coping to deal with challenges that come across the way during treatment processes. Equipping patients with appropriate knowledge can help build a sense of empowerment within them, reduce their feelings of helplessness, and build realistic hope to keep moving forward. Alongside this, the boon of support groups can help patients meet other patients and individuals who have been undergoing similar experiences. These often act as a source of a positive support system by sharing experiences, encouraging patients to cope better, and enabling the patients to feel understood and not alone during their treatment and beyond.

• Collaboration with psychiatrists: Psycho-oncologists also work very closely with psychiatrists who have the expertise in providing pharmacological interventions. Cancer treatment does lead to a psychological burden on patients but often patients have been experiencing mental health concerns and/or illness before diagnosis.  Psychiatrists not only aid the process in dealing with the diagnosis but also provide close observation and intervention which can further aid the cancer treatment by enhancing the well-being of the patients as appropriately required. Additionally, sometimes individual body responses to medications and long-term hospital admissions may require pharmacological intervention which can be provided by the psychiatrists.

Therapeutic and psychiatric interventions can provide support in a wide spectrum of concerns. These may range from adherence to the treatment to dealing with the fear of recurrence, from maintaining a healthy lifestyle to building a positive body and self-image while navigating through all the challenges during the treatment. Thus therapeutic interventions form an integral part of cancer care by building psychological strength and resilience in patients. Additionally, the aid in enhancing the overall quality of life.

Caregivers ( The Hidden Patient )

While the patients require the best possible attention and care, cancer diagnosis and treatment of the dear ones have a significant impact on caregivers as well. The integrated approach of psycho-oncology extends support beyond the patients to their family members and caregivers. Besides the healthcare team, caregivers are the most important pillars of support, and they are constantly there to help their loved ones through the stormy treatment. Amongst the continuous hustle between visiting hospitals for treatment/ follow-ups and meeting priorities and commitments of their personal life, caregivers often put their well-being as the last priority. Psycho-oncology integrates individual counseling, family therapy, and support groups to support caregivers equally with the patients. Caregivers need to find a healthy outlet for their feelings, fears, and frustrations which can result in anxiety and mood disturbances. Counseling can help caregivers build better insight, prioritize their well-being, and build better coping. Stress management and mindfulness-based strategies can serve as essential toolkits for caregivers. 

Caregivers often lack the knowledge about aspects of care that can be provided by them. Psycho-education can be an essential component of counseling. Acquiring appropriate knowledge can help caregivers to feel empowered in terms of help that they have to offer to their loved ones, not just emotional support but physical assistance as well. Knowledge and healthy coping strategies can ensure a sense of calm even in the face of challenges. This can help the caregivers make better decisions and maintain better well-being for their dear ones. Alongside providing good care to their loved one, prioritizing oneself can prevent caregiver burnout, balance responsibilities with balance, and aid in maintaining the normalcy of daily life. Often, apart from individual counseling, family therapy holds importance. Family therapy can aid the process of building close connections within the family even during tough times. Improving communication and gaining better knowledge can help foster better teamwork at home making the care much more effective. 

Support groups at the same end provide a medium for sharing experiences with people experiencing similar circumstances. It helps build a sense of community who not just take care of their loved one in isolation. Instead, emotional support provided to the caregivers can help them navigate better through times of challenges.

Prioritizing Mental Health Of Healthcare Professionals

At its core, the field of Psycho-Oncology prioritizes the mental health and well-being of individuals and families dealing with cancer, but alongside it emphasizes the overwhelming efforts put in by the oncology healthcare professionals. Treating individuals with cancer is a physically and mentally demanding profession. It does have a long-term impact on healthcare professionals as well. Treating and following up with patients over months and years, witnessing their struggles and many times losing patients to death can lead to an array of challenges. Despite their fast-paced life and coming in of new patients and their years of practice keep them moving forward, yet at the end of the day, they are humans with all forms of thoughts and emotions. Not being able to express their concerns and built-up emotions can lead to psychological distress, burnout, and compassion fatigue. Psycho-oncology practices ensure the safeguarding of the mental health of healthcare professionals including all multi-disciplinary experts as part of medical, surgical, radiation oncology, and genetIcs involved in any form. The field of psycho-oncology promotes individual and group interventions on a regular basis that can help professionals foster resilience and persistent performance satisfaction and continue their compassionate care with healthy coping.

Grief And Bereavement

With the changing times of advancement in treatment modalities, some hope has risen with respect to recovery and a better quality of living during and post-treatment. Yet, loss and death are inevitable truths of life. Whether it is the loss of a body part that had to take place with surgery due to the spread of cancer or the passing away of a loved one due to a poor prognosis of the disease, grief will be a natural response. Dealing with loss could also be in anticipation. Once a poor prognosis is explained by the treating team, the approaching loss is a bigger baggage that takes a huge toll on the patient as well as caregivers. Dealing with grief and bereavement is one of the core elements of the field of psycho-oncology. Grief counseling under psycho-oncology provides an in-depth understanding of the concept of grief and bereavement. It provides space to express one’s emotions, process loss, and navigate life alongside the circumstances. The field emphasizes ways to extend empathetic and compassionate support for those experiencing the loss. There is no right or wrong way to grieve, but the right support can help navigate through it better. It is essential to understand therapeutic models, psycho-educate through different stages of grief one undergoes, types of grief, and ways to cope with the loss. Grief counseling can be carried out in terms of individual counseling or through support groups. The main aim of grief counseling is to aid individuals process their loss, communicating and expressing their thoughts and emotions, never finding themselves dealing with their tough times alone, finding comfort, and navigating through their pain while moving forward in their lives. Time is not the real healer but genuine, empathetic support can make all the difference. Grief work helps in providing a personal space for individuals to build and practice rituals, honouring their loved ones and continuing the close connection while moving forward in their lives.

The pain of the loss experienced will never completely disappear but the goal of grief counseling in the field of psycho-oncology is to promote resilience, emotional recovery, and rebuilding of life to the best possible extent.

Support provided By Us

Here at the Department of Mental Health and Behavioral Sciences, psycho-oncologists work collaboratively with the teams under Fortis Cancer Institute to provide holistic care to the patients and families dealing with cancer. Currently, psycho-oncologists are working at the Delhi-NCR and the Bangalore branches of Fortis Healthcare, aiming to expand the psycho-social oncology support services to the other branches of Fortis pan India. Patients are not just provided support during their hospital stay but support is also extended to patients and caregivers in an OPD setting. An active helpline, “Cancer Psychological Support Helpline” (+91 8586091051, Monday to Saturday 9 am-6 pm) is being run to extend psychological support for families dealing with cancer. Keeping the goals and vision of the field of psycho-oncology individual and group interventions are planned and implemented regularly to ensure the mental well-being of the patients, caregivers and the healthcare professionals to receive the best possible support.