Screening
Psychological and Social Assessment
Psychological and Social Therapies for Distress

Most patients experience some level of distress, however, only a small percentage receive help. Distress is an unpleasant emotional, psychological, social, or spiritual experience that interferes with the patient's ability to cope with cancer treatment. Patients may experience a range of feelings from normal sadness and fear to deep depression, anxiety, panic, or isolation. These feelings can interfere with a person's ability to relate to family, friends, coworkers, and others during the normal routines of daily living. This is called social distress.

Health care professionals may have patients complete questionnaires periodically to identify the need for referral to a mental health professional. Key times that distress may become disabling include the time of diagnosis, during cancer treatment, at the end of a long course of treatment, during remission, when the cancer returns, or when beginning palliative care. Patients who are experiencing mild distress may benefit from a referral to a self-help group. Patients who are experiencing moderate to severe distress may require a referral to a mental health professional such as a psychiatrist, psychologist, social worker, or pastoral counselor.

It is important that patients understand the benefits of talking with a mental health professional about their concerns and worries. A patient can expect the health professional to:

• Listen closely to his or her concerns.
• Show an interest in his or her experiences with cancer.
• Ask about his or her family, friends, and other persons who provide support.
• Ask how he or she has been adjusting to the cancer.
• Encourage him or her to continue using coping strategies that are successful.
• Suggest other coping strategies to address his or her concerns.

Patients will be encouraged to continue counseling or psychotherapy as needed.

Recent studies of psychological and social therapies have shown benefits for cancer patients. These therapies are defined as non- drug treatments offering psychological and educational support, such as:

• Relaxation training.
• Coping strategies.
• Cancer education/information sessions.
• Group social support.
• Hypnosis.

These therapies may be combined in different ways for various lengths of time, in both individual and group formats. To date, these therapies have most commonly been studied in white, middle-to-higher income American women with breast cancer, though they are currently being studied in more patient groups. Cancer patients who receive such therapies show positive benefits compared to those who do not, including lower levels of depression, anxiety, and disease-related symptoms, as well as improved immune system functioning and health habits like exercise. The size of these benefits and how they affect patients' recovery will need more study.

Glossary Terms

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

To adjust to new situations and overcome problems.

The methods a person uses to deal with stressful situations. These may help a person face a situation, take action, and be flexible and persistent in solving problems.

The process by which a professional counselor helps a person cope with mental or emotional distress, and understand and solve personal problems.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

The process of identifying a disease, such as cancer, from its signs and symptoms.

Extreme mental or physical pain or suffering.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

A trance-like state in which a person becomes more aware and focused and is more open to suggestion.

The complex group of organs and cells that defends the body against infections and other diseases.

A person’s overall psychological and emotional condition. Good mental health is a state of well-being in which a person is able to cope with everyday events, think clearly, be responsible, meet challenges, and have good relationships with others.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of palliative care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, supportive care, and symptom management.

Sudden extreme anxiety or fear that may cause irrational thoughts or actions. Panic may include rapid heart rate, flushing (a hot, red face), sweating, and trouble breathing.

A person who is trained to give spiritual and mental health advice.

A medical doctor who specializes in the prevention, diagnosis, and treatment of mental, emotional, and behavioral disorders.

Having to do with how the mind works and how thoughts and feelings affect behavior.

A specialist who can talk with patients and their families about emotional and personal matters, and can help them make decisions.

Treatment of mental, emotional, personality, and behavioral disorders using methods such as discussion, listening, and counseling. Also called talk therapy.

A method used to reduce tension and anxiety, and control pain.

A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body.

A network of family, friends, neighbors, and community members that is available in times of need to give psychological, physical, and financial help.

A professional trained to talk with people and their families about emotional or physical needs, and to find them support services.

Having to do with deep, often religious, feelings and beliefs, including a person’s sense of peace, purpose, connection to others, and beliefs about the meaning of life.

Treatment.