Three Things I Learned From Working in Oncology
As a clinical health psychologist, I have had the opportunity to work in a variety of healthcare settings such as inpatient medical units and outpatient care centers. A common thread to my training and subsequent career has been my work supporting people affected by cancer, something which I have found incredibly meaningful both personally and professionally. The reality is, most of us know at least one person with a history of cancer given the prevalence of the disease. Recent estimates suggest that over 2 million people will be diagnosed with cancer in 2024 in the United States alone (National Cancer Institute, 2024). While I enjoy supporting people navigating a variety of physical and emotional challenges, I can readily admit that my time in oncology has sharpened my clinical skills, expanded my understanding of the complex factors which affect well-being, and informed my approach to psychological care. In truth, it would be difficult to summarize everything I have learned from working in oncology settings, however, I have selected three lessons to share in this month’s blog.
Grief comes from all types of loss.
We often think of grief as distress or anguish following the death of a loved one. From my time working in oncology settings, there certainly is no shortage of grief related to death. Families grieve the loss of a loved one, and those living with advanced cancer may grieve their own death before it happens (this is considered anticipatory grief, when the distress is experienced in anticipation of an upcoming loss). While the emotional pain related to death can weigh quite heavy and is worth our attention and compassion, death is not the only event which triggers grief. Grief can be experienced in response to nearly any kind of significant loss. It could be loss of vitality, loss of a job or the ability to work, loss of a relationship, loss of what you thought the future would be for you and your family, loss of function (such as loss of vision, motor function, speech, cognitive), and loss of independence. Grief can even appear when we have regret for something lost or remorse for something we have done (APA Dictionary of Psychology, 2018).
As I work with people to help them identify and understand their emotions, grief is often an emotion that comes as a surprise (perhaps because they have had a limited sense of when we grieve, or maybe even when we are “allowed” to grieve). I regularly hear people say they do not feel entitled to experience grief (maybe as if that feeling is only reserved for someone going through something “worse”). If that sounds like you, I’m here to tell you: (1) grief comes from all types of significant loss (and you are the one who gets to determine if the loss is significant) and (2) we have to acknowledge the feelings of grief before we can work with, and through, them.
We often underestimate our ability to navigate hurdles.
A cancer diagnosis is undoubtedly life changing— it presents a series of new challenges (financial, physical, emotional, social, spiritual). Further, a cancer diagnosis does not come with a “Coping with Cancer 101” manual that can guide us forward. While some may have a natural ability to approach cancer with confidence, others may doubt their ability to cope. When facing something frightening, we can overestimate how bad things will be and underestimate our ability to navigate hurdles. In the world of cancer, this might come up as: “I’ll never feel like myself again.” ...“There’s no way I can deal with losing my hair.” …“If I start crying, I won’t be able to stop.” … “If they try to draw blood, I just might get up and run out of the hospital.” In my experience, people are far more resilient than they give themselves credit for. If you are questioning your ability to cope in difficult times, regardless of the stressor, I would encourage you to:
Identify your personal strengths, which can help you navigate whatever adversity you are facing
Ask yourself: What is the story my mind is telling me? Is there any space to re-write the narrative to not only be more encouraging, but more accurate?
Ask yourself: Do we have to believe all thoughts that enter our mind? Even if the thoughts are loud or convincing, does that make them fact?
Develop a coping plan— work to identify coping strategies which you find helpful, and learn new strategies to add to your toolbox.
Seek support (such as friends, family, peers, community members, and professionals).
Managing physical symptoms can improve well-being and quality of life.
People living with cancer are faced with a myriad of physical symptoms both related to the disease itself (such as pain related to bone cancer) and the treatments (such as chemotherapy, radiation, surgery). Common physical complaints include pain, fatigue, nausea/vomiting, weakness, taste changes, shortness of breath, and changes in bowel/urinary function or habits. Physical symptoms, especially when severe or left unmanaged, can diminish quality of life, impact functioning and independence, and contribute to depression (Fitzgerald et al., 2015; Henson et al., 2020).
Importantly, the challenge of navigating physical symptoms is not only applicable for someone living with cancer, but anyone living with acute or chronic medical illness or injury. If you are someone living with a medical condition, I’m sure this feels like old news to you. Perhaps you’ve struggled with nagging back pain, which at times becomes debilitating. Maybe you have persistent fatigue which makes it difficult for you to stay active and engaged in the activities you enjoy the most. Maybe you never know when you’ll need to go to the bathroom, which makes it difficult to travel or even run errands around town. It’s not hard to understand how living with challenging physical conditions can impact well-being and limit our sense of hope. If you’re feeling defeated and stuck, please know that you are not alone and there are treatments that can help.
While medical intervention is often beneficial for targeting problematic physical symptoms, psychological interventions have been shown to help manage a variety of problems including but not limited to pain, tinnitus, nausea/vomiting, and fatigue (Ehde et al., 2014; Hughes et al., 2017; Landry et al., 2020; Mustian et al., 2017; Samami et al., 2022). Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can be incredibly helpful for managing a plethora of distressing physical symptoms by shifting behavioral patterns and empowering us to respond to our sensations, thoughts, and feelings in a way that promotes reduced distress and improved quality of life.
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References
American Psychological Association. (2018). Grief. In APA Dictionary of Psychology. Retrieved July 23, 2024 from: https://dictionary.apa.org/grief
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. American psychologist, 69(2), 153.
Fitzgerald, P., Lo, C., Li, M., Gagliese, L., Zimmermann, C., & Rodin, G. (2015). The relationship between depression and physical symptom burden in advanced cancer. BMJ supportive & palliative care, 5(4), 381-388.
Henson, L. A., Maddocks, M., Evans, C., Davidson, M., Hicks, S., & Higginson, I. J. (2020). Palliative care and the management of common distressing symptoms in advanced cancer: pain, breathlessness, nausea and vomiting, and fatigue. Journal of clinical oncology, 38(9), 905-914.
Hughes, L. S., Clark, J., Colclough, J. A., Dale, E., & McMillan, D. (2017). Acceptance and commitment therapy (ACT) for chronic pain: a systematic review and meta-analyses. The Clinical journal of pain, 33(6), 552-568.
Landry, E. C., Sandoval, X. C. R., Simeone, C. N., Tidball, G., Lea, J., & Westerberg, B. D. (2020). Systematic review and network meta-analysis of cognitive and/or behavioral therapies (CBT) for tinnitus. Otology & Neurotology, 41(2), 153-166.
Mustian, K. M., Alfano, C. M., Heckler, C., Kleckner, A. S., Kleckner, I. R., Leach, C. R., Mohr, D., Palesh, O.G., Peppone, L.J., Piper, B.F., Scarpato, J., Smith, T., Sprod, L.K. & Miller, S. M. (2017). Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA oncology, 3(7), 961-968.
National Cancer Institute. (2024, May 9). Cancer statistics. https://www.cancer.gov/about-cancer/understanding/statistics
Samami, E., Shahhosseini, Z., Hamzehgardeshi, Z., & Elyasi, F. (2022). Psychological Interventions in Chemotherapy-Induced Nausea and Vomiting in Women with Breast Cancer: A Systematic Review. Iranian journal of medical sciences, 47(2), 95–106. https://doi.org/10.30476/ijms.2020.86657.1660