Finding Oncology-Informed Mental Health Care

Call or text 988 for the 988 Suicide and Crisis Lifeline. Text HOME to 741741 for Crisis Text Line. Call 911 in an emergency. The rest of this page is about ongoing care, which takes longer to arrange.

The field has a name: psycho-oncology. It is mental health care built around cancer. Its professional body in the United States is the American Psychosocial Oncology Society, which describes its work as advancing evidence-based psychosocial oncology care.

A good therapist who has never worked in cancer can still help you. But there are things an oncology-informed clinician will not get wrong, and those things matter.

They know the symptoms overlap. This is the big one. NCI's clinical guidance points out that fatigue, appetite change, sleep change, and slowed movement may come from the cancer or the treatment rather than from depression. It advises assessing the emotional and thinking symptoms instead, because that is more accurate and avoids false positives.

Put plainly: a clinician who scores your exhaustion as depression may miss what is actually wrong. One who ignores it may miss depression. You want someone who can tell the difference.

They know the medicines interact. NCI's guidance notes that some antidepressants, including fluoxetine and paroxetine, strongly block a liver enzyme called CYP2D6. That enzyme also processes other drugs. Whoever prescribes for you needs your full cancer medicine list, not a summary.

They know the timeline. Fear before scans. The drop after treatment ends, when everyone else thinks it is over. Fear of recurrence. NCI describes how sights, sounds, and smells linked to hard treatments can later set off distress on their own, and how being inside a scanner can restart older trauma.

NCI reports that nearly half of people with cancer have a lot of distress. Almost half feel some anxiety, and about a quarter feel a great deal of it. About 2 in 10 people diagnosed with cancer become depressed.

NCI's clinical summary puts distress prevalence between 22% and 58%, with roughly 40% reporting significant distress.

This is a normal part of cancer care, not a separate failing.

The fastest route is almost always the one already attached to your treatment.

Ask whether your center has any of these:

• A psycho-oncology service.
• Oncology social work.
• Psychiatry or psychology on the cancer service.
• A palliative care team. They treat symptoms and distress alongside active treatment, at any stage.
• A survivorship clinic.

Oncology social workers are the most under-used people in the building. They handle distress, family strain, money, transport, and referrals, and you usually do not need anyone's permission to ask for one.

If your center is small, NCI keeps a directory of NCI-designated cancer centers by state. A larger center nearby may take you for supportive care even if your treatment stays where it is.

Titles are confusing. Here is the short version.

• Psychiatrist. A medical doctor. Prescribes and manages medicines, and is the right person when drug interactions are complex.
• Psychiatric nurse practitioner. Also prescribes, in most states, and is often easier to get in to see.
• Psychologist. Provides therapy such as cognitive behavior therapy, and does formal testing of thinking and memory.
• Licensed clinical social worker. Provides therapy, and also handles practical and family problems. Often the quickest route in.
• Licensed counselor or therapist. Provides talk therapy.
• Chaplain. Trained for questions of meaning and mortality, and available to people of any faith or none.

• findtreatment.gov is SAMHSA's confidential and anonymous tool for finding mental health and substance use treatment across the country.
• Call 1-800-4-CANCER (1-800-422-6237) for the NCI Cancer Information Service.
• Ask your oncology nurse who other patients have seen. Nurses know.
• Ask your primary care doctor for a referral, and give them the cancer detail so they route you well.

NCI names approaches with evidence behind them:

• Cognitive behavior therapy.
• Relaxation training, including hypnosis, meditation, guided imagery, and biofeedback.
• Counseling, one-to-one or in a group.
• Antidepressant medicine, which NCI notes may take 3 to 6 weeks to work.

Two useful principles from NCI. For people having trouble adjusting to cancer, counseling should be tried before medicine. And when counseling alone is not enough, or there is a mental health disorder such as severe anxiety or major depression, medicine may be needed alongside counseling.

NCI also reports that at least 150 minutes a week of moderate to vigorous exercise reduced depression in breast cancer survivors. Do that alongside treatment, not instead of it.

Ask on the first call, before you invest months:

• Have you worked with people during cancer treatment?
• How will you tell my distress apart from treatment side effects?
• Will you speak to my oncology team, and what do you need from me to do that?
• Do you offer telehealth for weeks when I am too unwell to travel?
• What happens if I need you between sessions?
• Do you take my insurance, and what will each session cost me?

If you are asked to fill in a distress score at clinic, answer honestly. NCI's clinical guidance treats a score of 4 or higher on the 0 to 10 distress scale as the point that best identifies people needing follow-up. It also recommends routine screening, with extra attention at diagnosis, at recurrence, and at progression.

If nobody screens you, say it yourself: "My distress is about an 8 and I want a referral."

• Adjustment to Cancer: Anxiety and Distress (PDQ) — NCI
• Adjustment to Cancer: Anxiety and Distress (PDQ), for Health Professionals — NCI
• Depression and Cancer (PDQ) — NCI
• Depression (PDQ), for Health Professionals — NCI
• Cancer-Related Post-Traumatic Stress (PDQ) — NCI
• Find an NCI-Designated Cancer Center — NCI
• FindTreatment.gov — SAMHSA
• American Psychosocial Oncology Society — APOS
• 988 Suicide and Crisis Lifeline — 988 Lifeline