When should you consider talking with a counselor or psychologist about your emotions after CAR T-cell therapy? Myeloma nurse practitioner Daniel Verina discusses the importance of recognizing your stressors, communicating openly with your care partner and healthcare team, and addressing emotional concerns early.
Daniel Verina is a nurse practitioner at the Center of Excellence for Multiple Myeloma at Mount Sinai Tisch Cancer Center in New York City.
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Transcript
Katherine Banwell:
Daniel, emotional ups and downs are common following CAR T-cell therapy. What should patients know about this time, and when should they seek professional help?
Daniel Verina:
I think that’s a phenomenal question because like always, it’s the unknown. Any new therapy that a patient goes through, or the caregiver goes through with the patient itself, it’s an unknown. Will it work, not work? And I think that’s kind of why it wax and wanes. It’s kind of understanding that it is part of the healing process.
And it’s not a personal failure when we’re actually going through the treatment. So, CAR T patients should know the stressors. And do they go in with anxiety and depression? And the caregiver has to be able to recognize, is it part of themselves, that person’s anxiety and depression, or is it part of the ICANS, and neurotoxicity, or something that I need to recognize soon enough that they need to notify their healthcare providers, and things of that nature.
Good news is when the therapy works, and I think that’s what we try to tell our patients even after discharge from the hospital, and every few weeks that we see them, and every time, every month, every six months, as their disease stays away.
My philosophy is you’re there to help support them. I don’t want to say the rah-rah, but you’re always giving them the light, saying, look how good you’re doing. The numbers are great. We did a bone marrow biopsy PET scan. I don’t see any disease left.
But one of the things we need to recognize is, yes, the patient may have anxiety, depression, but we also need to understand, are the transient agitations or sleep disturbances part of the ICANS? So, again, bringing it up to the healthcare team, no question to me, even a year, two years later, and my patients with CAR T, no question is too small to say I feel like this has changed. I don’t belittle it saying, oh, no, that’s just them. No, it still have delayed effects even two, three years later in CAR T. So, really having that open conversation with healthcare providers, I think helps us guide.
I think also tying ourselves into psychiatry and psychology, having a good relationship with both the community social worker and our academic CAR T social workers for another set of support, holding the hand because it takes a takes a village to put a patient through CAR T, and it’s lifelong.