Tag Archive for: depression

Dr. Craig Cole: Why Is It Important for You to Empower Patients?

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Dr. Craig Cole: Why Is It Important for You to Empower Patients? from Patient Empowerment Network on Vimeo.

How can patients and families be empowered? Expert Dr. Craig Cole from Karmanos Cancer Institute discusses methods of empowering patients in their care and the benefits of patient empowerment.

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Charise Gleason: Why Is It Important for You to Empower Patients? 

Transcript:

Dr. Craig Cole:

Well I think I’ll start with the why that’s important first. It is not only good patient care. I mean, it’s good patient care to have your patients empowered, that you’re not making decisions for them, but you have shared decision-making and work as a team. And so that’s, I think the biggest thing is it really is good patient care. It enhances compliance, it enhances the patient experience, the provider experience to have empowered patients.

The other thing is that it makes your job fun to have empowered patients. For me to walk into a room and a patient just says, “Well, I’m okay,” is one thing to have a patient, for me to walk in a room and say, “Well, I’m okay. So what’s new in myeloma?” And then being able to talk about that, because I can’t talk about this new myeloma at home anymore. I mean, my wife and kids are sick of hearing about myeloma. So who do I have to talk to? I have patients to talk to. And you can’t talk to unempowered patients. You have to talk to empowered patients. So it just makes your job fun to have an empowered patient. So, how do you do that?

 And again, it’s good patient care. So how do you do that? Is that you start on day one and giving data to patients so that they see giving their data so that my patients go home with their bone marrow biopsy. They go home with their cytogenetic data. They go home with the data that they have so that they see that what happens in the clinic, what happens at home, that it’s not black and white, but there’s a continuum there, that they’re empowered and they have the data in front of them to see that this is really happening.

The second thing is offering options to patients that patients understand that is just not, a four drug therapy or two or one drug therapy, but there are options for therapy and that you can pick the best option for you as we go through sort of the risks and benefits. So I’ve been criticized by offering too many options to my patients, and I think that’s impossible to, that you can’t offer too many options because I don’t live in my patients’ shoes.

They’re the best ones to say, do I want to be here once a week, every week, for an hour or don’t want to be here once a week for two hours, three weeks out of four weeks, or do I want to not come in at all and get an oral therapy and they’re the best judge for that. So we offer things, including offering clinical trial space. So offering options gets them involved in the process, so they’re part of the empowerment.

Also referring them to educational resources. We have fantastic support groups and patient advocacy organizations here and around the world, and they’re very, very helpful. And when you see other empowered patients, it’s hard to not be empowered yourself when you see all the great opportunity. We also make sure the patient uses their portal so that if they have a question that they can communicate directly to me, they don’t have to wait a month in order to, it is very un-empowering to sit there with a rash for two weeks, as opposed to just, sending me a message to the portal. And probably most importantly, I think, is really listening and validating patients’ concerns.

There was a study that was done by the Cancer Support Community and their Patient Experience Survey, and that a lot of patients, over 50 percent of patients, don’t discuss financial toxicity, don’t discuss their behavioral health concerns, such as depression, because they think that the doctor can’t or the providers can’t do anything about it. And part of that is that if someone says, “Well, it’s kind of expensive for my drug,” and you don’t validate and listen to that, then they’re going to drop it and they may never bring it up again. Or if they say, “I’m having trouble with sleep and engaging other people,” basically saying that they have depression, if you don’t validate and listen to that, then they may never bring it up again, and they’re going to suffer with that along with their myeloma. So it’s really important as an empowering thing for patients for you to listen and validate what patients have and their concerns. 

Pain Outcomes Among Black Women With Early Stage Breast Cancer After Mastectomy

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Pain Outcomes Among Black Women With Early Stage Breast Cancer After Mastectomy from Patient Empowerment Network on Vimeo.

What do studies show about early breast cancer after mastectomy in Black women? Expert Dr. Demetria Smith-Graziani explains research into discrimination, trust, and pain outcomes in this patient group.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

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Transcript:

Lisa Hatfield:

Dr. Smith, you’ve done extensive research in this area. Can you talk a little bit about your recent research investigating the association between discrimination, trust, and pain outcomes among Black women with early stage breast cancer after mastectomy?

Dr. Demetria Smith-Graziani: 

Sure, so I am very passionate about racial, ethnic and socioeconomic disparities in breast cancer risk treatment and outcomes, and most recently, I’ve been doing research looking at disparities in pain outcomes, so unfortunately, it’s well-documented that Black patients as a whole and women, and then particularly Black women, often have their pain not properly assessed and then not properly treated compared to their white counterparts. So I initially looked at a study of women who were undergoing different types of breast surgery, we compared women who were either getting what we call breast-conserving surgery, which is also called a lumpectomy, compared to those who were getting their entire breast removed, mastectomy.

Compared to those who were getting both breasts removed, what they call a bilateral mastectomy, and we looked at how much pain patients had after that surgery, how long it lasted, and other factors that were associated with their pain and how they felt after surgery. Now what we found is that regardless of the type surgery Black women were reporting more severe pain compared to white women, and so that’s what prompted me to engage in my most recent research project, in which I am looking at the association between perceived discrimination in the healthcare setting, trusting one’s healthcare provider and pain outcomes, particularly the severity of pain and how much that pain interferes with one’s life for Black women after they’ve had a mastectomy surgery to remove the entire breast for the treatment of their breast cancer.

So I have recruited some patients, and I am in the process of getting ready to enroll more patients on this study, and I’m hoping to get some good information about whether or not that discrimination that people receive in the healthcare setting affects the way that…how much their pain interferes with their life and how severe their pain is, and whether part of the reason that the discrimination affects their pain is related to the amount of trust that they have in their oncologist or their oncology team. And the reason that I’m looking at that specific…the reason that I’m looking at those specific set of factors is because there are a number of psychological components to the way that we feel pain, such as anxiety, depression and yes trust that are linked to the way that we experience pain and how severe that pain is and how much that pain affects our lives. 

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How Has COVID-19 Impacted Myeloproliferative Neoplasm Care?

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How Has COVID-19 Impacted Myeloproliferative Neoplasm Care? from Patient Empowerment Network on Vimeo.

How has myeloproliferative neoplasm (MPN) care been impacted by COVID-19? Expert Dr. Krisstina Gowin from University of Arizona Cancer Center shares information from an MPN care study by the Mayo Clinic on some of the impacts experienced by patients. 

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Transcript:

Lisa Hatfield: 

So the pandemic has resulted in significant changes to many aspects of daily living for many of us, but for patients living with cancer like myself, there are different realities that we’ve had to deal with. Do we go in for our monthly blood draws, or do we wait a couple of months? So question for, Dr Gowin, can you give us an overview of the impact that COVID-19 has had on MPNs or MPN care?

Dr. Krisstina Gowin: 

Absolutely. Well, there was a really wonderful study that was done, really led out of Mayo, by Jeanne Palmer and Ruben Mesa, and it was an international study, and it looked at 1,500 MPN patients. And they asked questions like, “How many of you are actually having telemedicine?” And this was in 2020, kind of at the beginning. And over half of them had already been engaging in telemedicine. And about a quarter of them felt that their care actually was delayed a little bit and that there were actually consequences to that delay, so that really speaks to an international kind of change in the paradigm of how we’re delivering care for MPN patients. The other thing is the lockdowns, the lockdowns that were occurring for us here in the US and really internationally. And what they did is, they asked patients their MPN symptom burden, and those that were on lockdown, not surprisingly I think to all of us, had a significantly higher symptom burden.

So I think that really speaks to that A, yes, there was a very large impact of COVID on the development of telemedicine and the need for telemedicine. But it also underscores the need for symptom management that we now have a group of patients that are having a higher symptom burden, probably likely secondary to more sedentary behavior, more anxiety, more depression, but a higher symptom burden because of COVID. And so we really need not only more therapeutics and perhaps non-pharmacologic interventions to support their symptom burden, but it needs to be delivered on a digital platform.

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How Does Stress Correlate to Our Physical Ailments?

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How Does Stress Correlate to Our Physical Ailments? from Patient Empowerment Network on Vimeo.

What are the effects of stress, anxiety, and depression on physical health? Dr. Nicole Rochester and Dr. Broderick Rodell discuss how personal experiences and environmental conditions can impact patient health and a prostate cancer study that examined prostate cancer cells in Black patients.

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Transcript:

Dr. Nicole Rochester:

We know that stress and anxiety and depression and all of those things impact your physical health, and as I said earlier, I think traditionally, there’s been this ridiculous disconnection between our minds and our bodies, and we know a lot more now, in fact, there’s a study, there are many studies, but there’s a study specifically looking at prostate cancer by Dr. Burnham, a researcher. And what they found in this study is that they looked at prostate cancer cells from African American patients and white patients, and when they treated these cells with stress hormones, they saw that the Black patient’s prostate cells would begin to up-regulate the genes and the proteins that are known to make that cancer more resistant to therapy. And so it starts to look at the role of stress and stress hormones, and we know that there’s increased stress among minority communities, among… sorry, urban communities, those who are otherwise disenfranchised, so from your perspective, can you just share a little bit about the connection between stress and physical illness and maybe how you approach that in the work that you do?

Dr. Broderick Rodell:

So, these various patterns we don’t operate, we have a framework that we all operate from, and it’s beneath the surface of our conscious awareness. And so our subconscious mind operating system is there, but that operating system comes from our conditioning, we’re conditioned by our families, by our local communities, our societies. And so, the various structures that are in place are facilitating our conditioning and from our conditioning we…that our conditioning creates our perspective, the framework that we operate from, that’s determine…that’s going to determine how we relate to our experiences. And how we relate to our experiences can be gracefully, or it can be stressfully, just to put it in those two different terms, and so that stress that is created based on how we’re relating to our experiences has a historical perspective, and so we have to address those issues. We can address our familial issues that has a historical relationship and say that maybe the relationship that my mother and father or grandparents had towards their own health is not necessarily to be the most optimal way to do that. And they may have had those ways of relating to their experience, based on their conditioning, based on the suffering that they’ve experienced, environmental conditions that were conducive for that mental framework that they’re operating from, and so we have to work towards transforming that, and again, the place where we have the most power in ourselves, “How can I change myself?”

I have to advocate for myself, and so how do we increase that by increasing our education and learning about ourselves and learning about our mental models that we’re using to relate to our experiences and transforming those mental models to reduce unnecessary stress and tension? Because when we’re under unnecessary stress, we have our epinephrine cortisol, these hormones that are increasing in our body, that’s going to suppress our immune system. It’s going to cause damage in our blood vessels, organs are not going to function optimally, and I think that we’re going to keep finding out more and more about this. I was interested, as you hear that about the prostate, prostate cells in African Americans, why would that be the case? You’ve got generations of hyper-vigilance for historical reasons, cultural reasons, or social reasons. Then, of course, that’s going to get passed on from generation to generation, a sense of hyper-vigilance, a sense excessive amount of stress hormones was floating around in the bloodstream, and it’s going to have a significant influence on how the body is capable of dealing with various illnesses – be it cancer, be it cardiovascular disease, or any other disease that’s associated with, or probably all disease that’s associated with stress these days.

In particular, with cancer it’s very interesting, that relationship and why are these cells dividing and rapidly producing in the way that they’re doing, and how is that related to stress? I don’t think it’s…no, simple relationship there. You can’t just say, “Stress causes cancer.” I’m not saying that at all. But there is a correlation, there is a relationship, and if the thing that we can tackle, we can’t change our genes, but what we can do is change our relationship to our experience. Transform that to reduce the amount of stress or suffering and maximize well-being, and that’s the kind of work that I try to focus my attention on and what comes out of that is, “Okay, I need to work on how I relate to my experience,’ but also “How do I create favorable conditions in my internal system, in my body through the food, in through the exercise that I do, through the literature and I expose myself to, etcetera?”

How Can BIPOC Breast Cancer Patients Overcome Health Disparities?

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How Can BIPOC Breast Cancer Patients Overcome Health Disparities? from Patient Empowerment Network on Vimeo.

How can BIPOC breast cancer patients help overcome health disparities? Experts Dr. Nicole Rochester and Dr. Regina Hampton share ways to be more proactive with breast cancer screening, in interaction with healthcare providers, and in sharing breast cancer stories.

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Transcript:

Dr. Nicole Rochester:

You alluded to the different care sometimes that patients of color receive. So I want to shift and talk about racial and ethnic inequities, and unfortunately, we know that with every other illness, unfortunately similarly with breast cancer, there’s a long history of women, particularly in BIPOC communities receiving disparate care, a lot of times they are not offered some of these treatment options, maybe they don’t have access to some of the breast cancer centers, so can you just share some information about some of the disparities that we see, in breast cancer? And then I’m curious to know how you specifically address them being a Black woman breast surgeon 

Dr. Regina Hampton: 

So, one of the things to know is that as African American women, we tend to get breast cancer at younger ages, and not a lot of physicians know and can recognize that, so it is very important that when a young African American woman has a breast complaint that that’s taken seriously and worked up to make sure that we’re not missing a breast cancer. So, I think it’s important again to have those conversations talking about family history, because we don’t talk about family history, in our families. I’ve had a patient just come in and say, Yeah, well, grandma had a breast missing, no no nobody said cancer, well they probably should’ve said cancer, so we’ve gotta have those health conversations in our family, so I think it’s important for patients to really be their advocate because many times these young women are dismissed and thought, “Oh, you’re too young,” and I’ve even been kind of fooled myself by some of the young women, so knowing that younger women get breast cancer at younger ages, if you think something is going on, you need to really take that seriously. And then I think it’s also talking about the options, we do tend to get a more aggressive form of breast cancer, but the treatments have changed, and while chemotherapy may be indicated for many patients, it’s not for all patients, and so really taking that time to understand what all the options are, “Well, why are you recommending chemotherapy? What’s going to be the benefit for me? What’s the survival benefit for me? What are the side effects? How this going to affect my sex life? How is this going to affect me and my relationship with my children, with work?” 

So really just asking all of those important questions, I think it’s also important to ask for what you want. I don’t think we speak up enough, there was actually a study that I was looking out that shows that we don’t get offered reconstruction as often as our white counterparts. The disparity is about 24 percent, and that’s really huge. That’s important. So, we really need to ask those questions and to know, well, maybe I can’t get reconstruction at this juncture, but can I get it in the future, there’s a federal law that covers all of those for all breast cancer patients, no matter what color you are, so again, it’s just asking those questions. Sometimes taking somebody and having somebody else ask the questions can be helpful. 

Dr. Nicole Rochester: 

Yeah, making somebody else the bad guy, so to speak. Absolutely, any time I have a conversation about health disparities and health and inequities, honestly, I get a little angry inside because for you to share that statistic that we’re not as often offered reconstructive surgery, that is a huge part of our identity as women. Our appearance, our self-esteem, and I just want to point out for our viewers that unfortunately, as Dr. Hampton has stated. A lot of times, these disparities are sometimes due to lack of knowledge, so Dr. Hampton mentioned that Black women tend to get breast cancer at a younger age, and you need to know that if you’re seeing a breast surgeon or even an internist or oncologist who is not a person of color or who is not up-to-date on that information, they may not know those statistics, but unfortunately, there also is this bias that you’ve talked about as well, and we know that we all have bias, we are exposed regularly to negative images, negative stereotypes of African Americans, Latino, Native Americans, and doctors are not immune to that bias and we carry those biases into the exam room, and so for people of color with breast cancer, it is particularly important that you follow these recommendations that Dr. Hampton has mentioned, and I just love that really all of them center around advocacy and speaking up for yourself and standing up for yourself. Are there any other things, Dr. Hampton in closing that you can think of specifically for patients of color, things that they can do to really protect themselves from these inequities that exist in breast cancer care. 

 Dr. Regina Hampton: 

I think we have to really start at the beginning and being more proactive about our screening, making sure that we’re getting those mammograms, making sure that when we get a mammogram, we’re asking for the best mammogram if there’s new 3D technology, making sure that you get that so that we can find things at an earlier stage, and I think also we have to call it kind of throw out all the myths. We got to let them go people, we got to let them go. And I know there have been some challenges and we have had some historical issues, I think Dr. Rochester and I both agree and acknowledge that, but at some point, we have to move forward and be more proactive and really knock down some of those barriers and not let some of those old things that happen hold us back from the new technologies that are available. So, I think the good thing, we’re in a day and age where most early-stage cancers are not a death sentence and we find them early, we can treat them early, and I think we have to just talk in our community, I’m always amazed that many Black women still don’t share their stories. 

So, you have women who are in the same circle and don’t realize that the person two seats down went through breast cancer, and you all still go to coffee, and she didn’t share her story. And now you’re facing breast cancer, you’re thinking, “Wow, I’m just alone.” And so, I think we have to really share that, not only in our families, but we’ve got to share it with our sisters, because you never know who you’re going to be helping through that journey. I find it interesting that there’s really a difference between how African American women take a breast cancer diagnosis and white women take a breast cancer diagnosis, and we’re getting ready to really look at this, and I’m really excited about it because I really want to know what is it and why is there such a difference? But I think we have to not hide, we have to really share our stories, and sharing your story is going to help somebody else. 

Dr. Nicole Rochester: 

Absolutely, I think part of the hiding and even what you mentioned about the family history not being shared as part of this kind of myth that we have to be strong or that Black women are invincible and that we can’t be vulnerable. And you’re absolutely right, we need to talk about this in our circles, we need to talk about it with our daughters or nieces, all of our family members, so that we’re all educated and empowered.  

Dr. Regina Hampton: 

It’s funny you mentioned that because that’s one of the first things I tell patients to do. I say, “Look, you’ve got to let other people take over, because we’ve got work to do, and kids have got to eat peanut butter and jelly, they’ve just got to eat some peanut butter and jelly, they’ll be all right, but you’ve got to put yourself first.” And I think if we put ourselves first, put our screenings first, we’re good about getting our kids, getting them to their health appointments, we as women have got to get ourselves to our health appointments and put ourselves first, so that we can be there for our families. 

Dr. Nicole Rochester: 

You just reminded me of something we as women, are really good at taking care of our kids and our spouses and other members of our family, but then we do that at the expense of ourselves, and I can say when I used to practice as a pediatrician, we were trained to address postpartum moms, and people realize early on that, hey, okay, they may not have their postpartum visit for six weeks, but they’re taking that baby to the pediatrician in two or three days, and so we would talk with the postpartum moms about screening them for depression and things of that nature, but I never thought about…you literally just gave me this idea that maybe pediatricians should also be checking in with our patients’ moms and asking them about their screening, I don’t know if they would be offended by that, but it truly takes a village, and so maybe we need to be encouraging the parents of our patients and making sure that they’re getting their regular screenings and their health maintenance as well, because you’re right, we will look out for the babies, and we will put ourselves on that back burner every single time. 

How to Regain Self-Esteem and Body Confidence After Cancer Treatment

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Getting through cancer treatment is a huge accomplishment. The moment you’re finished with your final session, it can feel like you’re on cloud nine. You’ve done something incredible.

Unfortunately, it may not take long for those positive feelings to waver.

Cancer treatments are often intense and can cause noticeable changes to your body. While those changes are necessary to fight back against the disease, many can linger once treatment is done. That can leave you with low self-esteem. You might even start to struggle with mental health conditions like depression or anxiety1.

Whether it’s healing from major surgery, dealing with hair loss, weight fluctuations, or a change in your sex drive, it’s not uncommon for the after-effects of cancer treatment to make you see yourself differently.

So, how can you regain confidence in your body after your treatment journey is over?

Common Body Image Issues

Going through cancer treatment can make you feel strong on the inside, but lose confidence in your external appearance. Because both the disease and treatment can cause your body to change, it’s not uncommon for your physical appearance to affect your self-esteem.

If you’re feeling “off” after your treatment or you’re struggling with your self-confidence, it could be the result of how you see yourself when you look in the mirror. Some of the most common signs of body image issues are:

  • Your feelings about your body are affecting other areas of your life
  • You speak negatively/harshly about your image
  • You avoid seeing your own image as much as possible
  • You obsessively try to change your image with makeup/grooming

Unfortunately, we’re currently living in a period that makes it harder than ever to avoid your own image. If you’re working remotely, for example, you might be one of the 300 million people logging into Zoom meetings every day2.

The current remote culture has created some self-esteem issues of its own. Working from home can be beneficial for patients going through treatment or those in recovery. But, it’s not without its potential drawbacks.

Problems like Zoom fatigue and Zoom dysmorphia have come to the forefront for many people. Zoom dysmorphia, for example, is a condition that causes someone to develop self-image issues from looking at themselves on a screen. When you’re on Zoom meetings all day, it’s easy to start nitpicking your flaws or seeing things that others wouldn’t even notice. If you’ve recently gone through cancer treatment and are already dealing with body image issues, seeing a pixelated version of yourself on a screen can make matters worse.

So, what can you do if you’re struggling with any of these problems?

Explore Your Emotions

You might feel negative about having a negative image of yourself. After all, you just went through something life-changing and came out on the other side. But, one of the biggest mistakes you can make is ignoring how you really feel. By shoving your feelings aside, you’re putting yourself at risk for them to “bubble up” and explode later.

Instead, accept how you’re feeling. Accept the loss you’ve experienced when it comes to the way you used to look. It’s okay to feel sad or frustrated. It’s okay to grieve.

Once you’ve worked through those feelings, you can attempt to shift your mindset. Focus on the things you’ve been through and how they have made you stronger. What have you gained from this experience, and how have you changed positively?

If you’re having a difficult time focusing on the brighter side, lean on your support system. That can include:

  • Family members
  • Friends
  • Doctors
  • Support groups
  • Online forums

You can even talk to other cancer patients for advice about self-image3. The important thing is to remember you’re not alone. You undoubtedly had support with you throughout your treatment. That doesn’t just disappear because you’re cancer-free. Keep leaning on that support for help with your mental health and advice on how to keep moving forward.

Focus On What You Can Change

When it comes to your physical appearance, there are things you can and can’t control.  For example, if you lost your hair during treatment, you can’t make it grow back any faster. But, you can opt for a wig, or choose to wear hats when out in public. If your skin became dull and dry, you can’t change it overnight. But, you can use creams and lotions to bring back hydration and elasticity. If you experienced weight loss, you can purchase clothes that fit better for now, and work on slowly regaining the weight over time.

By focusing on the things you can control, you’re less likely to get frustrated. Most image issues you’ll face after cancer treatment are temporary. It may take a long time to get back to normal. But, you can take comfort in knowing most of them aren’t permanent.

When it comes to physical issues like surgery scars, they will typically fade over time, too. You can help that process with different creams and body butter. But, it’s okay to accept the fact that you may always have a scar or two. Instead of looking at those scars as something “ugly” or embarrassing, consider the fact that you get to stand there and see them. You made it through something that not everyone else gets to. A surgery scar is a sign of strength and victory.

In addition to changing what you can and accepting what you can’t, regaining confidence can come from leading a healthy life. Practice self-care every day. Develop healthy habits that make you feel good about yourself, inside and out. Get enough sleep, work out if you feel strong enough, and take time to relax each day.

Your body has been through a lot. While it’s understandable to feel self-conscious at first, realizing what it’s done for you can make you more accepting and willing to love yourself again.

Sources:

  1. Cancer patients left to cope with mental health problems alone
  2. Zoom User Stats: How Many People Use Zoom in 2021?
  3. Self-Image, Sexuality, and Cancer

Cancer-Related Depression: What You Should Know

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An overwhelming 40 percent of people are projected to experience cancer at some point in their lifetime and of those patients, over 10 percent will suffer from depression related to their illness. There are a variety of reasons a person’s mental health can be impacted by cancer. Common factors are if the cancer is terminal or invasive, feeling a lack of autonomy or control over one’s life, feelings of guilt or shame for behaviors associated with cancer like smoking, loss of identity resulting from weakness, appearance changes, or loss of friends or a job.

The mental health of cancer patients is often less considered, but its impact on the progression of cancer is strongly considered by doctors, with over 70 percent of oncologists believing that mood affects the progression of cancer.

Wherever you are in your journey with cancer –– if you were recently diagnosed, if you’re a caregiver, relative, or friend of a patient, or if it is a long part of your past –– it’s important to consider mental, not just physical, health. Even cancer survivors can develop depression after they are declared cancer-free. Fear of recurrence, permanent changes to the body and overall health, and lack of community or understanding take a huge mental toll on patients.

For a variety of reasons, it’s important to recognize symptoms of depression in yourself or loved ones who live with cancer. Keep reading to explore methods of acknowledging and alleviating depression related to cancer.

Common symptoms to look out for:

  • Loss of interest in things you used to enjoy
  • Irritability
  • Frequent crying
  • Lack of motivation
  • Feelings of worthlessness
  • Sleep changes
  • Fatigue
  • Appetite loss
  • Decreased libido

Methods of coping

Get professional help

As with any serious mental health issue, it is best to see a mental health professional. A mental health professional such as a therapist or a psychiatrist can help you view your mental health holistically, not just in the context of cancer, and help determine triggers and various treatment plans individualized for each patient.

Although cancer patients may feel overwhelmed with doctor’s appointments, there are increasingly more flexible options like online psychiatry services that incorporate treatments like talk therapy with the option to prescribe an antidepressant if needed.

Surround yourself with community

Feeling supported by friends and family in difficult times is extremely important for one’s well being. In fact, it has been found that a lack of friendship is a major diagnostic criterion for a variety of mental health issues.

If you have lacked friendships or support in the past, cancer may be an opportunity to bond with those with similar experiences. There are often a variety of cancer support groups associated with charities and hospitals that help cancer patients establish community and social assistance. Some even organize retreats and wellness clinics so it is worth looking into the resources available to you. Your oncologist, for example, may be able to point you in the right direction.

If you find it difficult to keep up with your friendships, or if you lack the energy to socialize in a way that feels comfortable, pets are also found to be extremely therapeutic in the way that they provide a sort of social support. For example, dogs can provide a sense of companionship and help lower stress levels by increasing “feel-good” hormones like oxytocin in their owners. Pets like dogs even help promote a healthy lifestyle by walking them and helping their owners socialize with other dog owners at places like a dog park. This is an especially beneficial option for introverted individuals.

Make an effort to laugh

Laughter is also therapeutic, and luckily also extremely accessible. Whether it be with family and friends or by watching a comedy on Netflix, laughter can counterbalance the somberness of cancer treatment and recovery. Laughter is even considered a serious treatment for stress and depression in the medical community. However, it’s not something that can be prescribed, it has to be actively sought.

Be aware of the content you’re consuming and ask yourself whether it lightens or dampens your mood. When you pick a movie to watch or a book to read, if not a comedy try and choose something lighthearted. Ask your family and friends to send you pictures of their pets or funny videos. Go after whatever makes you happy and promotes laughter in your life!

It is completely natural to experience overwhelming emotions and even develop depression while experiencing, and even long after, cancer. Cancer is not only a diagnosis but an experience that changes nearly all aspects of a person’s life. Whether it be you yourself or a close friend or family member, it is important to recognize not just the physical, but the mental health implications of cancer. There are many ways to support someone who is experiencing cancer-related depression. Try experimenting with different options to see what works for you.

Empowerment Tools for Nurturing Your Health During Stress

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The pandemic has distorted our livelihood and forced many of us into teleworking whether we were willing or unwilling. We’re plastered to our computers not just in the home office, but at our kitchen tables, or on the bed. We find ourselves having to make adjustments on a regular basis. Responsibilities may have been added to your already hefty plate. Your new work environment may not be favorable. Maybe you simply can’t concentrate. We just can’t seem to escape the pings and alerts from work colleagues. Working from home is new to many of us. However, the concept of work-life balance is not. Yet, instead of home being a sanctuary, it has become a boundless environment for work and stress. Through this journey, we can relearn what work-life balance is, and how intervening factors like stress meddle with our body and mind. We can learn the value mindfulness has in creating boundaries that benefit our health and productivity, and be empowered with tools to build and sustain our immunity.

In the moments we’re experiencing stress we don’t stop to think about the effects it can have on our mind, body, and soul. Being overworked, getting familiar with remote working conditions, or trying to make child-care arrangements can be awfully difficult during a pandemic (Harnois & Gabriel, 2002). Stressors such as these can drive workers into depression, cause sleep disorders, body aches and headaches, and lead to other short- and long- term effects. Job-related stress can affect our immune system by lowering our resistance to infections. Brace yourself, we’re about to hop on the science train, but only for a few stops so you’ll be fine.

Who turned off the lights?

Stress flips the switch on the central nervous system causing it to go into defensive mode (Han, Kim, & Shim, 2012). The body reacts in efforts to regain homeostasis or regain balance. As previously mentioned, stress has the ability to cause depression, sleep disorders, body aches, and a lower immune system. Did you know that stress, sleep, and immunity are related (Han, Kim, & Shim, 2012)? Small immune signaling proteins called cytokines aid in regulating sleep. When these proteins fail to perform properly due to stress, this interrupts phases of sleep. When experiencing this stress, an irregularity in the secretion of the hormone Cortisol occurs.

Depression is a common and complex disorder with the ability to affect your daily life including work and productivity (National Institutes of Health, 2016). The hippocampus, amygdala, and the prefrontal cortex are three parts of the brain that seem to have major roles in depression (Cirino, 2017). When we experience depression, Cortisol secretion increases causing chemical imbalances which can lead to the reduction of brain cells (neurons). In a Korean study published in Stress and Health, individuals who experience work-related stress are at a higher risk of experiencing major depressive issues (Lee, Joo, & Choi, 2013). Symptoms associated with work-related stress include a reduction in the ability to concentrate, fatigue, insomnia, and feeling counterproductive.

An increase in proinflammatory cytokine levels can cause inflammation within the body (Leonard, 2010). This can lead to major depression followed by type 2 diabetes and other inflammatory diseases. Cytokines are involved with adaptive immunity and have been linked to COVID-19 infections (Costela-Ruiz, Illescas-Montes, Puerta-Puerta, et al, 2020). Weakened immune responses have been linked to patients with comorbidities. While the available information regarding COVID-19 is ever changing, what we do know is severe pre-existing conditions, including pregnancy, are linked to weakened immune responses placing these individuals at a higher risk of contracting the virus.

Road to Redemption.

Now that we have a better understanding of stress, learn to set your boundaries to alleviate it. Establish boundaries in all aspects of your life, especially with work. This ensures that your needs and your health are placed at the forefront. Think of them as safeguards for yourself. As difficult as it may be to establish them, understand that they are without question essential for your efficacy in and out of work. Working without boundaries is when stress raids the mind, body, and soul creating an imbalance. Here are a few practices to reclaim your balance: be mindful, create a workable workspace, listen to your body, reevaluate your time, say no.

Being mindful is having that ability to find calm in times of chaos. Be conscious and aware of the moment, relax, and BREATHE. Only you are in control of you. This is a type of meditation that can be implemented in your daily life at any moment. Let’s take a few moments to practice. Stop what you’re doing, turn off the TV, put your laptop to the side, get comfortable, and gently close your eyes. Take a deep breath in, then slowly exhale. If you hear noises, leave them be, continue to breathe. Do this for about 5 minutes. This practice is to help you find your calm, clear your mind, and become hyperaware. This method of nurturing your mind and body has the ability to mitigate stress, anxiety, improve sleep, and improve attention (Mayo Clinic, 2018). There are many practices for mindfulness which can be found on the Complete Guide to Mindfulness.

We are no longer in our offices or confined to our cubicles so we must create workable workspaces, and implement our boundaries. Yes, your new comforter was just shipped from Amazon, but allow the bed to be a place for rest not work. Create a space to enhance productivity yet allow comfort. Here are tips to transform a section of your home into a conducive workspace:

1. Invest in a quality chair and desk/or small table

  • Maintain good posture. If you feel yourself slouching, readjust or move around We want to avoid body aches, so listen to your body. Be aware of its needs.

2. No desk?

  • Use the kitchen table or counter, a coffee table (make sure you have some sort of back support).
  • If you must use your bed because your room is the only place of silence, ensure your bed is made. Sit on top of your new comforter with your back against the headboard

3. Good lighting is a must.

 

4. Keep your workspace organized using bins and folders

  • Disorganization is distracting, limits movement, affects motivation, reduces your performance, and shows lack of control (Roster & Ferrari, 2019).

5. Do not let work leave your workspace. The rest of your home should be designated a non-working area.

Listening to your body is an aspect of creating boundaries. Do not let work interfere with your health. Know when to get up to stretch, grab water, have a snack, or take lunch. If you must, inform your team of the time you will take lunch daily. Having good nutrition is the first thing that will ensure we’re energized and healthy. Instead of ordering something to go for lunch, try meal prepping. Use Sunday as the day to prepare and organize your meals for the week, including your snacks.

Restock on the elderberry! Since we’re all being hyperconscious of where we venture in the world, incorporate things to boost your immune system such as Emergen-C and elderberry. Elderberry is a substance extracted from the elder tree which many use as a dietary supplement to help boost their immune system. It can be consumed in the form of syrup or even gummies. Disclaimer, before the use of any dietary supplement it is best practice to consult your healthcare provider.

Reevaluate your time. You may find that during this time you have accumulated more than 40 hours a week. It’s fine to work additional hours sometimes, but this takes away time from caring for yourself. It interferes with your work-life balance. Although we’re home, this shouldn’t equate to extra time to tap on computer keys. Reevaluating your time takes a level of mindfulness to understand the importance of taking care of you: your mind, your body, your soul.

Saying no can be difficult, especially to a loved one or your boss. However, you should listen to your mind, be aware of what you are capable of, and respect your time. Knowing when to say no in some respects may be less difficult than others. Saying no is powerful. It is the ultimate boundary we can create for ourselves and it is okay.

Our fight with this global pandemic has yet to near the end. If we are equipped with the tools to tackle our stress and adjust as needed, we may be equipped to continue our lives teleworking. We have learned to understand the deteriorating effects stress has on our health. It can disrupt sleep patterns, make us susceptible to depression, and weaken our immune systems. Each one of these conditions are tightly tied together by stress which we must keep unbound. However, the tools to reclaim our balance will aid us in this situation. Being mindful, creating the awareness we need to breathe and focus for productivity in work and life, will assist us in creating needed boundaries. Whether these boundaries are centered around a conducive workspace, listening to our bodies, reevaluating our time, or simply saying no, it is a necessity to properly control and lessen the amount of work-related stress we experience in these crucial times.

References

Cirino, E. (2017). The effects of depression on the brain. https://www.healthline.com/health/depression/effects-brain#1

Costela-Ruiz, V. J., Illescas-Montes, R., Puerta-Puerta, J. M., Ruiz, C., & Melguizo-Rodríguez, L. (2020). SARS-CoV-2 infection: The role of cytokines in COVID-19 disease. Cytokine & growth factor reviews, S1359-6101(20)30109-X. Advance online publication. https://doi.org/10.1016/j.cytogfr.2020.06.001

Han, K. S., Kim, L., & Shim, I. (2012). Stress and sleep disorder. Experimental neurobiology, 21(4), 141–150. https://doi.org/10.5607/en.2012.21.4.141

Harnois, G. & Gabriel, P. (2002). Mental health and work: impact, issues, and good practices. https://www.who.int/mental_health/media/en/712.pdf

Lee, J., Joo, E., & Choi, K. (2013). Perceived stress and self-esteem mediate the effects of work-related stress on depression. Stress and Health, 29(1), 75–81. https://doi.org/10.1002/smi.2428

Leonard B. E. (2010). The concept of depression as a dysfunction of the immune system. Current immunology reviews, 6(3), 205–212. https://doi.org/10.2174/157339510791823835

Mayo Clinic (2018). Mindfulness exercises. https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/mindfulness-exercises/art-20046356

National Institute of Health (2016). Depression basics. https://www.nimh.nih.gov/health/publications/depression/index.shtml

Roster, C., & Ferrari, J. (2019). Does Work Stress Lead to Office Clutter, and How? Mediating Influences of Emotional Exhaustion and Indecision. Environment and Behavior, 1391651882304–. https://doi.org/10.1177/0013916518823041

Can Diet and Exercise Reduce MPN Symptoms?

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Can Diet and Exercise Reduce MPN Symptoms? from Patient Empowerment Network on Vimeo. 

What can YOU do to make a positive impact on your overall MPN care? Researchers Dr. Jennifer Huberty and Ryan Eckert review the latest research on how movement and diet can benefit people living with myeloproliferative neoplasms (MPNs).

Dr. Jennifer Huberty is an Associate Professor at Arizona State University. She focuses her research on the use of complementary approaches to manage symptoms and improve quality of life for patients living with myeloproliferative neoplasms. More about Dr. Huberty here: chs.asu.edu/jennifer-huberty.

Ryan Eckert currently works at Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center. Ryan is the Research Coordinator for the MPN QoL Study Group and assists in research related to complementary health approaches in myeloproliferative neoplasms and other hematological disorders. More about Ryan here: mpnqol.com/research-team.

See More From the The Path to MPN Empowerment

Related Programs:

Am I Meditating Correctly? Getting the Most Out of Mindfulness

Expert Tips for Managing MPN-Related Anxiety

Improving Life with MPNs: The Latest Research and How to Get Involved

Transcript:

Ryan:

So, as far as the benefits of exercise for MPN patients, there’s many, and so, I guess starting with cancers as a whole, there’s a lot more research that’s been done in recent decades that looks at the effects of various forms of exercise and physical activity on other cancers. They just tend – researchers tend to do a lot more of that work in breast cancer, lung cancer, colon cancer, et cetera.

And so, the research in exercise for MPN patients is actually really new, and nobody outside of Dr. Huberty in conjunction with Dr. Mesa and a few other researchers have done any research related to exercise specifically in MPN patients. Our yoga studies that we’ve done have been the first venture down that route for MPN patients. But, what we do know in general is that exercise has obviously systemic effects across the whole body.

So, you’re gonna get health benefits just in general from exercise, but as far as for MPN patients specifically, some of the things that we’ve seen with our yoga studies, which is obviously a form of physical activity, is that we’ve seen sleep improve in MPN patients, so we’ve seen a reduction in sleep disturbances or disruptions in their sleep, a quicker time to fall asleep, and then, less waking up throughout the night – so, just better sleep in general.

We’ve seen some reductions in fatigue that have been reported by MPN patients who have gone through our yoga studies, and then, we’ve also seen a few other reductions in some other symptoms, such as anxiety and reduced depressive symptoms, a little bit of reduced pain is another one we’ve seen. So, just in general, we’ve seen some of those effects on MPN patients through some of our yoga studies.

Dr. Huberty:

So, in terms of adding to what Ryan just said, I would just say that exercise – maybe yoga or walking – is good for your body. It’s good for your health. It’s a recommendation that we get 150 minutes of moderate-intensity activity every week. The more that MPN patients can be achieving that goal towards 150 minutes – yoga counting at that – the better off they’re gonna be, and it doesn’t have to be going for a run.

It can simply be going for a walk around the block. It can be standing at your desk when you’re working instead of sitting all the time. That’s not necessarily activity per se, but it is moving your body and less sedentary. So, I think just focusing on the more that patients can move their body every day, the better off they’re gonna be.

Dr. Huberty:                

So, yeah, the role of diet in MPN patients – so, this is the beauty about the quality of life study group, because we have all these wonderful investigators that are part of the team, and we do have Dr. Robyn Scherber, who’s at Mays with Dr. Ruben Mesa. She’s doing some work with keto diet right now, so it’s very new, so I don’t know if you’re familiar with the keto diet, but it’s very high-fat and very low-carbohydrate, extremely low levels of carbohydrates. I wouldn’t tell any patient to go start doing those things unless they’ve talked to their physician for sure, but we do know that based on how you eat does certain things to your body.

So, MPNs have high inflammatory markers, and so, we wanna decrease inflammation; we probably wanna eat foods that are going to be anti-inflammatory. So, berries, let’s say, is a good example of fruits that are anti-inflammatory, almonds are anti-inflammatory, and I’m not a dietitian by any means, it’s just that things that I know to be true for my own diet because everybody should be thinking about having an anti-inflammatory diet.

Processed foods are not healthy. They are higher-inflammatory. Breakfast foods, eating out, and the foods that you get when you eat out a lot are going to be more inflammatory than not. So, just those small things – lots of vegetables. Vegetables are very good. Lots of greens. But, there is research going on – again, just like exercise and yoga, it’s in its infancy because MPN has been an under-studied population for years, and we’re trying to power through and make that difference.

Tackling Medicine’s ‘Taboo’ Subjects

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Many people feel reticent to speak about their personal medical problems and for 3% of Americans, the problem is so extreme that they feel they cannot speak to a doctor at all. While most concerns lead to nothing serious, there will be occasions where an inability to speak up can lead to further problems. Empowering people to feel confident is important, and there are stages to breaking down the barriers to this.

Improving Awareness

One important step to creating a safer environment for speaking freely is through improving awareness over conditions. Simply put, there are almost no conditions that significant numbers of people won’t have experienced and that doctors won’t see as run of the mill. Diseases concerning sensitive parts of the body and, similarly, venereal disease, are a good example of this, with literally millions being diagnosed every year according to the CDC.Despite this, studies have shown that many men and women are reluctant to discuss their symptoms with doctors.Teaching awareness of these sorts of facts, and outlining how nobody is going to judge, is an important base layer.

Getting Information Out There

Part of the reasons some people will refuse to approach a doctor is through fear of diagnosis, or of invasive diagnostic processes. A great way to combat this is through having as much medical information available online as possible. Services like Mayo Clinic and Healthline have done a lot to aid this in recent years, but more work can be done, especially with more obscure conditions.

De-Stigmatizing

Most crucial is the process of de-stigmatizing all illness. Regardless of the cause, condition or outcome, illness remains the same and should be treated with sensitivity. The effect of stigma on illness is clearly felt. Anonymous polls of men by the NCHS found that 10% of men had experienced feelings of anxiety or depression, but less than half had sought treatment. This fear of stigma has led to men being 3.5x more at risk of suicide than women. De-stigmatizing is key, both for mental health and for conditions across the board.

Illness should never be something to be ashamed or scared of broaching the subject of. Instead, it should be something that people feel confident and free to talk about with a doctor, with no worry of abuse or shame. Through awareness, dispersing information and tackling stigma, society as a whole can create an environment in which people of all ages are happy to pursue their medical issues.

Resources:

https://health.usnews.com/health-news/patient-advice/articles/2014/07/01/how-to-overcome-extreme-fear-of-doctors

After Cancer, Ambushed By Depression

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At some stage in all our lives there comes a time when feelings of sadness, grief or loneliness gets us down. It is part of being human. And after all, what’s more human than feeling down after such a life-changing and stressful event like cancer? Most of the time, we bounce back; but what happens when the blues stick around and start to interfere with our work, our relationships and our enjoyment of life?

Dana Jennings, whose writings in the New York Times about his treatment for prostate cancer, so eloquently captured the mix of feelings which cancer survivors face after treatment ends, wrote that while he was “buoyed by a kind of illness-induced adrenaline” during treatment, once treatment ended, he found himself “ambushed by depression.”

Jennings’ words will have a familiar ring to many of us who have struggled with that unexpected feeling of depression and loneliness that creeps up on us after treatment is finished. For some survivors, depression kicks in shortly after diagnosis or at some stage during treatment; for others it may ambush them weeks, months or even years after treatment ends.

What Causes Depression?

Depression is a word that means different things to each of us; people use it to describe anything from a low mood to a feeling of hopelessness.  However, there is a vast difference between clinical depression and sadness. Sadness is a part of being human; it comes and goes as a natural reaction to painful circumstances, but it passes with time. Depression goes beyond sadness about a cancer diagnosis or concern about the future.

In its mildest form, depression doesn’t stop you leading your normal life, but it does make things harder to do and seem less worthwhile. At its most severe, the symptoms of clinical depression are serious enough to interfere with work, social life, family life, or physical health.

Incidence of Depression in Cancer Survivors

Research shows that cancer survivors are more likely than their healthy peers to suffer psychological distress, such as anxiety and depression, even a decade after treatment ends. Although estimates of the frequency of depression in cancer patients vary, there is broad agreement that patients who face a disruptive life   event like cancer have an increased risk of depression that can persist for many years.  While most people will understand that dealing with a chronic illness like cancer causes depression, not everyone understands that depression can go on for many months (and even years) after cancer treatment has ended.

The Challenge of Identifying Depression in Cancer Patients

Some research has indicated that depression has been underdiagnosed and undertreated in cancer patients.  This may result from several factors, including patients’ reluctance to report depression, physician uncertainty about how best to manage it, and the belief that depression is a normal part of having cancer.

Several of the characteristics of major depression listed below– like fatigue, cognitive impairment, poor sleep, and change of appetite or weight loss—are hard to distinguish from the common side effects of cancer treatment. This makes it harder to tease apart the psychological burden of cancer, the effects of treatment, and the biochemical effects of the disease.

Are You At Risk of Depression?

Depression can occur through a combination of factors, with some of us being more prone to depression than others.  Factors such as a history of depression, a history of alcohol or substance abuse, and a lack of social support can increase the risk of depression in both the general population and among cancer patients.

Even if a person is not in a high-risk category, a diagnosis of cancer is associated with a higher rate of depression, no matter the stage or outcome of the disease.

Distress over a cancer diagnosis is not the same thing as clinical depression – it is important to recognize the signs and get treatment. The first step is to identify if you are experiencing symptoms of depression.

Try answering the following two questions.

Have you, for more than two weeks (1) felt sad, down or miserable most of the time? (2) Lost interest or pleasure in most of your usual activities?

If you answered ‘YES’ to either of these questions, you may have depression (see the symptom checklist below). If you did not answer ‘YES’ to either of these questions, it is unlikely that you have a depressive illness.

Depression Checklist*

(Tick each of the symptoms that apply to you)

  • Trouble sleeping with early waking, sleeping too much, or not being able to sleep
  • On-going sad or “empty” mood for most of the day
  • Finding it hard to concentrate or make decisions
  • Feeling restless and agitated, irritable or impatient
  • Extreme tiredness and lethargy
  • Feeling emotionally empty or numb
  • Not eating properly; losing or putting on weight
  • Loss of interest or pleasure in almost all activities most of the time
  • Crying a lot
  • Losing interest in your sex life
  • Preoccupied with negative thoughts
  • Distancing yourself from others
  • Feeling pessimistic about the future
  • Anger, irritability, and impatience

Add up the number of ticks for your total score: _______

What does your score mean?

  • 4 or less: You are unlikely to be experiencing a depressive illness
  • 5 or more: It is likely that you may be experiencing a depressive illness.

NB This list is not a replacement for medical advice. If you’re concerned that you or someone you know may have symptoms of depression, it’s best to speak to your doctor.

Depression – The Way Forward

It’s common to experience a range of emotions and symptoms after a cancer diagnosis, including feelings of stress, sadness and anger. However, some people experience intense feelings of hopelessness for weeks, months, or even years after diagnosis. If you continue to experience emotional distress from your cancer, it’s very important to know that help is available, and to get the help you need.

The first step on the path to recovery is to accept your depression as a normal reaction to what you have been through –don’t try to fight it, bury it or feel ashamed that it is there.  Think of your depression as just another symptom of cancer. If you were in physical pain, you would seek help, and it’s the same for depression.  There are many people willing to help you but the first step is to let someone know how you are feeling. Finding the courage to talk to just one person, whether that’s a loved one, primary care physician, or specialist nurse will often be the first step towards healing.

The psychological effects of cancer are only beginning to be studied and understood. In time, doctors will not only treat the body to kill the cancer, but will treat the mind which suffers the consequences of the disease long after the body has healed. When you’re depressed it can feel like you are barely existing. By obtaining the correct medical intervention and learning better coping skills, however, you can not only live with depression, but live well.

A Note on Helping a Loved One with Depression

Perhaps you are reading this because you’re concerned about a loved one who might have depression.   You may be wondering how you can help. For people who have never experienced the devastating depths of major clinical depression, it may be difficult to understand what your loved one is going through. Depressed people find it hard to ask for help, so let your friend or family member know that you care, you believe in them and that you’re there for them.

The best thing you can is to listen. Don’t offer preachy platitudes about things never being as bad as you think, or suggesting the person snap out of the depression. Our culture doesn’t encourage people to talk about their emotional pain. We’re taught to suppress our feelings, not to show weakness, to get over things quickly. Most people, when they feel upset, benefit greatly by talking to someone who listens with empathy and without judgment. Most of the time the person who is depressed is not looking for advice, but just knowing that someone cares enough to listen deeply can make all the difference.

*References: American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed (DSM-IV). Washington, DC: APA, 1994; and, International classification of diseases and related health problems, 10th revision. Geneva, World Health Organisation, 1992-1994.