Psychosocial oncologists: a critical niche in the field

Cancer is the second most common cause of death in the United States, according to the American Cancer Society (ACS); the organization expects 1.6 million new cases will be diagnosed in 2013. While medical treatment is paramount in managing a cancer diagnosis, psychological intervention also plays a key role.

Ellen Dornelas, Ph.D., director of the behavioral health program at the Helen & Harry Gray Cancer Center at Hartford Hospital and associate professor at the University of Connecticut School of Medicine, sees a huge need for more psychologists to work with cancer patients. Whether the prognosis is poor or good, psychologists have the necessary tools to treat distress, anxiety, depression and a host of other emotional issues, which are “part and parcel of a cancer diagnosis,” she says.

The ways in which psychologists can bring their expertise to the table vary, depending on the situation. Intervention requires an integrated approach that might consist of psychotherapy; support; cognitive behavioral therapy; or individual, family or group therapy. “Treatment spans a range as it would in private practice. Having many tools is really useful,” she says. “Each case requires a different approach. You need to focus on understanding the source of the patient’s distress.”

The settings in which psychologists deliver care also vary. Inpatient care for those undergoing chemotherapy and/or radiation may alleviate stress and anxiety; outpatient therapy may help individuals deal with body image and sexual functioning issues following reconstruction surgery and fear of recurrence. And those with a poor prognosis may require help in both settings to face the demands of the treatment regimen as well as cope with anxiety, grief, depression and existential issues related to imminent end of life.

Lately, the growing trend toward genetic testing raises new questions. “There are huge psychological ramifications for these individuals,” Dornelas says. “People have to make heart-wrenching difficult decisions as more and more genetic screening becomes available.”

Moreover, the psychologist’s role extends beyond the patient and family. Tenuous relationships between patient and members of the medical team may call for the skills of a psychologist to help bridge a communications gap. Nurses who work closely with cancer patients can also benefit from some form of psychological assistance on occasion.

Rose Colletti, Ph.D., who works at the Cancer Patient Support Program, part of Fletcher Allen Health Care in Burlington, Vermont, says that as the number of survivors grows, the demand for post-cancer psychological care will increase. “Community providers will be an important area in the future.”

The National Cancer Institute reports that as of January 2012, there were 13.7 million cancer survivors; by 2022, that number will jump to 18 million.

Colletti says, “Once treatment has been completed, there are still practical, family, emotional, spiritual and physical issues. It takes a long time for the body to heal. Whatever treatment is, it takes at least one year for the body to get back into feeling normal.”

That treatment may involve individual therapy, as well as some form of group therapy. Colletti points out that a number of different group models exist, including diagnosis-specific and gender-specific. However, groups don’t seem to be as appealing as they were 20 years ago. Colletti notes that she does much of her therapy via phone. She says some patients choose other modalities including mindfulness, chair yoga or Reiki.

Colletti emphasizes the importance of including the family and caregivers in post-treatment therapy. “Sharing with others is beneficial. Cancer doesn’t just impact the patient. It impacts the entire social network,” she says.

The profession will receive a boost in 2015 when the American College of Surgeons Committee on Cancer will require cancer centers to implement psychological screening and refer patients for further assessment if necessary. “This exemplifies that physicians recognize if people are having distress, it gets in the way of potential treatment,” Colletti says.

Psychologists interested in working in oncology typically begin their careers in community mental health and then find a niche in a health psychology field. Such was the case for Nancy Frumer Styron, Psy.D., interim director of the health concentration at the Massachusetts School of Professional Psychology (MSPP), who has a private practice in Lexington and works at The Children’s Room, a support center for grieving families in Arlington. “The health psychology concentration brings about greater awareness of health and illness and well being and how those relate to lifestyle choices and changes,” she says.

Although MSPP does not offer a program that specifically addresses oncology, Styron teaches several sessions on working in oncology based on her professional experience in pediatric oncology at Dana-Farber Cancer Institute for more than 20 years and seeing patients privately. “I use case examples throughout the course,” she says, emphasizing that this field requires teamwork to address physical, psychological and spiritual needs of the patient and family.

Student internships provide an opportunity to explore the discipline and help build an experiential foundation. “The last two years, an MSPP student interested in oncology might work in a behavioral health clinic or a hospital. Some MSPP students work at college counseling centers or even the prison unit at Shattuck Hospital. At a hospice, the students train in end-of-life care,” says Styron.

Internships in an oncology setting offer hands-on training and seminars that explore cancer-related issues, various therapies and new research findings. “Students learn specifics about cancer diagnoses from doctors during their clinical internships. They learn about the different cancers and treatment options,” Styron says. “They learn about the psychological aspects related to illness and treatment as well as feelings of isolation. There is an interweaving of medicine and psychology.”

Additionally, students begin to value working as part of a medical team as they attend medical rounds, become familiar with the language, consult with patients and family. “All of these skill sets around illness and health involve issues like response to diagnosis, decision making, treatment options, end-of-life care and survivorship,” Styron says.

Oftentimes, a cancer diagnosis takes a patient by surprise so psychoeducation is important. “It can teach patients about the illness and what may happen to them,” Styron says, adding that patients and family are better prepared to make choices for themselves or their children when they understand the illness.

Although working with this population can be emotionally draining, it can also be extremely rewarding, Colletti says. “This is meaningful work. I’ve learned more about living with dignity from working with cancer patients.”