Counselling and Psychotherapy

Psychological support for those affected by cancer

Psychological distress is common among people affected by cancer and is an understandable and natural response to a traumatic and threatening situation. Patients at every stage in the patient pathway can find themselves dealing with difficult and distressing issues. They can develop problems ranging from sadness or worry to psychological symptom sufficiently intense to interfere with their ability to function on a day-to-day basis. 

People use a variety of resources to respond to this distress, including their own inner resources and emotional support from family and friends. For some patients, however, the level and nature of their distress is such that they would benefit from professional support. 

Around the time of diagnosis about half of all patients experience levels of anxiety and depression severe enough to affect the quality of their life adversely. About a quarter continue to be so affected during the following six months. Among those who experience recurrence of their cancer, the prevalence of anxiety and depression rises to 50% and remains at this level throughout the course of advanced illness. 

Patients and carers are likely to benefit from some form of psychological support whether they experience mild and transient emotional turmoil or severe depression. The psychological support service available at the London Oncology Clinic assesses and helps patients and carers with psychological problems of all types and severity including:

• anxiety, including adjustment disorders, generalised anxiety states, treatment phobias and panic attacks
• depression, ranging from adjustment disorders to severe clinical depression
• problems with personal relationships
• communication with health professionals
• psychosexual difficulties, including erectile dysfunction and loss of libido
• body image problems
• alcohol and drug-related problems

Professor Amanda Ramirez, a consultant psychiatrist who specialises in the psychological management of those affected by cancer says:

"Effective psychological and social support can help patients overcome these debilitating emotions and to regain control over their lives. We support patients and carers to:

Express emotion. Those patients who deal openly with their feelings about their illness seem to do better rather than worse.

Re-order life priorities. The realities of the disease need to be taken into account when managing day-to-day living and planning the future. We work with patients to learn to live as fully as possible within the constraints of the cancer and its treatments and their side effects.

Strengthen relationships with family and friends. Cancer can be a very isolating experience. We encourage patients to discuss problems openly and to be clear with family about what they need and want from them.

Deal with fears of death and dying. Death confronts us all, but for cancer patients it carries a special dread. Anxiety about death is actually reduced when the possibility of death is faced in a direct and supportive manner.

Deal well with doctors. We find there are three keys to cancer patients having good relationships with their cancer doctors: communication, control and caring. We encourage patients to be clear with their doctors about what they need and want from them."

Professor Rob Bor says

"Cancer is not a psychological problem. Nonetheless, most people who are diagnosed with cancer, and a high proportion of their loved ones, experience significant stress during the course of their illness. There is evidence that good emotional and social support can improve health outcomes.

No two people are alike in how they cope and adjust to their cancer diagnosis. Many people report having distressing thoughts and feelings at times. This is normal. However, if these persist, it may be helpful to try to identify negative thoughts. Cognitive behaviour therapy and other modern psychological therapy approaches can help to address and manage your concerns. Anxieties can be explored, unhelpful thoughts redirected, low mood challenged and treated, and positive coping can be promoted.

It is important to learn relaxation techniques as these come in handy both in the treatment suite as well as when one is at home feeling stressed or distressed.

The reactions of family and loved ones to illness can be complex and varied. Some people report that a cancer diagnosis brings them closer to others, while for others, they may feel more distant from some friends and family members. There are practical and effective ways in which to enhance family relationships and open communication around difficult issues with loved ones.

Psychological support, where needed, can help to tackle the emotional challenges of cancer in a sensitive but practical way. Nowadays, psychological therapy has moved on from “Tell me about your childhood …” to “Let’s talk about what’s affecting you the most right now”. It should be practical and relevant. Psychological therapy should target what you are thinking and feeling and how you are reacting in different situations. It should not be prescriptive, but supportive. We recently published a self-help written with the experiences and interests of LOC patients in mind (Coping with the Psychological Effects of Cancer by Robert Bor, Carina Eriksen and Ceiladh Stapelkamp, published by Sheldon Press, ISBN 978-1-84709-097-3). This book provides up-to-date practical ideas and insights into how to cope better with a diagnosis of cancer. The Psychology and Counselling Service at the LOC offers one-to-one, confidential counselling sessions for patients and their loved ones. This could be for a single therapy session or for several, as may be needed."