Cancer Survivorship: Response to Diagnosis
Guest: Dr. Cindy Carter – Hollings Cancer Center
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am talking today with Dr. Cindy Carter who is a licensed clinical psychologist and Assistant Professor at Hollings Cancer Center here at MUSC. Dr. Carter, so many people get the diagnosis of cancer and as a psychologist working with these folks, I bet you see a huge range of ways that people react to that diagnosis. And, of course, not all diagnoses are the same or of the same degree of seriousness. What are some of the different responses you see?
Dr. Cindy Carter: Well, I would say that certainly a universal response, simply anxiety. There can be a wide range of how this anxiety may be expressed. Among different people who are diagnosed with cancer, depending on the type of cancer they have, the stage of disease, as well as the type of treatment that they receive, all of the factors can affect the emotional, or psychological, response in people. But, anxiety, which very commonly can be referred to as simply, distress, is fairly common among most people who have been diagnosed with cancer. And, certainly the time of diagnosis is typically a time where we see distress levels increase very quickly.
Dr. Linda Austin: If you do not see distress, does that concern you?
Dr. Cindy Carter: Not necessarily. I think that people have a lot of different ways that they cope. They have different resources. We know some things, such as social support, can be a powerful buffer for the impact of stress and distress on a person who is diagnosed with cancer. I think that we do know, however, most people who are able to talk about their experience, to welcome the support that they receive from other people, tend to do better, or cope better, through the experience.
Dr. Linda Austin: And, of course, there is such a difference, for example, between, let’s say, a young person who has a diagnosis of a very devastating form of cancer with a very poor prognosis and, let’s say, a person who has lived their full life and may have other illnesses. Maybe they get a diagnosis of something like prostate cancer which is very slow growing, much less threatening. So, there is a huge spectrum there.
Dr. Cindy Carter: Absolutely. There is no question that younger survivors do have higher risks of things like depression and anxiety. They simply are dealing with a very serious illness at a time in their lives where they may be still forming intimate relationships. They may be at the beginning of their careers. They may be beginning to have children. So, at a time when they are laying down the foundations of their life, they are forced to deal with a disease that may have profound implications for their future planning.
Dr. Linda Austin: Let’s imagine that a person who is undergoing treatment for cancer, so, early stages now, let’s say chemotherapy or radiation therapy, does begin to have some symptoms of low energy, not sleeping, easy tearfulness, feeling very discouraged. What are some of the recommendations that you would make to that person, as a psychologist?
Dr. Cindy Carter: Ask for help. I would tell them that their experiences are not uncommon. I think it can be a very isolating experience to be a cancer patient. Even though you may have the support of your family, friends, doctors, it can be difficult. We see that it is not uncommon, actually, near the end of treatment when people are beginning to turn that corner. They have made it through most of their treatment. We can see an increase in symptoms associated with depression or anxiety, and that fear of recurrence can set in. Typically, we encourage people to talk about their experiences, to be willing to embrace what they are going through, and understand that this is a normal part of being a cancer survivor. There are a lot of people who are out there to help. Talk with a professional if you feel that you are not really improving over time. Transient experiences of insomnia and feelings of anxiety come and go for many cancer patients. So, if you find that it is staying with you, longer than you want it to, or it is lasting for several days, that might be a real indicator that it is time to really talk about what you are feeling and what your fears are.
Dr. Linda Austin: Can antidepressants be useful for these folks?
Dr. Cindy Carter: Yes. There has been, I think, a great deal of research that has suggested and underscored the importance of addressing psychological symptoms, not only from a behavioral, social, emotional standpoint, but also from a pharmaceutical standpoint. So, cancer patients may find that a short term trial of antidepressant medication may be helpful for them.
Dr. Linda Austin: And, I would think, also, possibly sleep medications, or anti-anxiety medications, for some people might be useful, as well as, obviously, talking to a professional.
Dr. Cindy Carter: Absolutely. In terms of talking to a professional, we have a great deal of evidence that psychotherapy that is cognitive-behavioral in orientation has been shown to be an efficacious treatment in cancer survivor populations, as well as other types of therapy, including group support, family, marital, and individual psychotherapy.
Dr. Linda Austin: My impression is that cancer support groups are less widespread than they used to be.
Dr. Cindy Carter: I think that cancer support groups really have gone through a transformation. We find, at least locally, that support groups are somewhat cyclical in terms of participation. You can develop a support group that has strong participation and involvement for a period of time and then it seems to run its course for individuals. People, perhaps, feel that they have gotten the most that they want from it. A group just simply has an evolving sort of focus, and the goals of the group can change. So, we try to offer short term focus, sort of skill building groups in addition to simply supportive groups.
Dr. Linda Austin: Dr. Carter, thank you so much.
Dr. Cindy Carter: Thank you for having me.
If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection: (843) 792-1414.