Stop Ignoring Mental Health in Prostate Cancer Patients
Let's include mental health screening in urology and oncology practices
(About half of men leave active surveillance within five to six years. “Progression” of cancer—more advanced cancer being found—is involved in 30% of these cases. But many make a choice to move on apparently based on anxiety or depression. It’s not an easy adjustment to learn to co-exist with prostate cancer, even if it’s very low-risk.
(More research needs to be done on why some men succeed with AS and others drop out and also on how to help these patients stay on AS longer.
(That said, our friend Richard Maye, a former hospital administrator and an AS patient, has been advocating for mental health screening in men as they go on AS to head off problems in these patients to help them succeed on AS. Please contact Richard if you want to help his efforts to incorporate mental health screening into urology and oncology practices. You can reach him at rmayer1@embarqmail.com)
By Richard Maye
Is living longer the one and only best way to measure successful survivorship for prostate cancer patients? One may think, well, isn’t that enough? Perhaps not if the survivor is clinically depressed and experiences a high degree of anxiety. These debilitating factors can have a profound impact on how the person will experience life day in and day out.
Beginning at the time of receiving their cancer diagnosis, many patients, along with their spouses and family members, will likely experience some degree of depression and/or anxiety. Depending on the degree of severity of the decline in a patient's mental health status, non-compliance with their plan of care along with the inability to understand their disease and make informed decisions will directly impact their clinical quality outcomes and the total cost of care.
It is well documented that coordinated clinical integration models produce superior clinical quality outcomes. With that in mind, more emphasis should be directed toward learning the current and ongoing status of your patient’s mental health. In conclusion of a recent study presented at the 2022 ASCO conference, Risa Liang Wong, of the Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh, said: “Longitudinal screening for depression and anxiety in men with prostate cancer not infrequently identifies men who initially screen negative and subsequently develop significant mental health concerns.”
As a hospital administrator, I was in the position to design and implement a clinical integration model in hospital-employed physician clinics. A behavioral health specialist was placed on-site in the clinics providing support for the patients as well as consulting with the physicians regarding the High Risk-High Cost patients. I witnessed the profound improvement in quality outcomes of care and patient satisfaction as the medical staff saw their most difficult-to-treat patients getting better.
Urology and Oncology service lines should provide the opportunity for each patient to complete two short behavioral health screening tools at the point of entry into your practice. This first step will provide the practitioner with a measurable baseline status of the patient’s emotional state. As the patient travels the care pathway beginning at the point of diagnostic testing, receiving the diagnosis to the discussion of treatment options, and then post-treatment, ongoing monitoring of their mental health status is essential and needs to occur at identified milestone intervals.
The PHQ-9 (Anxiety scale) and the GAD-7(Depression scale) are two well-known behavioral health assessment tools completed by the patient in the office while waiting to see the physician or at home prior to their visit. This self-assessment screening provides several very important advantages:
1) The physician is now aware of the best approach to present the diagnosis and treatment information to the patient;
2) where indicated the patient can be referred to a behavioral health specialist for evaluation and therapy;
3) the patient is an active participant in the shared decision-making process;
4) and better prepared to face life
The July 17, 2022, edition of The Active Surveillor newsletter contained a quote from Dr. Mark Scholz, Medical Oncologist and co-founder of the Prostate Cancer Research Institute. Dr. Scholz said, “Do patients follow your advice? That’s the problem. Once they hear the word ‘cancer’, most of what I tell them after that won’t even be absorbed.”
This is a perfect example of why mental health screening prior to diagnosis and thereafter is absolutely essential in order to monitor the patient's well-being and what is being done about it. It is wrong just to send them out the door and think that after just giving the person the shock of their life that everything is going to be alright.
Implementation of this simple process can serve as the first step to implementing a complete clinical integration model of care. With that in mind, I am asking that those of you who agree with me that it is time to integrate mental health screening in urology and oncology practices to let me know your thoughts and suggestions as to what you can do and what we may do together to achieve the beginning of an integrated system of prostate cancer care.
Each week men are going to be told that they have prostate cancer. They may hear the physician talk about their Gleason scores, risk status, treatment options, and side effects, and the patient is expected to absorb all of this and make an informed decision.
We can do better than this. It is past time to improve how medical staff deal with their prostate cancer patients and to view them as people with emotions and feelings.
Contact me at rmayer1@embarqmail.com
The Active Surveillor newsletter published a two-part series that he wrote on this subject earlier this year and can found at:
Whole Person Care to Better Treat Cancer--Anxiety-Depression (Part I)
Whole Person Care to Better Treat Cancer – Anxiety – Depression (Part II)
This just in: The Prostate Forum of Orange County is holding a webinar “Making Peace with Anxiety” (Perspectives from a cancer survivor) at 7:00-8:30 p.m. Pacific July 28.
Sarah Fenlon-Falk, LCSW, of Sarah Falk Coaching and Consulting, a therapist and cancer patient, will be speaking about how to identify stressors and soothers and rethinking anxiety so it won’t stop us.
Click on: https://us02web.zoom.us/j/85477749453
Join the ASPI program on diet: “Eat to Beat Prostate Cancer,” at 12p.m. Eastern July 30 featuring Dr. William Li, a famed TED talker on diet and cancer.
Free Registration: www.aspatients.org or go direct to: https://bit.ly/3t5lFLx
Free prostate-healthy recipes for all registrants.
More info: info@aspatients.org; or DrDavidKingKeller@gmail.com
Stacy Loeb, MD, of NYU Langone, and Justin Gregg, MD, of MD Anderson, recently presented a webinar on diet and other lifestyle factors to the AnCan group. To view, go to: https://ancan.org/webinar-optimizing-sleep-exercise-and-nutrition-in-prostate-cancer/
Join Dr. Channing Paller, associate professor of Oncology and Urology at Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, and Rob Finch, Director of Urology Medical Affairs at Myriad Genetics as they discuss the impact of genetic factors in prostate cancer and the PROMISE study.
Genetics, the PROMISE Study, and Prostate Cancer: a Town Hall Webinar
July 20, 6:00 p.m. - 7:00 p.m. Eastern Time
Register: https://bit.ly/3ypgAzr
Join a ZERO webinar, Prostate Cancer and the Unique Needs of the LGBTQIA+ Community featuring Anne Katz, PhD, RN, FAAN, of CancerCare Manitoba, Winnipeg. It will July 27, 2022 at 06:30 PM Eastern.
Register here: https://us06web.zoom.us/webinar/register/WN_eUvLX0yNSAmRe5b-ST7zeg.
This mental health topic is a vital consideration for any healthcare journey - but especially for one in the prostate cancer arena.
> the cancer label itself will knock most men and their families senseless because most will think its a death sentence - what do I do? how long do I have? who can I trust? etc etc etc. For the majority, it is not a death sentence - even without treatment.
> waiting for appointments and results is torture.
> some so-called cancers are not cancers - the Gleason 3+3=6 is called a cancer but actually LACKS the hallmarks of a cancer according to both clinical and molecular biology findings.
> many other cancers are slow growing and will be outlived without need for treatment.
> trying to understand the prostate cancer lingo is impossible for many men because of its complexity and because different medical camps recommend different "treatments" - this represents another level of torture.
> trying to empower yourself with knowledge is difficult as most prostate cancer tests and treatments lack irrefutable and reproducible supporting scientific data. Little wonder most patients in the prostate cancer arena are nervous, anxious and depressed - how could you not be with all of this very suspect information?
Thanks, Bert. This is something all patients, families, urologists and other specialists need to consider. Howard