Counseling for cancer patients and survivors

DEFINITION: Counseling involves the services and service providers available to help people with cancer, those who have survived cancer, and their families cope with the physical and psychological effects of the illness, during and after medical treatment.

Why counseling might be needed: Those diagnosed with cancer and their families face many complex issues at all stages of the illness. The experience of being diagnosed with and treated for cancer changes every aspect of life: The person suddenly is faced with combating a disease with an uncertain outcome. Patients must strive to cope with the physical aspects of cancer, including pain, fatigue, and treatment side effects, as well as psychological and emotional issues, such as fear, stress, anger, denial, change in physical appearance, loss, death, anxiety, and even guilt. Families and caregivers also experience intense emotional reactions. In addition, the person with cancer may need to address financial and legal issues, spiritual issues, and the practical aspects of living with cancer. Together, these emotional and practical concerns often are referred to as psychosocial issues.

Thus, a person who has cancer (and their family members) may seek counseling for help with a specific issue or feeling (such as death), for support in working through the many emotions encountered throughout treatment, or simply to “talk through” the experience with someone else and to retain a sense of meaning in life. It is important for both the patient and family to understand that seeking help to address these issues can be beneficial and often requires a great deal of courage.

Emotional and psychological problems: Some patients might encounter psychological problems resulting from cancer treatment. Depression, for example, can be caused by some types of chemotherapy. In addition, patients inevitably experience emotional reactions to physical changes created by some types of cancer therapy, such as hair loss or weight changes. Sometimes, emotional or psychological problems can create physical reactions, such as a rapid heartbeat, tense muscles, or insomnia.

Further emotional difficulty is created if a patient must face the disease and treatment without any emotional support. In contrast, other patients may be surrounded by family and friends but nevertheless feel isolated and lonely.

The person’s “developmental stage” will affect how they feel about and deal with the emotions surrounding cancer. Children and teenagers, for example, experience different emotions from adults. In short, each patient experiences different emotions and reacts differently. These emotions, as well as an overwhelming feeling of helplessness and lack of control over life, may affect the person’s ability or motivation to seek medical or psychological treatment. The emotions themselves often feel very foreign to the person experiencing them, and this alone can introduce additional fear and anxiety.

Reactions of family and caregivers: Family, friends, spouses, parents, and colleagues—indeed, everyone involved with the person who has cancer—is affected by it and responds in their own way. It is important that those involved understand that everyone’s reactions affect one another, including the patient. For instance, family members may experience fear and anxiety, just like the patient, but may keep it to themselves to “protect” the patient. Often, this lack of communication between caregivers and patient may be more damaging than helpful. It is equally important to address the emotions experienced by the family to benefit both the patient and family.

Problems with practical issues: Many practical aspects of life may be affected by cancer. These include financial difficulties, as well as problems with employment, education, and obtaining healthcare services. Addressing these problems can help patients and families feel some sense of control in their lives despite the uncertainty of cancer.

Types of counselors and what they do: Many types of counselors and counseling services are available to help cancer patients and their families. Yet, there is so much information available, it can be difficult to know where to begin to find help and what type of help different service providers can offer.

• Medical staff involved in the patient’s care may help patients address some of the issues listed above. Yet, there are many people who are trained specifically to address the emotional, psychological, and practical issues that patients face. These service providers may be employed by hospitals, government agencies, or private organizations or work in private practice.
• Genetic counselors help people who are concerned about inherited forms of cancer and their family’s or their own risk for certain types of cancer. Training includes a master’s degree with work in medical genetics and counseling. Many genetic counselors also are certified by a professional board.
• Medical social workers help patients find and access various services (such as financial advice or at-home care) needed during and after treatment. Some social workers also may be trained to help patients and families address emotional issues. Training includes a bachelor’s degree and usually a master’s degree in social work (MSW) and state licensure.
• Mental health counselors work specifically with the emotional and psychological issues affecting patients and families. The counselor may work individually with the patient and/or with the patient’s family members. Some counselors specialize in working with illness-related issues. Training usually includes a master’s degree in psychology or a related area (MS or MAP) and state licensure.
• Nurse practitioners are registered nurses who have completed additional training (usually a master’s degree) in managing specific medical conditions, including cancer. The nurse usually provides medical services but also may advise patients on psychosocial issues. Often, nurses talk through issues with patients during medical checkups or treatments.
• Oncology nurses are registered nurses (with advanced certification or a bachelor’s degree in nursing) who specialize in working with cancer patients. These nurses provide a broad range of medical services, which also may include addressing psychosocial issues.
• Pastoral counselors address emotional and psychological issues affecting patients and families within the context of a specific religious orientation. Training includes a master’s degree in psychology or divinity (MDiv), with further state licensure (often in marriage and family therapy) and certification by a professional board.
• Psychologists are trained specifically to address emotional and psychological issues and to diagnose psychological problems (for example, major depressive disorder). Training includes a doctorate (PhD) in psychology or related area with state licensure.
• Psychotherapists are trained specifically to address emotional and psychological issues through talking with the client. Psychotherapists often work with patients primarily to address aspects of meaning and emotion in the patient’s life, and they work secondarily with specific psychological or behavioral symptoms. The psychotherapists are not licensed to prescribe medication, but they often work with people who are taking medication for mental health problems. Training includes a master’s degree, usually in psychology (MAP), and state licensure.
• Psychiatrists usually focus specifically on psychiatric and psychological disorders that require medication and are caused by a physical process (for example, brain cancer that is creating behavioral difficulties). These providers are medical doctors (MDs) who specialize in mental health. Some psychiatrists focus mainly on diagnosing conditions and prescribing medication rather than on counseling.
• Volunteers are key in many organizations, providing services such as support groups, Internet chats, or telephone hotline services. Often, the sponsoring organization provides brief training for these volunteers, and in many cases the volunteers have had some personal involvement with cancer or with cancer patients.

Types of counseling services: Counseling services can include individual sessions with the providers mentioned above; group sessions with other patients or family members, led by a mental health professional; support networks available by phone or by computer; and organized activities or classes led by volunteers or by trained professionals.

Bibliography

Carr, Brian I., Jennifer Steel. Psychological Aspects of Cancer: A Guide to Emotion and Psychological Consequences of Cancer, Their Causes and Their Management. New York: Springer, 2013.

Cousins, Norman. Anatomy of an Illness as Perceived by the Patient. New York: Norton, 1979.

Fiore, Neil. The Road Back to Health: Coping with the Emotional Aspects of Cancer. Berkeley: Celestial Arts, 1990.

Granet, Roger. Surviving Cancer Emotionally: Learning How to Heal. New York: Wiley, 2001.

Holland, Jimmie, and Sheldon Lewis. The Human Side of Cancer. New York: Harper, 2000.

Marshall, Catherine A. Surviving Cancer as a Family and Helping Co-survivors Thrive. Santa Barbara: Praeger/ABC-CLIO, 2010.

Periasamy, Ummavathy, et al. "Effects of Counselling on Quality of Life among Cancer Patients in Malaysia: A Randomized Controlled Trial." Iranian Journal of Public Health, vol. 49, no. 10, 2020, pp. 1902-1911, doi.org/10.18502/ijph.v49i10.4693. Accessed 12 Jun. 2024.

“Psychosocial Support Options for People with Cancer.” American Cancer Society, 9 June 2023, www.cancer.org/cancer/survivorship/coping/understanding-psychosocial-support-services.html. Accessed 12 June 2024.

Schneider, Katherine A. Counseling about Cancer: Strategies for Genetic Counseling. Hoboken: Wiley, 2012.

Siegel, Bernie. Love, Medicine, and Miracles. New York: Harper, 1986.