During a recent webinar, we asked Integrative Oncologist and Hematologist Dr. Krisstina Gowin at City of Hope a few questions about mental health and cancer. For Mental Health Awareness Month, we’re revisiting the insightful discussion on how integrative therapies can be incorporated into treatment to enhance not only physical well-being, but also emotional well-being. Our integrative oncology webinar recording is also available if you’d like to listen to the full conversation.
The following questions and responses have been lightly edited for grammatical purposes.
1) Can my care team help me cope with anxiety and depression?
Most of the patients I see have some element of depression and anxiety, and it changes according to the trajectory of where you are in your disease. There’s the anxiety of a new diagnosis and feeling so overwhelmed with all of the new therapies, and also the grief that’s associated with the prior life. The prior way of feeling and being of your physical, emotional, and spiritual body, so there’s all that grief and loss that’s occurred with a new diagnosis.
Even in the survivorship phase, there’s a whole new host that comes up. There are survivors thinking, “What do I do now? I’ve been so focused on my treatment that I don’t even know what to do with myself right now because I’m just here waiting for my next mammogram or my next scan. I’m anxious and I’m fearful.”
I think mental health is a huge aspect of cancer care, and [it’s] probably under-treated. We do our best, but I think there’s so much going on for us as providers and as a healthcare team, and also in the patient’s life, where it just kind of gets swept under the rug a little bit. It’s so important for all of us to be asking these questions and to be looking internally and saying, “Okay, am I really dealing with my emotional landscape? Let’s be honest. How am I dealing with all of these changes? Do I need to reach out and get some help?” I would say that’s one critical point that as a team, within healthcare, and from the patient and caregiver standpoint, let’s really raise awareness for this issue. It’s such a big issue and we do what we can to talk about it and address it.
There are definitely things we can do. Going back to the foundational elements of integrative oncology, looking at the landscape of lifestyle, stress management, joy finding, meaning, making and building a support group, all of that helps with mental health. Certainly, there’s a role for pharmacologics. There are some of us who will need that. We can do everything, but the neurotransmitters that you need are just not there. That’s not a failure. That’s why we have those medicines, so I think it’s critical to take pharmacologic therapy with a qualified psychiatrist if necessary.
Finally, there are a lot of integrative modalities that we can do. In our guidelines, mindfulness, yoga, tai chi, and qigong are really well-studied maneuvers as well as cognitive behavioral therapy. I think there’s a lot that can be done, and there’s even more beyond that. It’s definitely an important, critical point.
2) What is reframing and can it help improve mental health?
It’s all perspective, right? It kind of goes back into what we were saying about integrative oncology and how it gives you empowerment. So does reframing. It empowers you that no matter what happens around you, the response to it is what we can change. Reframing, I think, is changing the stress pathway. When we reframe something, it’s no longer activating those central kinds of primal pathways within the brain that then translate into our stress pathways. The HPA axis (which is our adrenals), and the norepinephrine, epinephrine, and cortisol, all of that is tied to how we think about things, how we reframe, and whether or not we see something as a threat or an ally. That’s almost a binary thing we do in our brain. Is this a threat or an ally? Trying to diminish the threatening perspectives and really reframing them into “How did this help me? What am I learning from this?” and being empowered by it, really has the potential to not only help our mental health and our quality of life, but also our biology.
3) Can you tell us anything about psychedelics? Can they help with any cancer side effects like brain fog or depression?
Psychedelic therapy, so things like ketamine, MDMA, and psilocybin, are definitely gaining interest in the community. There are some studies looking at PTSD, for example, and depression. They’re still Schedule I, so it’s very difficult to do these kinds of trials. When it comes to the cancer community, there’s a lot of research that we still need to do before there are recommendations to look into these different therapies for your own use. There are certainly some providers that are out there doing ketamine-assisted therapy, particularly for depression.
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