Quality of mind matters

Fighting cancer triggers a staggering variety of emotions. It takes a tremendous level of strength to face uncertain outcomes, and feelings of loss, anxiety and depression can be overwhelming. While such emotions can be expected after a life-changing diagnosis, the Psychiatry and Psychology Consultation Service has been targeting cancer-related distress and helping people find strength for more than two decades.

The service, now part of the Seattle Cancer Care Alliance, helps patients who are struggling with emotional, behavioral or cognitive problems during the entire spectrum of the cancer experience, from prevention to end of life.

Cancer patients face many unique challenges — such as dealing with medications that can have adverse affects on emotion and cognition — that can be extremely frustrating, said Dr. Jesse Fann, service director. "The lack of certainty and loss of control in one's life, particularly with the diagnosis and treatment of cancer, can lead to very significant distress," he said.

Cancer-related distress requires a high level of expertise to deal with complex medical and psychological issues, and the service is capable of taking those challenges head-on, Fann said. "All of us on the team have expertise in treating not only patients with medical illness, but patients with cancer specifically. We partner with patients in developing a treatment plan and use both pharmacologic and nonpharmacologic treatments in helping to maximize functioning and quality of life."

The service was created at the Hutchinson Center in 1985 to help bone-marrow transplant patients get through their treatment, but with the opening of the SCCA, it expanded to include all SCCA patients. Since then, the number of people seeing a mental-health expert has increased exponentially as awareness of cancer-related distress and the service's visibility have increased. Comprised of two psychiatrists and three psychologists, the service sees patients at about 1,000 appointments annually, which range from a one-time consultation to ongoing psychiatric care. Fann estimates the clinic sees about 250 new patients every year. "We're definitely growing," he said.

Clinic staff members hope to continue that growth through partnerships with new initiatives being developed. By teaming up with new clinics such as the Cancer Prevention Clinic, the LIVESTRONG Survivorship Center of Excellence and Palliative Care, the service could have a greater reach. "Right now, we're a referral service, but I think where we're heading is to be able to be more proactive about recognizing distress among our patients. Hopefully, through a more universal screening process, we can actually recognize and treat the distress earlier and prevent the development of crisis situations," Fann said.

After receiving a new referral, the psychiatrists and psychologists establish regular communication with the referring teams to share assessments and recommendations. Whenever possible, the teams talk before the first meeting with the patient. The referring providers are copied on every note concerning the patient and kept abreast of any developments. If issues are more complex, the teams have a face-to-face meeting to ensure the best possible care. "We really see ourselves as an integral part of the team approach at the SCCA," Fann said.

Holistic care

Being part of the team means going the extra mile, such as conducting rounds with the Breast and Ovarian Cancer Prevention Program. Fann emphasizes the importance of the clinic's integration with the wide range of care offered by the SCCA, such as the Pain Clinic, social-work services and pastoral care.

Such services are proving critical as time progresses. Due to developments in medicine and better knowledge of diseases, cancer patients are living longer, but there are a number of issues related to long-term survival. Patients must often deal with ongoing fatigue, depression and sleep difficulties, which take their toll. "That's why our service tries to work very integrally with the primary-treatment team and other support services," Fann said.

While the teamwork with other departments is crucial to providing holistic care for patients, the psychiatrists and psychologists of the service must also rely on one another. "Each of the members of our team also has specific expertise, so we often work collaboratively with each other to provide each patient with the most comprehensive care," Fann said. Areas of expertise include mood and cognitive disorders, medical fears and anxieties, sexuality and relationship problems, and survivorship issues.

Strength in the face of cancer

For instance, one of the service's clinical psychologists, Dr. Sylvie Aubin, focuses her research and clinical work on helping patients and their spouses who are struggling with couple and sexual issues as a result of cancer diagnosis and treatment. In addition, she facilitates a monthly support group of five to 10 spouses and partners of patients who help each other through such challenges and other life changes. "The access to other spouses to see what they are going through provides a great sense of validation and emotional relief," said Aubin. By giving the spouses support and providing them with concrete strategies to deal with the issues they're facing, Aubin hopes to help improve the couple's quality of life.

Caring for the whole person is a big part of what happens at the Psychiatry and Psychology Consultation Service. Taking care of the mind is equally as important as taking care of the body during treatment, and Fann said the determination he sees in patients is moving. Friends and colleagues often ask him if working with cancer is depressing, but he believes the strength found in patients is one of the best parts of the job. "I actually find it quite inspiring," he said. "The level of strength in the patients that I see is incredibly rewarding and inspiring to me, and that's what I enjoy the most."