The Invisible Side of Cancer Treatment

This Mental Health Awareness Month, the conversation around cancer care is shifting. While oncology has traditionally focused on physical survival, the field is seeing an increasing shift towards a holistic approach that treats mental wellness as a core component of care. In this discussion, Dr. Joseph McCollom and Dr. Jasmin Hundal highlight a critical truth: a cancer diagnosis impacts not just the body, but the mental, emotional, and spiritual health of the patient.

The Power of Quantification

One of the most significant barriers to addressing mental health in a clinical setting is its perceived subjectivity. To combat this, Dr. McCollom advocates for the use of research-validated tools like the PHQ-9 and GAD-7. These tools allow clinicians to track progress in a way that mirrors how they monitor physical health. As Dr. McCollom noted, “They allow us to quantify the unquantifiable.” 

Beyond providing data, these screenings are essential for identifying those who might otherwise suffer in silence. Clinicians often face time pressure, focusing on treatment toxicities and scan results, but Dr. McCollom argues that skipping mental health check-ins is a missed opportunity for life-saving intervention. He emphasized, “If we don’t screen, we won’t find it. And if we don’t quantify, it’s hard to be able to show that measurable change.” By making these questions standard, oncology teams can identify patients who are struggling with issues as severe as suicidality, preventing tragedies before they occur.

Normalizing the Whirlwind

The initial phase of cancer care is often described as a blur of trauma. Dr. McCollom compared the experience to a sudden accident, stating, “Some of my patients say that it feels like a car accident—this diagnosis hit them out of nowhere, and all of a sudden there was a flurry of tests, scans, and biopsies.” In this environment, it is natural for patients to feel overwhelmed or to only absorb a fraction of the information provided to them. 

During Mental Health Awareness Month, it is vital to destigmatize these emotional responses. Dr. McCollom often reminds his patients that feeling overwhelmed is a logical reaction to an illogical situation. “It's reasonable to feel anxious. It's not a mental illness,” he explained, referencing a patient facing a life-altering recurrence rate. Taking away the stigma allows patients to focus on "mental wellness" as a resource for their journey rather than viewing their emotions as an additional "illness" to be cured. 

Survivorship and "Scanxiety"

The end of active treatment does not signify an end to mental health challenges. In many ways, the transition into survivorship brings a new set of stressors, such as body dysmorphia, social distress, and "scanxiety"—the acute fear that arises before and after follow-up imaging. Dr. McCollom pointed out that the fear of cancer recurrence is incredibly common, and patients often experience it at home without disclosing it.

Furthermore, he noted that mental health manifests differently across the patient population. Observations in his practice show that while some patients may be tearful, others show distress through frustration or a lack of drive. “Do you feel like your ‘get up and go’ got up and left? That is asthenia, a lack of drive that could be an indicator for depression.” Understanding these varied manifestations allows for more personalized and effective care.

A Holistic Approach to Lifestyle

Mental health does not exist in a vacuum; it is deeply intertwined with physical symptoms and lifestyle habits. Dr. McCollom described "symptom clusters" where pain leads to poor sleep, which leads to irritability, which eventually leads to social isolation and deeper depression. Addressing one physical link can often trigger a positive emotional chain reaction.

He challenged patients and providers to remember that humans are multifaceted. “It’s important to discuss with patients that we are holistic beings. We have a body, a physical body, but we also have a mental, emotional, social, and spiritual self, and they are all interconnected,” he stated. Simple interventions—like standing-and-sitting exercises or sleep hygiene rituals—can be as impactful as pharmacological therapy.

Navigating the Digital Double-Edged Sword

In the modern era, social media plays a massive role in how patients process their diagnoses. While it can build "beautiful communities," it also leaves patients vulnerable to misinformation spread by influencers who are “profiting off of the harm of patients going through cancer.” Dr. McCollom’s motivation to be active on social media stems from a desire to be a source of truth. 

“Anybody with a camera can go on there, and some individuals are just plain misinformed,” he warned. Instead of letting patients be steered away from medical care by eye-grabbing headlines, he encourages them to bring what they see online back to their doctors. As he concluded, “I want you to know everything I know. I want to educate you. That's my role as a doctor.”

Key Takeaways

• Quantification is Key: Using validated tools like the PHQ-9 helps make mental wellness a measurable, tracked part of standard care.

• Normalize the Response: Anxiety following a diagnosis is a "situational" response, and removing the stigma helps patients engage with support.

• Identify Symptom Clusters: Mental health is linked to physical pain and sleep; treating one often improves the other.

• Watch for Varied Signs: Depression isn't always tearfulness; it can manifest as a lack of drive, irritability, or changes in appetite.

• Be a Critical Consumer: Social media is a tool for connection, but patients should verify medical advice with their clinical team to avoid harmful misinformation. 

About the Speakers

Jasmin Hundal, MD, MS, MPH, is a second-year Hematology/Oncology Fellow at the Cleveland Clinic in Cleveland, Ohio. Previously, she completed her Internal Medicine Residency at the University of Connecticut. Dr. Hundal’s main area of interest is the overlap between cardiometabolic health and cancer, particularly for breast cancer patients and survivors. Outside of work, she enjoys traveling, cooking, and hiking.

Joseph McCollom, DO, is a Palliative Oncologist and a Gastrointestinal Medical Oncology Physician at Parkview Cancer Institute in Indiana. He specializes in the treatment of patients with gastrointestinal cancer and the use of cutting-edge treatments to improve outcomes. Dr. McCollom serves as the Medical Director of Palliative, Survivorship, and Integrative Oncology at Parkview, and is he is passionate about integrating palliative medicine throughout the cancer care journey.