A cancer diagnosis is a life-altering event. Patients often experience anxiety at the time of diagnosis, at the onset of new treatment regimens, when transitioning from active treatment to follow-up care, and at annual follow-up visits with their health care provider once in remission. Patients may also develop symptoms of depression during or following any of the phases of the cancer experience. It isn't uncommon for nurses caring for patients and their families to feel unprepared to assist them through the emotional reactions to this experience.
A comprehensive nursing assessment of the oncology patient includes assessing for a history of depression, anxiety, or posttraumatic stress reactions before the cancer diagnosis. A patient with these histories may be at higher risk for developing depression or anxiety in response to the cancer experience.
Ongoing assessment of the patient for current symptoms of depression or anxiety is essential. Keep in mind that patients may not directly report these symptoms to you—but, they may verbalize physical complaints or a decreased ability to function on some level. And, patients may present with complaints of insomnia, fatigue, anorexia, nausea, weakness, or palpitations. They may also report decreased interest in usual activities, isolating themselves at home, feeling like a burden to their caregivers, or having feelings of worthlessness or hopelessness.
You might observe patients being irritable, nervous, sad, angry, uncooperative, or noncompliant with treatment. Caregivers may directly or casually report that patients are having difficulty coping when at home, despite their presentation in the outpatient clinical setting.
Although many of these symptoms may be expected responses to cancer treatments, it's still important to further assess the severity of the patient's symptoms, and evaluate if those indicators or if decreased functioning in everyday activities may be an abnormal emotional response to the cancer experience.
It is critical to recognize symptoms of anxiety and depression in oncology patients, and differentiate which symptoms would respond best to additional supportive care and which would be most effectively treated with medication and professional counseling.
How a Nurse Can Intervene
Nursing interventions that may be effective in bringing relief to patients and families experiencing emotional distress related to the cancer experience include:
- Providing education regarding the patient's diagnosis, treatments, and expected physiologic responses to help alleviate fear of the unknown;
- Providing time for the patient to ask questions and for listening to the patient's stories;
- Validating the patient's experiences, feelings, thoughts, and emotions;
- Sitting quietly with the patient;
- Assessing the patient's perceived strengths to access and build on for coping with this difficult time;
- Assessing for the presence or lack of a support system;
- Assessing the willingness, availability, and resilience of the patient's family and friends to serve as supportive caregivers;
- Seeking information and making the patient and family aware of support groups;
- Promoting socialization and support from other patients and families in infusion room or clinical practice areas to decrease isolation during treatments; and
- Advocating for the patient and family while collaborating with the treatment team if a psychiatric consultation is indicated.
When Outside Help Is Needed
It's critical to engage the treatment team if you suspect your patient may be experiencing an abnormal emotional response. There may be other factors such as pain, infection, or complications from the treatment regimen contributing to the patient's presentation. Many cancer treatment centers have a nurse, social worker, or psychiatrist available for consultation who can help further evaluate the patient if an abnormal psychological or emotional response is suspected.
There are many agencies and nonprofit organizations dedicated to serving and supporting those recently diagnosed with cancer, undergoing cancer treatment, or living as a cancer survivor, including:
- Imerman Angels: One-to-one peer support for patients and caregivers (www.imermanangels.org)
- Ulman Cancer Fund for Young Adults: Support, education, and networking for young adults affected by cancer (www.ulmanfund.org)
- Lance Armstrong Foundation: Working globally to improve the lives of people with cancer (www.livestrong.org)
- National Coalition for Cancer Survivorship: Survivor-led cancer advocacy program (www.canceradvocacy.org)
- American Psychosocial Oncology Society: Referral program aimed at connecting cancer patients and their caregivers to psychiatrists, psychologists, nurses, social workers, and counselors skilled in the management of cancer-related distress (www.apos-society.org).
Adapted from Nursing made Incredibly Easy! 2011;9(4):55-56