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Emotional and psychological impact

Dr. Alan Bates, MD, PhD, FRCPC

Dr. Alan Bates finished a PhD focused on neuroimaging at the University of Nottingham before completing his MD and Psychiatry residency at UBC. He has also completed a fellowship in Psychosomatic Medicine and Psycho-oncology at Memorial Sloan Kettering Cancer Centre in New York. Dr. Bates has published peer-reviewed articles on topics ranging from brain imaging to delirium to palliative care and has a special interest in incorporating physical fitness and teamwork into treatment for psychiatric illness. His volunteer work has been recognized through honours including a Queen Elizatbeth II Diamond Jubilee medal and participation in the Vancouver 2010 Olympic Torch Relay. Dr. Bates is also the Provincial Practice Leader for Psychiatry at the BC Cancer Agency and a Clinical Assistant Professor in the Department of Psychiatry at UBC.

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Dr. Mark Katz

Dr. Mark Katz is the Provincial Head for Psychosocial Oncology (PSO) at Cancer Care Ontario and Co-Medical Director for the Psychosocial Oncology and Palliative Care Program at Stronach Regional Cancer Centre in Newmarket, Ontario. He is a Staff Psychiatrist and Medical Director of the Psychiatric Consult Liaison Service at Southlake Regional Health Centre in Newmarket, and is the founder and Director of the Rapid Assessment for Psychopharmacologic Treatment (RAPT) Clinic at Southlake. His academic and clinical interests have included depression in cancer, psychosocial aspects of head and neck cancer, depression in the medically ill, and mood disorders in general. He is an Assistant Professor in the Department of Psychiatry at the University of Toronto.

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Dr. Christine Maheu, RN, PhD

Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.

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Ms. Rosemary Cashman

Ms. Rosemary Cashman is a nurse practitioner at the BC Cancer Agency and an Adjunct Professor in the Faculty of Nursing at the University of British Columbia. Her professional experience includes the care of lymphoma, lung cancer and brain cancer patients. She co-chairs the Patient and Family Advisory Council, which guides the brain tumour care program at the BC Cancer Agency. She has authored book chapters and articles related to the care of brain tumour patients and their families. Ms. Cashman was involved in developing and implementing a rapid-access radiotherapy clinic for the palliative treatment of lung cancer and she continues to work in this clinic.

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Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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A cancer diagnosis can have a profound effect on our mental and physical health bringing on changes in our feelings, roles, relationships and on our finances. The experience of cancer can be a truly life-altering experience that can lead us to have new priorities and see life in a different way at times. This new way of seeing life can bring about positive changes in our lives, but it can also be disruptive and painful, and it is not uncommon to feel distressed, anxious and sad. It is important to take some time to reflect on the emotional and psychological impact that your cancer has had on you.

Depression and anxiety are common in people recently treated for cancer who are trying to make the transition back to work as part of a return to the “new normal”. In fact, some cancer patients who have been emotionally strong through painful treatments like surgery, radiation, and chemotherapy will experience great difficulty with depression and anxiety once they are done treatment and recovering physically. It is so common that there are some theories about why this happens. Some call it the “vacuum effect” because one may go from having lots of support with lots of contact with the healthcare team during treatment to far less post treatment. This vacuum effect also may result from perceiving less support coming from family and friends who may not believe everything is “okay” and may not be as available for support. You also have less frequent visits with your family doctor and nurses, with them saying “see you in a few months” instead of “see you in a few weeks” that can further lead to this vacuum effect. Even when there is no evidence of cancer remaining, it can be disconcerting to feel that there may be cancer somewhere and be feeling like little is being done to actively “fight” it.
Some who fear a recurrence of their cancer may have difficulties setting goals for the future which can include work-related goals (for more information on fear of cancer recurrence see the 30-minute talk video on this topic by Dr. Christine Maheu, co-lead of the Cancer and Work website). Additionally, people with cancer often experience a kind of surreal feeling related to friends and co-workers having just gone about their regular lives while so much was happening for the person with cancer. There is often a feeling that others just don’t “get” or feeling “disconnected to others” after what one has been through. Another reason for depression and anxiety when one is anticipating a return to work is that there might be lingering effects of cancer treatment that may affect work performance.

Some people take longer to recover from chemotherapy and may suffer from prolonged fatigue or cognitive challenges also known as “chemo brain” or “brain fog”. These challenges can affect memory concentration, multitasking or decision-making. Other challenges following the end of cancer treatment can include changes in mood, persistent low energy, painful pins and needles, all affecting one’s ability to work. These additional challenges can contribute to distress if people feel pressured to return to work before they are ready and able.

Another reason why a return to work can be stressful for people is that they may have linked getting cancer with the stress of their job, and they may be fearful of returning to the same environment that they believe caused their cancer. Finally, people may be concerned with what to say to colleagues when they return from a medical absence, how much to share and whether they will become emotional when they return to work. The symptoms of depression and anxiety described below can also directly affect work performance and coping at work. Fortunately, depression and anxiety are treatable conditions, and there are many resources available to make improvements on one’s own or with the assistance of a mental health professional.

What can you do to improve your emotional stability for the return to work process

Speak to your healthcare team early on about concerns regarding return to work. Ask about resources like a vocational counselor, psychologist, psychiatrist or social worker who might be able to work with you on your return to work transition. These resources may be available at your cancer treatment centre, through your work employee assistance program or insurance provider.

Tell your healthcare team if you are noticing changes in your mood. Just like physical health problems, mental health challenges are easier to manage when detected early.

Don’t be afraid to see a psychiatrist if another doctor suggests referring you to one. Psychiatrists are experts in mental health and can recommend treatments that will not interfere with any cancer treatments you may still be undergoing. Contrary to common belief, psychiatrists do not only treat depression and anxiety with medications. They also use psychotherapy or talk therapy.

Consider seeing a psychologist. Psychologists are generally not able to prescribe medications and are often not covered by provincial health plans. However, they are experts in psychotherapy or talk therapy, which is often the best treatment for mild to moderate depression and anxiety. Depending on local resources, there may be psychologists on staff at your cancer treatment centre who provide services free of charge.

Try a medication for depression or anxiety if one is recommended by your oncologist or family doctor. Family doctors treat many people with depression and anxiety and are often very familiar with the most commonly used medications.

Communicate with your employer about what you can and cannot do. Employers are often very willing to make appropriate accommodations, but cannot do so if they do not know what your limitations are. Your doctor can support your needs with medical documentation as long as you have discussed this with them. If you are on long-term disability, your insurance plan may allow for a consultation with a vocational rehabilitation consultant to become involved to help develop and implement accommodations within a return to work plan. Examples of accommodations can include starting out with part-time hours that include modified duties.

Don’t say yes to everything. Sometimes you have to decline taking on another task at work if you know it is ­­oing to be too much. You may not be able to multitask as well as before or take on as many projects as you did before during your initial return to work.

Advocate for retraining or refresher courses if you have been away from the job for a long time.

Delegate tasks. Are there other people at your workplace who can share some of your workload?

Try to detoxify very negative thoughts about the work environment. There is no evidence  that normal work or life stress causes cancer. Returning to work can help you move on from your illness experience.

Learn relaxation exercises focused on breathing, visualization/guided imagery, or muscle tension and relaxation. Many guides or tutorials are available on the internet.

Exercise. Research has repeatedly shown that 30 minutes of moderate exercise (e.g. a brisk walk) per day provides substantial physical and mental health benefits. The 30 minutes could be 1 x 30 minutes, 3 x 10 minutes, or 10 x 3 minutes. As long as you get about 30 minutes in a day, research suggests you will get the health benefit. There are many strategies for turning sedentary time into exercise time. For example, one can march in place during TV commercials, get off the bus a few blocks early, park further away from the destination, window shop at the mall before entering any stores, etc.

Practice good sleep hygiene: Getting an 8 hour sleep per night provides means to reenergize the physical and mental stamina of the day.

Seek diversion. Make a list of things you can do for 20 to 30 minutes to distract you from difficult emotions. Or use a diversion list that has already been made for you.

Connect with nature. Spending time outdoors can be helpful for one’s mental health.

Spend time with friends. It’s easy to isolate oneself when feeling depressed or anxious. Breaking the cycle of isolation by getting out and spending time with friends will improve your mood and make you less anxious about doing it next time.

Reach out to a friend at work even before you return to work.

Resources:

Moodgym

Antidepressant Skills Workbook

If you struggle with a fear of cancer recurrence, view this video – Living with uncertainty: Discussing the fear of cancer recurrence (30 mins)

The Feel Good Handbook – Using the New Mood Therapy Every day (1989) by David Burns published by William Morrow

Mind Over Mood by Greenberger and Padesky, a Cognitive Behavioural therapy workbook for anxiety and depression

The Mindshift app

See also other resources under workplace wellbeing.