Shanna M 00:11
It's time to be well with your health. I'm Shanna. Welcome to the Adventist HealthCare & You podcast. And today we're joined with two very special guests Elba Rivas, a social worker with palliative care at Adventist HealthCare White Oak Medical Center, and Natasha Dotrang, a social worker also with palliative care at our other hospital, Adventist HealthCare Shady Grove Medical Center. Welcome. Thank you for coming.

Elba Rivas, LCSW 00:34
Thank you for having us.

Shanna M 00:35
Thank you.

Natasha Dotrang, LCSW 00:35
Thank you.

Shanna M 00:36
We are going to talk about caring for your mental health during and after cancer treatment. Elba, let's start with you. Tell us a little bit about what you do here at Adventist HealthCare and how do you work with cancer patients.

Elba Rivas, LCSW 00:50
My role as the palliative care social worker is to work with patients and loved one as they navigate their hospitalization. So a lot of the patients that we work with unfortunately, it is their cancer diagnosis that's leading to complications for them to be inpatient. So part of the palliative care approach is looking at caring from a lens of physical, spiritual, emotional support.

Shanna M 01:14
Natasha, anything to add to that?

Natasha Dotrang, LCSW 01:15
My role is very similar. We work on a team of multiple people. So we have a physician, a nurse practitioner, and also a chaplain.

Shanna M 01:25
So you all specifically mainly work with cancer patients that have been hospitalized. But do you do anything in the cancer centers that we have as well?

Natasha Dotrang, LCSW 01:33
Yes, we actually do. We just started a meaning centered group therapy. And it's eight sessions and we work with cancer patients who are trying to find meaning through their diagnosis, their journey with cancer, and what's to come.

Shanna M 01:46
I like what you said about physically, mentally and spiritually, because there's so much more to treatment than just the physical aspect of it. Which is what we're here to talk about today, which isn't often really talked about, a stat that I looked up is about 1/3 of patients who are treated for cancer have some sort of common mental health condition and it can happen after diagnosis and during treatment. But oftentimes, and this is the part where maybe it's not talked about a lot is after treatment there is there is some aftermath to deal with and handle. That's what we're going to talk about today. What effect does cancer treatment have on a patient's mental health?

Elba Rivas, LCSW 02:24
Yeah, so when you're dealing with cancer, basically, your life is turned upside down, the day to day routine that you have is now replaced with appointments, follow ups and just physically the toll that the cancer and the treatment itself takes on you as well. The emotional stress, uncertainty and physical pain can take a toll on an individual's mental health, from processing the news of a diagnosis to navigating the plan of care. It is important for cancer patients to focus on both the body and the mind during and after treatment.

Shanna M 02:56
Natasha, anything to add?

Natasha Dotrang, LCSW 02:58
I think even going through treatment also brings up a lot of emotions and a lot of feelings. So even with that initial diagnosis, feeling shock, anxiety, worry, hopelessness and even the loss of identity.

Shanna M 03:13
Okay, what about after treatment? What does that often look like?

Natasha Dotrang, LCSW 03:17
After treatment can be a difficult, difficult part in this whole journey, there's oftentimes less support. So you're seeing your doctors less, less time in the hospital. Your support systems oftentimes can feel as though now you're done with treatment, so you're cured. Right? And a lot of times, that's not the case. So I think the biggest thing after treatment, is that loss of support,

Shanna M 03:42
Okay, how about a caregiver in this case? You know, we talk a lot about the patient, but a caregiver is important here as well, because they're affected just as much. How can cancer treatment impact a caregivers mental health? It could be a family member or a friend, what does that look like?

Elba Rivas, LCSW 03:59
Yeah, and I think this question speaks to the different ways the mind and body can respond to stress. We might have a cancer patient that retreats inward, that is feeling more withdrawn, isolated. That same person can also have more external behaviors that might not coincide with kind of what's going on around them. So I think the uncertainty of how the individual responds mentally to their cancer diagnosis then impacts on how their caregiver responds. So a lot of times they might not exactly know what's going on through their head, not knowing how to help sometimes, putting their own feelings and needs aside to focus on the person with cancer can be stressful. So caregiver burden is very much a reality, the stress or strain felt by the person who cares for the family member or friend who needs help during the treatment or illness.

Shanna M 04:49
It's a hard thing as like as a caregiver or just a friend to figure out what is the best thing to do. How can people improve prove their mental health during cancer treatments? What's available to them or what what should they know to, to look out for seek out?

Natasha Dotrang, LCSW 05:07
There's a lot of services available and it can be daunting in not knowing where to begin. Oftentimes, we do recommend seeking therapy, whether that's individual therapy, group therapy, a lot of cancer support groups have been very helpful for somebody who has cancer. Talking to somebody who may not even be a family member, so whether that is a social worker, your physician to really get some insight on what's going on.

Shanna M 05:41
And I think that's what's one of the things that makes our Adventist HealthCare's Cancer Centers both at White Oak Cancer Center and Shady Grove Aquilino Cancer Center is it's a whole person approach. And so that support is right there. And so you might not realize it's there. But it is and that you can take advantage of those things right on site. What are some other ways patients can cope with anxiety or depression?

Elba Rivas, LCSW 06:06
Just building on what Natasha shared, I think when you're in your cancer journey, you get this new label on you right, which is patient, which might not be a label that you've had before, not having navigated the health care system like that. So I think anything that helps you reconnect with your sense of self, whether it's going on a walk, whether it's listening to music, but things that make you reconnect with who you are, your hobbies and interests, and part of that is there is an adjustment period, because it could be like, well, I used to walk x amount of miles, and now I can barely walk down the block. But the idea is, what are elements of are routine that we had before that, yes, might not look exactly the way that they do right now. But what elements of that can I still try to incorporate in my day to day?

Shanna M 06:54
I love that, because I don't often think about it that way. And I've never gone through that. So that's a different perspective that I never realized is you really can lose your sense of self, because you just sort of come wrapped up in all the appointments and everything that kind of goes with that, and that you might just forget. And so reminding yourself, let's talk about after treatment is over, and people are sort of getting back to their lives, getting back to and beginning a more normal day to day. How does the fear of recurrence impact someone who had gone through that cancer journey? Does that affect their mental health at all?

Natasha Dotrang, LCSW 07:35
That fear and anxiety of recurrence is huge. People who do experience it have anxiety about every single pain, every discomfort that they feel, because it brings them right back to that diagnosis or whatever symptoms they did have before they were initially diagnosed. So even if it is something, a very small pain to somebody who is worried about a recurrence, it can be very, very huge.

Shanna M 08:01
I mean debilitating, probably.

Natasha Dotrang, LCSW 08:03
Absolutely.

Shanna M 08:03
And maybe even some PTSD almost like, right, because it's very traumatic, the whole process. What is the way to cope with that?

Elba Rivas, LCSW 08:12
So I think the first part is having that conversation. Because when you think of fear, it grows bigger, when it's quiet when it's in a dark room. But talking to your friends, talking to your family, talking to your healthcare professional team is a solid good first step, because talking about it helps us acknowledge, assess it and then be able to treat it as well, we don't want that to become even bigger in the future. If it goes untreated.

Shanna M 08:38
That's such great advices. And that can be for anyone who's maybe have have some sort of fear or struggling a little bit with with their mental health is just talking about it. You don't have to be afraid to talk about it, and you're not alone. And so just bringing it out into the open can help bring it down a little bit. So we've talked a little bit about some of the resources and classes and things that we have at our hospitals and cancer centers. Are there other community resources out there Elba that we could share?

Elba Rivas, LCSW 09:09
Yes, there is definitely a lot of support for cancer patients and for their caregivers as well. There's multiple organizations in the community and just to name a few, Smith Center for Healing and the Arts, Hope Connection and Life with Cancer. And just to expand a little bit more on the programs available through Aquilino Cancer Center specifically, there are classes like Gentle Yoga, Mindfulness Based Stress Reduction, nutrition classes, and like Natasha mentioned earlier our Meaning Centered Group Psychotherapy as well.

Shanna M 09:41
I know all of the classes and support groups at our cancer centers, White Oak Cancer Center, Aquilino Cancer Center, are offered free, but I do think some of the, a lot of the resources in the community are also offered for free too, right?

Elba Rivas, LCSW 09:55
Yes.

Shanna M 09:56
Okay. All right. Those are some really nice resources. Thank you. Is there anything else we want to share with our listeners before we wrap up today?

Natasha Dotrang, LCSW 10:05
Yes, I think it's also important to touch on the relationship between a patient and their health care provider.

Shanna M 10:12
Yes.

Natasha Dotrang, LCSW 10:13
And really to talk to your healthcare provider about how you're feeling. A lot of times you'll go to your appointment and talk about all the physical symptoms, but the mental health symptoms are just as important to talk about how you're feeling and and what resources might be available through your cancer center or through your oncologist office.

Shanna M 10:30
They can really help! So don't forget, be an advocate. Tell them how you're feeling. Mental health is just as important as the physical part here. All right. Well, thank you so much. We love having new experts on and we really appreciate your time and all this wonderful information for our listeners today. Thank you for coming.

Natasha Dotrang, LCSW 10:47
Thank you.

Shanna M 10:48
And thank you to our listeners for tuning in today. To find out more information about our experts visit AdventistHealthCare.com, search palliative care. Information will also be available in today's show notes, we'll include some information about some of the community resources we talked about as well. To learn more about Adventist HealthCare's Cancer Services visit AdventistCancerCenters.com. And we'd also love to hear from you our listeners, you can let us know if you like the podcast by leaving a rating or review, or you can email podcast at AdventistHealthCare.com. And let us know what healthcare topics you want to know more about. Don't forget to subscribe to the podcast so you can get all our new episodes. Thank you and be well

Elba Rivas, LCSW 10:48
Thank you.