Proactive Psychosocial Support May Improve Mental Health in Oncology Care

The conclusion of active cancer treatment marks a significant milestone, yet it often initiates a new set of psychosocial challenges. Although medical teams excel at addressing the cancer itself, clinical social worker Kelly Dyckman, MSW, LCSW, from the Navesink Wellness Center, highlights a critical gap in care: The information provided to patients regarding these posttreatment issues is often reactive, not proactive.

Dyckman notes that when complex information about potential complications—such as body dysmorphia, increased anxiety, or sexual health changes—is presented immediately following a major event such as surgery, the patient’s capacity to process and retain it is severely compromised. The patient is already "hijacked" by the immediate experience, making the valuable information less effective. Although providers may hesitate to "overwhelm patients," the feedback Dyckman receives suggests that a lack of proactive communication can ultimately be a disservice.

Dyckman argues that a proactive approach transforms the conversation from a sudden, overwhelming reaction to a collaborative discussion. By normalizing the possibility of these psychosocial struggles—from changes to body image to shifts in sexual health—before they fully manifest, the care team can get ahead of an issue even before it arises.

Transcript:

Based on the feedback that I get from many patients, a lot of information is reactive, not proactive. What does that look like for a patient who has surgery, [who is] post surgery, if they are presented with information [that] x, y, or z may happen? You may experience body dysmorphia. [Patients] may experience more anxiety after surgery. [They may feel like they are] already hijacked by the fact that they had surgery, so their ability to process and retain that information is going to be compromised. As a result, while the information being presented is valuable, it’s not going to be retained the same way. Many times, providers do not necessarily shy away from offering more information, but if it does not seem like a necessity, they do not necessarily want to do it, whereas the feedback I get from patients is that having this information would have helped a lot.

I happen to be a mom, and I think about my 2 kids, and had my ob-gyn [obstetrician-gynecologist] not said, “Hey, 2 weeks postpartum, your emotions are going to be all over the place,” I probably would have felt lost, or out of control, or like something was urgently wrong. Had she not been proactive, I would have had a hard time navigating those considerations. Because she was proactive in what she relayed to me about the normalcy of my experience, that helped me out a lot. It did not change the emotional implications I was experiencing at the time. It did help me validate and normalize what was going on and also know the temporality of it.

When I think about the cancer piece, especially that physicians have a wealth of information to offer, patients tend to experience that reactively, not proactively. Proactively, it can be more of a conversation, more of a collaboration, whereas reactively can feel almost discouraging to the [patient], because there’s so much up to the patient, almost because there’s so much overload that’s happening at the time. It can sometimes be a disservice to go about it that way.

I get it. We do not want to overwhelm patients. We do not want to overwhelm families. At the same time, if there is no normalization or presentation of the possibility of these different things happening, then we may miss those opportunities to get ahead of an issue even before it arises.