Psychological support for patients and their families

Patients with a cancer diagnosis have significant needs that extend beyond just physical – it’s hugely emotional, psychologist Chloe Oliver told a special BCNA Information Forum - Living Well with Breast Cancer – held in Darwin in May 2023.

Chloe has spent the last seven years working in the field of psycho-oncology and palliative care and is based at the Alan Walker Cancer Care Centre (AWCCC) at Royal Darwin Hospital. 

 BCNA’s Living Well Information Forums – being held in regional and rural areas around Australia – are designed to provide information and support to everyone affected by breast cancer – whether they have been diagnosed with DCIS, early breast cancer or metastatic breast cancer. 

Chloe, who works with patients facing a wide range of difficulties including adjustment to diagnosis, anxiety, mood disturbance, identity/self-concept changes, grief and loss, fear of death and dying and fear of reoccurrence, spoke about strategies and tools that can be used to manage the emotional impacts of breast cancer. 

‘We see patients from the point of diagnosis through to survivorship, for those with a metastatic diagnosis during their ongoing treatment or at times when someone may transition to palliative care,’ Chloe said. 'Bereavement support is also provided to family members whenever possible.’   

Therapeutic interventions are provided in line with best practice, evidence-based interventions under psycho-oncology, with the inclusion of Cognitive Behaviour Therapy and Acceptance and Commitment Therapy as primary forms of therapy frameworks. 

‘Being diagnosed and living with breast cancer is filled with an array of emotional and physical experiences, Chloe said. 

Chloe presented at two sessions – one for those with an early breast cancer and those with metastatic breast cancer.

There are unique challenge and factors associated with each of these groups and it’s important this is acknowledged, she said.

'Everything about your life changes – how you identify, the control you felt you had in life, your role with family, your friends, work. If we are only treating the physical; we are only treating part of this.' 

Chloe said the Alan Walker Cancer Centre and cancer care services through Top End Health acknowledge this – and pushed very hard for funding to have psychological services available in house and available through the public system.  

'I think it's fantastic that the centre itself acknowledges you can’t just treat the physical – you have to be looking at holistic care,'' she told attendees. 

'At point of diagnosis – that move from ‘me’ to the ‘cancer patient’ version of me can be one of the biggest adjustments people have to make - going from the way they have lived their life, their chosen work path, the control they have had over their life - that suddenly changes.' 

Chloe said there's no right way to react to this news, that people have individual responses to this. 

'Some people feel shock and confusion, others feel quite numb and that it doesn't feel quite real. Some don't have the big emotional swings they think they ‘should’ be having – and that's OK, there's no right way to do it,’ she said. 

'There’s a lot of things that come with that cancer diagnosis – you have to make a lot of decisions about treatment, about work, what it means for family, how you are going to juggle things and who you should tell and if you even want to tell people.’ 

After the active treatment phase, Chloe spoke about challenges of the active recovery period.

'For many people, at the point of diagnosis emotional stress can sit quite high – obviously, they’ve just had a huge diagnosis,’ she said.

‘They just want to do something about it and for treatment to start as soon as possible. For some, during active treatment that emotional stress can reduce somewhat once they’ve started treatment.'

'There can be a sense of relief they are doing something to target the cancer once treatment has commenced and the focus shifts to getting through the treatment and managing physical side effects.'

‘But moving from active treatment to the recovery period can feel they have gone from ‘cancer patient’ – to what? They are left with feelings of: What do I do now? Who am I? How do I want to identify? How do I want to live life? Have my attitudes, beliefs, values shifted?'

'Emotionally there’s a lot to do in that space. It’s huge. They might be thinking this doesn’t feel good, my body feels like it has gone through the wringer. I thought this would be better – what’s wrong with me that I don’t feel grateful, relieved and happy like I thought I would?’

'Active recovery is when people need to give themselves time without having that pressure to ‘bounce back’.' 

Chloe also spoke about fear of recurrence to those in the early diagnosis presentation group. This is when many people became hyper-vigilant of any signs of something going wrong.

‘While this is ‘normal’ there are still strategies we can use to ensure the reaction to these thoughts and worries don’t become reinforced over time.’

For the metastatic group automatic thinking examples were given around fear and anxiety in the lead up to re-staging scans.

To illustrate the impact of reacting to some automatic thoughts and worries as being ‘true’, Chloe took attendees through cognitive behaviour therapy techniques, including understanding the impacts of negative thoughts and triggers and strategies to manage these.