Question 1

Hello Dr Deshields, my daughter is receiving chemo for melanoma and has no energy right now. Can psychological intervention help with cancer-related fatigue?

Teresa Deshields · Accepted Answer

There is the most extensive evidence base for the use of exercise in addressing fatigue. And this involves a broad view of exercise, including gentler versions such as yoga. Mindfulness has also been studied as an intervention for fatigue. Psychological support can be helpful in strategizing around how to engage with exercise as an individual.

Question 2

I am more anxious about my family members' distress than my own situation with cancer. How can I help them?

Teresa Deshields · Accepted Answer

Excellent question. Whether you are the one with cancer or the family member, it's not unusual to see this sentiment - worrying more about your loved ones than yourself. There can also be significant variability in how well one or the other can cope with the challenges of cancer diagnosis and treatment. I think the most helpful thing is to talk things out, trying to understand each other's perspective and finding ways to support each other. It can also be helpful to get counseling support (for either person) or peer support (through a support group or online resources) if the distress is not resolving.

Question 3

How extensive a role should a psychologist play as the liaison between patient and oncologist, and are there guidelines to assist this role?

Teresa Deshields · Accepted Answer

Great question! My opinion is that it's typically the patient's call. I will typically follow the patient's lead on this. However, if I believe that an interaction with the oncologist will be helpful or that a patient particularly needs advocacy, I will strongly encourage the patient's consent for this. In general, I don't think it's a good thing to be positioned BETWEEN the patient and oncologist.

Question 4

I'm an ACT therapist and have done a few of the Psychwire courses via Russ Harris. I am supposed to start volunteer work for a local charity that provides emotional support for people living with cancer. From an ACT p.o.v., are there additional resources that could help me offer a better service?

Teresa Deshields · Accepted Answer

ACT is a great fit for work with those diagnosed with cancer. There are several helpful resources, and I will mention a few. There is a chapter on ACT by Hulbert-Williams and Owen in the classic reference guide "Psycho-Oncology" by Jimmie Holland and colleagues (published in 2015). There is also a review (The Use of Acceptance and Commitment Therapy in Oncology Settings: A Narrative Review) published in 2018 in Psychological Reports by Fashler, Weinrib, Abid Azam, & Katz. Another review is Acceptance and Commitment Therapy in Cancer: Review of Applications and Findings by González-Fernández & Fernández-Rodríguez, published in Behavioral Medicine in 2019. Thank you for taking on a volunteer role in helping those living with cancer!

Question 5

Do you know of any information that include using EFT Tapping/Emotional Freedom Techniques, to support oncology patients with their symptoms, or to support caregivers? I hope to offer it to a group soon. Thank you!

Teresa Deshields · Accepted Answer

I'm sorry, while I have heard of this, I am not well-versed in these approaches. Something I should look into!

Question 6

What psychological and physical symptoms of cancer would be targeted more effectively with ACT and which symptoms would be better targeted with CBT?

Teresa Deshields · Accepted Answer

In my experience, CBT and ACT can be utilized to address many of the same psychological and physical symptoms. I tend to go back and forth between the two approaches. Sometimes I will have a sense that one or the other might be a better fit for a patient, although I’m not sure I can articulate how that “sense” is derived. Or sometimes I’ll explain to the patient how one might approach the problem from both perspectives and ask if one of the strategies feels more comfortable to them.

Question 7

How can mindfulness practice be utilised to help relieve the experience of nausea from chemotherapy given that the nausea is part of their present moment experience?

Teresa Deshields · Accepted Answer

That does seem like a paradox, doesn't it? I'd explain it like this, with mindfulness, you are observing a sensation (or sound, feeling, etc.) without judgment (e.g. "this is awful"). Sometimes when we strip away the emotional responses to an unpleasant sensation, like nausea, it's not as bad as we thought it was. (This is like the concept of primary and secondary distress.) For some people, regarding the nausea objectively and clinically reduces the distress around it. Of course, it could also be that the relaxing qualities of mindfulness help to soothe the body and thus reduce the nausea.

Question 8

What is psychosocial oncology?

Teresa Deshields · Accepted Answer

The American Psychosocial Oncology Society defines psychosocial oncology as: "a cancer specialty that addresses the variety of psychological, behavioral, emotional and social issues that arise for cancer patients and their loved ones. In the broadest terms, there are two psychological dimensions of cancer. The first is the emotional response patients and families have to cancer. The second are the emotional, behavioral, and psychosocial difficulties that influence living with cancer. Psychosocial oncology is the specialty that addresses all of these dimensions.
https://apos-society.org/people-affected-by-cancer/what-is-psychosocial-oncology/

Question 9

Hi Teresa, in your experience what techniques are best for coping with cancer-related physical pain and nausea?

Teresa Deshields · Accepted Answer

From the aspect of supportive care, there are a number of possibilities. This is certainly not an exhaustive list, but there is good evidence for the use of cognitive-behavioral therapy or acceptance and commitment therapy for pain. There is also evidence for the use of acupuncture to address pain. For nausea, there is evidence for a number of interventions (again not exhaustive) such as relaxation techniques, mindfulness, hypnosis, imagery, and acupuncture.

Question 10

In your experience, what is the best way to approach someone who is focused on the medical side of their cancer and isn't open to psychological interventions?

Teresa Deshields · Accepted Answer

I believe in meeting the patient where they are. If they aren’t receptive to psychological interventions, I try to make sure they know about the options (education), and I leave the door open for them to explore any of these later when/if they are ready to do so. Sometimes the cancer experience is overwhelming enough that people don’t have the bandwidth to take on anything else.

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