Joey Wahler (Host): It is an important part of a cancer patient's journey. So, we're discussing psycho-oncology. Our guest is Dr. Ateaya Lima. She's a psychiatrist. This is Jamaica Hospital Med Talk. Thanks so much for joining us. I'm Joey Wahler. Hi, Dr. Lima. Welcome.

Dr. Ateaya Lima: Hi, Joey. Thank you for having me.

Host: Great to have you aboard. This is a unique topic that probably doesn't get enough attention. So, speaking of which, you provide psychiatric services to a very niche group, namely cancer patients. So, can you explain in a nutshell exactly what psycho-oncology is?

Dr. Ateaya Lima: Absolutely. So, the diagnosis of cancer comes with a significant emotional burden, concerns about recurrence, adjusting to physical changes, philosophical questions surrounding meaning, death and dying. The field of psycho-oncology is designed to address these deep emotional concerns through specialists in psychiatry, trained in brain and behavior psychology, trained in understanding thoughts, feelings, and emotions, social work with understanding of the environmental dynamics, spiritual services and palliative care services. These services come together to support patients in their cancer journey.

Another interesting part about psycho-oncology is that we also address factors that may influence cancer risk and outcome. For example, lifestyle such as smoking, diet, exercise, so much research is showing that stress has an adverse effect on immune systems, causes biological changes in pathways, and actually can cause progression or occurrence of cancer. So, our field is also designed to reduce the stress that can lead to these conditions.

Host: And so, when you talk about offering what really seems like a whole package of services psychiatrically under one umbrella, psychiatrically and otherwise, how unique are the services that you offer when you compare it to the overall world of psychology?

Dr. Ateaya Lima: It is relatively rare. A few cancer centers have a dedicated psycho-oncology team. But we at Jamaica Hospital offer all of these services, and we offer a lot of these services in the same space as our oncology colleagues. We coordinate our mental health visits with oncology visits.

For example, a patient may come in for a chemotherapy infusion that can last hours. And during that time, our psychotherapist will be engaging the patient in therapy. Our patients love that. It reduces their stress incredibly. And our goal is to make accessing mental health services as easy and seamless as possible. We offer virtual services. We offer individual therapy, group psychotherapy, in-person, and virtually.

Host: And so, what first drew you to this rather unique field in the first place?

Dr. Ateaya Lima: So, what drew me to this field is really I've always had a fascination with how the mind and body is connected, how psychological states can affect physical health, and physical health can affect psychological states. And my call to psychiatry was really the possibility of helping my patients experience positive emotions such as joy, happiness, peace, even as they face adversity. It's not the absence of psychiatric symptoms that I strive for. It's the presence of these positive emotions.

So, a cancer diagnosis has both of these qualities, the medical complexity and the diagnosis itself has so much fear around it, so much doom and gloom. And I find this to be the ultimate challenge.

Could I accompany my patients through these extremely difficult moments and help them experience and preserve positive emotions? Is that possible? And the answer is absolutely. I've seen it happen, and it's an amazing thing.

Host: Yeah, definitely sounds like it. And we can hear the passion in your voice. So, speaking of fear, Doctor, that's just one of them. What are some of the other feelings or emotions that cancer patients typically encounter?

Dr. Ateaya Lima: Absolutely. So, there's a broad range of emotions they experience, and fear is definitely one of them. You have shock in the early phases of the diagnosis and you have anxiety, about the treatment and outcome and side effects. You have feelings of anger, guilt, about why this disease happened to you, what you did to bring it to yourself. And then, there are feelings of loneliness, isolation. Depending on the type of cancer and the procedures you undergo, you may become limited in the things you were once able to do. It may cause you to lose a sense of your identity and, of course others: feelings of hopelessness and loss of meaning; thinking, "What's the point?" So, there are so many more, but these are the most common ones that I come across.

Host: In your experience, what would you say is the main similarity and then, in contrast, the main difference between providing psycho-oncology care as you do with traditional psychiatry?

Dr. Ateaya Lima: So in traditional psychiatry, we address a broad spectrum of mental, emotional health issues like anxiety, trauma, substance use, mood disorders, psychosis. Psycho-oncology does all of that, but the focus is tightly tied to the cancer journey. We grapple with how illness, treatment, and survivorship affect mental health; how cancer can cause psychiatric symptoms unmask underlying psychiatric illness or even be a presenting symptom of the illness. For example, pancreatic cancer can actually present with depression.

So, especially unique to our field is also the philosophical or existential dimension. Our patients struggle with mortality, finding meaning of their life, which is not common in traditional psychiatric care.

Host: Yeah, that's a great point. I can certainly see where that would be the case. Now, you also offer an innovative service called meaning-centered psychotherapy. And so, what is that and how did you come to offer that?

Dr. Ateaya Lima: Yes. We offer this very unique type of therapy. It was designed and developed by a psychiatrist named Bill Breitbart at Memorial Sloan Kettering. It helps patients who experience hopelessness, loss of identity, questions about meaning at the end of their life. It's a structured therapy that focuses on identity, who we are beyond the illness, the legacy we leave behind, what we give to the world, how we experience love, beauty, relationships, the attitude we have moving towards unavoidable suffering, and so much more. This type of psychotherapy has been shown in research studies, and patients have reported that it helps people feel a greater sense of purpose brings peace.

So with our affiliation with Memorial Sloan Kettering, my team of psychotherapists and I have received training in this special therapy, and we offer it to our patients in some form.

Host: Cancer patients, as you well know, often face issues going beyond just their physical and mental health. You touched on some of that a little earlier, Doctor. So in addition to your services, can you tell us a little bit more about what other advice you offer to cope with the diagnosis?

Dr. Ateaya Lima: So, one of the things that I ask my patients to do is to stay engaged in activities they value in their life. Sometimes the condition can limit those activities. For example, if you love to play sports, you may not be able to do it for a while. So, there are alternative ways of engaging with sports, maybe watching sports, but that's just one example.

To stay engaged with the things that brought you joy is key to sustaining yourself through these difficult times. And then, to remain connected with supportive people and communities, whether spiritual, social. This human connection is so essential to preventing that feeling of loneliness and isolation.

And I also recommend that my patients develop a mindful practice like meditation or journaling to connect with something deeper within themselves. But there are so much more to say, but these are the main ones.

Host: Gotcha. And you mentioned among what you just talked about, the human connection. And following up on that, it's also important in this situation for a patient to have a strong system. So, what kinds of tips can you offer to a loved one of a cancer patient to help them get through a very difficult time?

Dr. Ateaya Lima: Yes. Cancer is experienced not just by the patient, but everyone around them. And what I tell my caregivers and other family members is that listening without judgment is very important during this time to allow the patient to have a space to just express their feelings and thoughts. And then, to educate themselves about the specific cancer, the treatment, from reliable sources, by speaking to the oncologist to have the necessary information and not make assumptions.

And then, self-care is so important. This is a marathon, not a sprint. So, it's important for caregivers to really take care of themselves, pay attention to themselves, reach out for help if they need help. And finally, being a steady presence, it's really most important. Being a compassionate presence often makes the biggest difference.

Host: Yeah, going through cancer is definitely a family affair. And so, couple other questions for you. First, how can someone learn more about these psycho-oncology services offered a Jamaica Hospital?

Dr. Ateaya Lima: We offer the service through the oncology department so you can reach out to the oncology department. Also the psychiatry department would be able to connect patients to us. And we're also on the website for Jamaica Hospital.

Host: All right. And then, in summary here, Doctor, you've done such a great job here of breaking down some of the details about what you and yours offer. What's your main message to those joining us overall about the benefits of psycho-oncology? What do you want the main takeaway to be for them?

Dr. Ateaya Lima: I think the main takeaway is that mental health is a critical part of cancer care. it's a vital part of healing.

Host: Well, folks, we trust you are now more familiar with psycho-oncology. Dr. Lima, keep up all your great, very unique work. And thanks so much again.

Dr. Ateaya Lima: Thank you. Thank you for having me.

Host: Absolutely. And for more information, please visit jamaicahospital.org. And if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for being part of Jamaica Hospital Med Talk.