Eric Singhi, M.D. (Host) Hi, I'm Dr. Eric Singhi, thoracic medical oncologist and assistant professor at MD Anderson Cancer Center. I'm joined today by Dr. Erica Taylor, assistant professor in Psychiatry here at MD Anderson. And this is the Cancerwise Podcast. Hi, Erica. Thanks for being here. 

Erica Taylor, M.D. Absolutely. Thanks for having me. 

Eric Singhi, M.D. (Host) Of course. So, we're here today to talk about why it's so important for our patients with cancer to get regular mental health checkups. Let's jump right into it. Why, why is it so important? 

Erica Taylor, M.D. I think cancer in and of itself, right. It's, it's a huge undertaking. The name alone, you know, the word cancer is terrifying for a lot of people. And either there isn't your own experience with it or your experience with it is marred by what you've seen on TV and social media or a family member or a close friend who's undergone cancer and cancer treatment. So, to come into having a cancer diagnosis already is so overwhelming and so difficult and such a challenge that I think for patients and caregivers to have mental health support and on a regular basis is a huge part of cancer treatment. I consider mental health checkups sort of like dental checkups. I tell my patients, you know, you go to the dentist every six months, right? Maybe if you're not so great every year, your teeth build up tartar. You've got to get him checked out for a cavity, have the tartar kind of just cleaned off. It's just good dental care. Similar for mental health. I think stress builds up over time. The things that we're going through in life build up and it's good to check in on a regular basis, have those appointments, get a little cleanup, get things set up again and continue on your way. 

Eric Singhi, M.D. (Host) Yeah, I really like the way that you framed that: making it routine, trying to break down the stigma that's very much surrounded around mental health. When I'm thinking about and meeting these patients for the first time in clinic, for me, I talk about mind, body and soul and how it's just so important that we take care of all of those components when we're thinking about cancer care. When there's all of these appointments, though, they have to come for infusions, follow-ups, other visits, scans, right. Talk about how you balance that schedule and how you sort of talk to patients about making sure that's really important, that that's incorporated into their schedule. 

Erica Taylor, M.D. When I talk to my patients, especially when they have a heavy schedule burden, appointment burden, I talk to them about, you know, it's risk-benefit. So, that 30-minute, maybe 60-minute appointment, what might you be doing alternatively? Now, if you would be doing something else during that time that you feel like would be beneficial for you, maybe it's something that's going to rejuvenate you, improve your mental health, help you reduce your stress, then that's something to think about. Maybe that time should be used in a different way. But if, you know, during that 30-minute, 60-minute timeframe of your day, maybe you'd be worrying about your diagnosis, worrying about your prognosis, worrying about the scans, having something else on your mind or a different stressor, then maybe that's a 30 or 60 minutes of your day that could be used in the appointment instead and actually be beneficial and come out in a different light. The appointments, I tell my patients that they can really be used as sort of it's a safe space. It's a space that you can go to and really process, unload, whatever term you want to use, but come and put out whatever it is that you're feeling, fearing whatever mix of emotions that you might be having, but that it's a safe space that you can do that in. I think that no matter your support group, no matter the support you have from your family, your friends, your religious group, whatever it might look like that when we talk to our friends, our families, our loved ones, it's always going to be through a filter,, through a lens. No matter how honest we are with those people, there's always going to be this lens of not wanting to hurt them, burden them, worry them, whatever it might be, right. And so even if you have a great support system, having a safe space where you can speak openly, freely, without any lens can be really, really helpful and therapeutic. And that's what we offer in mental health. We offer that safe space. 

Eric Singhi, M.D. (Host) I absolutely love that, really emphasizing that safe space and making sure that you're valuing patients' time. 

Erica Taylor, M.D. Yeah. 

Eric Singhi, M.D. (Host) Let's take a step back. Let's say a patient was just diagnosed with cancer. Where should they start? 

Erica Taylor, M.D. Well, hopefully you've already come to MD Anderson, so you're already off on the right track, right? 

Eric Singhi, M.D. (Host) Yeah. 

Erica Taylor, M.D. And I think the next step in terms of mental health is talking to your provider. It's your oncologist, whoever that first step, first appointment's with, and letting them know if you have any history of mental health problems, if you've ever struggled in the past, if currently if you're struggling at all with your sleep, with anxiety, with fear, worry, and who wouldn't be, right? Letting them know that you are and just being open about it. Letting them know, talking to the social worker about it, and then they can take those next steps to get you resources. And those resources can look like so many different things. It might look like coming to me, to my department, speaking with a psychiatrist. It can look like talking to a therapist. It can look like finding a support group in your network. It can look like AYA, which is our young adults group. It can look like a lot of different things, but finding that support and kind of approaching things with that mental health aspect can just be extremely beneficial. 

Eric Singhi, M.D. (Host) I really like the way you said that too, because I'm thinking of this concept of multidisciplinary care, right? So, conventionally, when we're treating patients with cancer, we talk a lot about not only medical oncology but surgical oncology, radiation oncology. We're so focused on the body, but there's also this multidisciplinary care group all about mental health. So, I love that you plugged in all those resources and we absolutely have them here in MD Anderson. Another question I have for you: Is this something that every patient with cancer should be thinking about and considering, or how do you know if you need to seek out mental health support? 

Erica Taylor, M.D. Yeah, you know, I think that's a great question. I think it's something that every patient with cancer or, I mean, I'm a psychiatrist, so I'm biased. I think that every person should be thinking about and considering, right? I think of it, like I said, from like a dental approach, right? If you have a mind, you should take care of it. If you have teeth, you should take care of them. But I think that for the purpose of our discussion, how to know when it's time or if you need that support: Usually what I tell people is for the most part, when we have stress or a change in our lives, we can struggle and do so for maybe a week or two where we use our own natural, healthy coping skills. Maybe it's going out with your friends more often, taking some time away from work, going more to the gym, exercising more often, changing your diet a little bit so that you're eating more comfort foods to help you feel a little bit better during that stressful time, right. That we have our own coping skills and that usually we can get ourselves sort of back on track within a week or two, that our mood starts to get a little bit better. Anxiety or sleep, whatever was off usually gets a little bit better if you give it a couple of weeks. If after a couple of weeks and you've tried those coping skills that you normally use and it's not starting to get better, and if it's starting to get worse, you're noticing, "Gosh, my mood is still really low. I still feel really anxious. Every day I'm distracted at work. I'm having a hard time sleeping." Whatever it might be, if you're off from your norm and it's been a few weeks, that's when I say probably time to speak up. Probably time to ask for a little bit of help just to get you back on track. 

Eric Singhi, M.D. (Host) No, I like that a lot. Just thinking and being really cognizant of how you are, what's really impacting you, how you're feeling, and if your typical coping mechanisms aren't working, that's that's the time to really reach out, ask for help, feel supported. 

Erica Taylor, M.D. Yeah, and I think the nice thing about that approach to is it, it gives that leeway too, right. And sort of acknowledges and validates the stress and the impact of stress. And so, yeah, it's normal to have that week or two, right, where we have that period, we're not doing so great. 

Eric Singhi, M.D. (Host) Yeah.

Erica Taylor, M.D. That's normal. Being down for a few days, a week, have anxiety a few days, a week, that's normal. It's okay. There's nothing wrong with you. And if it goes longer than that, it's not to say it's abnormal either. It just means that we need a little more support. 

Eric Singhi, M.D. (Host) Yeah. Can I ask you a little bit more about this diagnosis of adjustment disorder, right? So, when you get, or a patient gets this diagnosis of cancer, it's normal, right? Like, as you're saying, to have many different sort of feelings about that diagnosis. And one of the more common diagnoses that we hear is called adjustment disorder. Maybe speak on that and what that looks for, what's like for a patient with cancer. 

Erica Taylor, M.D. Sure. A lot of patients might see the diagnosis of adjustment disorder in their, in their chart. And it typically falls under adjustment disorder with depressed features, adjustment disorder with anxiety or adjustment disorder, with mixed features of anxiety and depression. And I explain it to my patients as that diagnosis just means that you're having some symptoms of depression or some symptoms of anxiety or both due to a stressor, due to something, a trigger. And so, it is to say that if that trigger or if that stressor wasn't present, these symptoms wouldn't be present. And so, it's literally the stressor that has fueled the symptoms of the depression or the anxiety. But you in and of yourself are not having a major depressive episode or a generalized anxiety disorder or other kind of mental health disorder. It's just individually related to the stressor. And a lot of times with cancer, the stressor might not be going anywhere anytime soon, right? And so we can't rely on, we'll just wait it out, right, for us to start feeling better like we can maybe with other stressors, right. At work, "Oh, I got a new job. Well, it's stressful right now, but once I settle in, I'll start to feel better."  "I've got a new baby, but once they start sleeping through the night, I'll start to do better." Right? There's some things that we can sort of wait out sometimes. Cancer, the diagnosis, it's a long journey. And especially even once you're into survivorship, those periods of scans and waiting for, you know, there's anticipatory anxiety there as well. And so the stress can continue even after the diagnosis and after treatment. And so, we don't want to bank on the stressor going away in adjustment disorder. We want to do whatever we can to help boost your coping skills and reduce those symptoms that are causing the depression or the anxiety. 

Eric Singhi, M.D. (Host) Yeah, that perspective is so important that this is really a marathon sometimes for patients, right? It's not a sprint and we have to take care of all of those different components. Mind, body, soul. I keep coming back to that. My patients hear that from me all the time. So, I really appreciate our partnership and just being able to support patients throughout the entire cancer care journey, right? Journey. It's not just not just the sprint. 

Erica Taylor, M.D. Right. 

Eric Singhi, M.D. (Host) You know, the number one question that I get from loved ones, from caregivers is how can I help the patient with cancer? Right? How can I help my loved one? How can I support them? What tips do you have for them? 

Erica Taylor, M.D. Yes, I'm so excited about this question. 

Eric Singhi, M.D. (Host) Yeah. 

Erica Taylor, M.D. I get this a lot too. And you know, the reason I'm excited about it is I don't think it's as intuitive as people think it is. And I really think it's important to highlight that because it doesn't mean that you're not a great caregiver or a great family member or that you're not doing the very best you can because whatever you're doing might not be working. It's just I don't think it's as intuitive as people think it is to be a caregiver, provider to someone who has cancer. I think that naturally the instinct for a lot of people is to ask, "How are you doing? How are you doing? How's it going?" You know, "How's everything going with treatment?" And I find that a lot of my patients really don't like it or they kind of, they shy away from people or their family when they know that that's what they're going to be asked. Say, "You know, it's it's not that they don't mean well. I know they do, but I don't want to talk about it. I'm doing okay. Or maybe I'm not doing okay, but I don't really want to talk about it. And that's how they, you know, every time I call, they ask, they ask how I'm doing." So, a lot of times my advice to caregivers is offering a different approach. So, instead of focusing maybe on the diagnosis or the cancer and how the person is doing with that, looking at how they're doing in other parts of their life. "How's life going? How's work going? How are the kids? How's it going with your husband? What have you guys been doing for dinner recently? I know you've had a lot of appointments. I can't imagine trying to figure out dinner around that schedule. What kind of things have you been doing?" Right? And sort of redirecting it into another aspect of their life so that their life doesn't feel like it's all consumed by cancer. That everything we talk about is cancer. All my friends want to know is how is my cancer? And so finding those other ways to support our patients or your loved ones and an opportunity even, is to find parts of their lives that maybe have been altered or are just not the same anymore and sort of even trying to recreate them or finding alternatives. Right? So saying, for example, "I know we're not able to do X, Y and Z as much anymore, right? We've got chemo three times a week. And so you're not able to go to, with your port, you're not able to go to the gym anymore. I bet that's something that you miss a lot. What do you think we should do instead? What can we do instead? Should we start going on some walks? Should we start doing this? Should we start doing that. What about your life before cancer is different? What do you feel is missing and how can we either recreate it or do something different to sort of fill in that space?" And I think that's a great way that caregivers can show up and support their loved ones through cancer journeys. 

Eric Singhi, M.D. (Host) Wow. These are amazing tips because I feel like people really struggle with being able to show their support, show their love for, you know, their family members for their friends and initiate that conversation. So, the tips you just gave are fantastic to really spark that conversation and still show that support. So, thank you for that. 

Erica Taylor, M.D. Sure. 

Eric Singhi, M.D. (Host) Yeah. Let me ask you another question. So, let's say a patient is really nervous or anxious about seeking out mental health care or mental health treatments. How do you get around that? How do you encourage people to say it's normal? It's okay. Make it part of your routine dental check, right? Like, how do you encourage that? 

Erica Taylor, M.D. Yeah, I think that's it's a great question because I think that a lot of caregivers or the assumption would be that that should be intuitive, right? How do I get my family help that that should be intuitive on how to just encourage them. And I think that a lot of caregivers and family members naturally will tend to say things like, you know, "Oh, it seems like you're having a really hard time. You haven't been sleeping well. You seem like you're just not yourself. You've been really down. Maybe you should talk to somebody." Right? And that comes from a great place, and I don't think it's unhelpful for some patients to respond well to that. But there are some that find that, you know, that kind of approach, some patients find it a little invalidating. You know, that if someone is reflecting on, you know, "You seem like you're having a hard time. You know, you're not doing very well. You're not keeping it together like maybe you thought you would." That that can feel a little invalidating. You know, "I've got a cancer diagnosis. I just had surgery. I'm in chemotherapy. Of course, I'm not doing very well." Right? 

Eric Singhi, M.D. (Host) Yeah.

Erica Taylor, M.D. So, a lot of times what I encourage caregivers to do is take a slightly different approach and look at it more from "I statements." So, saying things like, "I've been having a really hard time with the change to our schedule. You know, chemotherapy is so frequent and it's so hard on the schedule. I can't imagine how hard it must be for you. You're getting the chemotherapy and have the schedule change.". 

Eric Singhi, M.D. (Host) Yeah. 

Erica Taylor, M.D. "I'm really anxious about the scans coming up next week. I'm so nervous. I hope they go well. I think I'm losing some sleep over it. I'm worried about, you know, how the kids are handling all this. It's been really stressful on the family and I think they're doing okay. But I'm a little worried, you know, what do you think?" Right. And I think that those "I statements," they normalize the struggle. They open a space to reflect together. And it's a nonjudgmental way to sort of bring up concern. And it gives that space for the patient to then meet you where they're at. Then you can take it a step further as a caregiver and say, "I'm going to start talking to somebody. This has been really hard for me. I talked to my PCP about this yesterday. I've been having a hard time sleeping and he said that this could be helpful for me. So, I'm going to try some over-the-counter melatonin and see if that helps a little bit." Right. We model the behavior that we want to see for our loved ones. So, a lot of times I just encourage caregivers to make those "I statements" and then do what you're hoping that they'll be able to do and model that behavior for them. 

Eric Singhi, M.D. (Host) I love that. So, normalizing the experience, modeling the behavior, really encouraging that open discussion that it's okay to prioritize, okay to seek out mental health treatment. So, love those steps. Let me ask you, because I'm thinking a lot about my patients, particularly in clinic. So, I see patients with lung cancer here at MD Anderson every day. And I get to meet them, get to meet their families. And I'm thinking about everything we're talking about, particularly young patients with cancer in general. They have so much going on already. They're working. They're primary caregivers often for young kids and really trying to build up their family. They have a busy social life as well, and then they get hit with a diagnosis of cancer. Can you talk a little bit about how you support these patients, particularly who are young, and what can we do as providers as well to help them? 

Erica Taylor, M.D. You know, it's a unique population dealing with the young adults especially what under under 50s, 40s. Right. And I think the first step we take for patients, especially in this population, is, again, it's normalizing, sort of talking through that the experience that they're having and the reactions that they're having, whatever they might be, are normal. Right. And sort of validating that experience. And when I talk to patients about their diagnoses, right, they'll come to me and say, "Oh, do I have depression? Do I have anxiety disorder? Am I going to be on medication for the rest of my life?" And like we talked about the adjustment disorder, a lot of times the diagnosis I find in patients with that population is normal grief reaction. I talk a lot about the fact that you can have a grief reaction even without a loss or a death. That grief can come from the loss of of our normal, the loss of the life that we were supposed to be having right now. The idea that the biggest stressor in my life right now is supposed to be getting my toddler potty trained or starting my new job or retiring or whatever in getting my daughter-in-law, you know, X, Y, Z. That it wasn't supposed to be going to scans and appointments and all of these other things. It wasn't supposed to be cancer. And so, there is that loss of what my life was supposed to be right now and what I expected my life to be, and that that is been taken away from me, oftentimes taken away very suddenly and abruptly. And that grief that we feel at the loss and working through the grief can be a big part of treatment. All the different experiences, symptoms and ways that people go through grief, that can be a lot of what patients are feeling when they feel their anger, their frustration, their depression, their anxiety. They might be manifestations of grief. So, I try to really normalize that, talk them through that grief process, encourage processing through it, and then taking steps like we had talked about before, about how to reach out for support, how to normalize and talk about it, having your provider talk to you about it. 

Eric Singhi, M.D. (Host) I love that. Yeah, I think it's really important just to make sure that we normalize this experience and really encourage people just to step up, advocate for themselves, advocate for their loved ones about mental health. Well, I've enjoyed talking with you so much today on this Cancerwise podcast. For our listeners, if there's a key takeaway for a patient with cancer that's thinking about really prioritizing their mental health, what key takeaway would you tell people today? 

Erica Taylor, M.D. I think the key takeaway would be it's a normal experience. 

Eric Singhi, M.D. (Host) Yeah. 

Erica Taylor, M.D. To step forward with what feels right for you. There's no wrong way to prioritize your mental health. It's going to look different for everybody. So, do what feels right for you and take those steps and incorporate it into your life, your routine in a way that feels easy and replicable for you. It doesn't have to look the same for everybody. And so, if you're wanting to prioritize your mental health, reflect on what it is that gives me that support and then try to implement it. 

Eric Singhi, M.D. (Host) Yeah, that's great. That's fantastic advice. Well, Erica, it's been a pleasure chatting with you today and for creating this protected space for us to talk about mental health. 

Erica Taylor, M.D. Lovely. 

Eric Singhi, M.D. (Host) All right. Take care. 

Erica Taylor, M.D.  Absolutely. Thank you so much. 

Eric Singhi, M.D. (Host) Of course. For more information or to request an appointment at MD Anderson, call 1-877-632-6789, or visit our website at MDAnderson.org. And thanks for listening to the Cancerwise Podcast from MD Anderson Cancer Center.