Joey Wahler (Host): It's a crucial part of their journey, so we're discussing support for cancer patients. Our guest is Patsy Astarita. She's Director of Oncology Integrated Health at UM Upper Chesapeake Health and the Kaufman Cancer Center.

Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. Thanks for joining us. I'm Joey Wahler. Hi there, Patsy. Welcome.

Patsy Astarita, LCSW-C: Hi, thank you for having me.

Host: Great to have you with us. So first, what would you say are the most common emotional responses people typically have when managing a cancer diagnosis?

Patsy Astarita, LCSW-C: Well, they are very individualized because each person arrives to this experience with their own history, but there are some common ones. Some of the more common initial reactions are shock or disbelief. And then, we often see worry and anxiety, just a sense of feeling overwhelmed. For some people, there's sadness or depression, and sometimes you can experience a sense of loneliness or disconnection and being set apart from others.

Host: So, obviously runs the gamut there, and certainly understandably so. That being said, what coping strategies do you recommend for patients that are managing those mental and emotional challenges?

Patsy Astarita, LCSW-C: Well, first of all, recognize that what you are experiencing is not easy. And so, having very strong emotional reactions or even no reaction because you may be in shock is normal. So, it's really important to be kind to yourself and give yourself some grace and a chance to really absorb what you're hearing and take it in.

Finding a trusted loved one or friend to be there for support where you can share some of your emotions or just have a second set of ears is very helpful because we don't always hear things after we hear it's cancer. Sometimes remembering that there are other challenges going on in your life. And so, that can be difficult as well. So, trying to prioritize yourself, your self-care, making sure you're eating and you're getting rest, and just looking for that support. It could be in the way of friends and families, it could be in the way of a professional, and it may be nice to connect with others when you're ready in, say, a support group setting.

Host: And speaking of support, how would you say you and yours help these cancer patients handle this wide range of emotions?

Patsy Astarita, LCSW-C: Well, one of the first things we do is we ask how you're doing. We have a process of what we call distress screening, and distress is multifactorial. So, you know, when you hear you have cancer, it's not just physical distress, it's emotional, it's psychological. It can impact your relationship, your work, as well as your finances, or your spiritual or existential sense of well-being. So, it's important to ask about it, and that's what we do. And then, secondly, making our patients aware that we have lots of resources, and we have a multidisciplinary team that are specially trained to help people get through the experience of cancer.

Host: When we talk about the ways in which a cancer diagnosis can impact a person's relationship with their family and friends, what are some of the common strains or other impact in that regard?

Patsy Astarita, LCSW-C: Certainly, it really depends on your age and what you have going on in your life. So for example, a younger person may be worried about employment. "Am I going to be able to work through cancer?" "How am I going to communicate with my co-workers or my supervisors?" "Am I going to be able to perform my job?" because that in turn impacts potentially their source of income.

Maybe you're a young parent and you have a young child at home. "How is this going to impact my child?" Or the other end of it, maybe you're caring for an elderly parent and you're worried, "Am I going to be able to do this?" So, it really depends upon where that individual is, but knowing that cancer impacts you, not just physically, but your social well-being and every aspect of your life.

Host: So clearly, social support from various sources here plays a huge role in someone's life when they're going through cancer. What advice do you have for patients to build a strong support system and try to tap into that support? Because I would imagine sometimes there are contradictory feelings like maybe being isolated or not wanting to be overbearing. How do you kind of reach out, but do so in a way that's comfortable for you?

Patsy Astarita, LCSW-C: Yeah. You raise a good point. Some people may feel more comfortable being more open about their diagnosis than others. And so, it really is so individualized. Some people proudly wear a ribbon or the color pink and other people, they don't necessarily want to be identified as a patient or someone as having cancer.

So, when you do reach out to people you trust, and it doesn't mean you have to put it on your social media right away, but maybe somebody close to you that you trust and who you're comfortable with, sharing that in a safe way, what that does is it opens up the opportunity for you to receive support. So, we do encourage people to think about at least their immediate circle, who they can look to to support them, whether that be emotional support, or being a sounding board, or accompanying them to an appointment to be that second set of ears, or helping with chores and other responsibilities you have, or really just being a good listener.

Host: You touched on this a moment ago, something that it seems is often overlooked here is how do social workers and the patient's care team support patients in navigating those financial and practical challenges of a cancer diagnosis? Because as you said, oh, by the way, these people still have a life to lead and oftentimes there are other problems to deal with along with the cancer and sometimes the cancer, of course, unfortunately can exacerbate those issues, right?

Patsy Astarita, LCSW-C: No, that's absolutely right. Life doesn't stop because you hear you're ill or you have cancer and you need to go through treatment. And so, people are going through all the other things in their life. And there may be other crises. And cancer has such a major impact because you're going to go through treatment for a bit of time in most cases, whether that's surgery or radiation or chemotherapy. And some of our patients are in treatment for years, and cancer becomes chronic. So, it really does have a major impact. And because it's multifactorial in terms of the types of distress. That's why we have multidisciplinary teams. So, you'll find at most cancer centers and certainly here at Upper Chesapeake and throughout the UMMS Cancer Network, we have not just treatment nurses and excellent physicians who are prepared to deliver that clinical care, but we have nurse navigators who help address overcoming barriers, help you to understand your diagnosis and to navigate the healthcare system.

We have clinical social workers where there may be other behavioral health professionals to help you with the emotional and the psychological adjustment, as well as getting access to meet practical needs you may have, whether it's transportation. And then, here at Upper Chesapeake, we also have financial navigators. And that's the person on the team who helps you understand your insurance. If you have out-of-pocket expenses or you lose your insurance during treatment, which happens sometimes, people are panicked. What do I do? So, we have professionals here who are specially trained to help navigate that, as well as identify resources that may be out there to help.

Host: A couple of other things. It seems like much of this, from the patient standpoint, involves walking kind of a fine line. You want to take care of yourself, first and foremost, of course, and your health and your cancer. But at the same time, you might have a family, a job, who knows what else, any or all of the above. So, how do you balance that?

Patsy Astarita, LCSW-C: That can be very difficult. And I think it takes a team effort. So, depending upon who's in your inner circle and who you identify as your family, having conversations about what your needs are, as well as people are often very worried about their families, because it's not just the individual with the cancer that is impacted, the whole family is or the couple is.

So, making sure you have good communication about what your needs are and helping to balance that with their needs. It's really important for family members to be good listeners. This isn't the time to swap stories or bring out all the issues. But it really just depends on what's going on in that individual family or that individual's life.

Host: So, how can patients and their families find resources to help with this emotional and mental well-being, both in their community and beyond? Where can they turn?

Patsy Astarita, LCSW-C: That's a really good question. And we know, first of all, you should really bring that forth to your treatment team. It's okay to let your doctor and your nurses know that you're having a personal struggle or you have a need so that we can tap into that multidisciplinary team. There's also lots of information online, where you can certainly access information about organizations that provide support. I do caution people when they turn to the internet for information that you want to stick with reputable sites, national reputable organization or government organizations like the National Health Institute, the CDC, certainly the American Cancer Society, and larger medical reliable sites like the University of Maryland site.

And you need to really be careful about researching information online, because keep in mind you don't have your healthcare team there to help you interpret that or understand it. And once you read something that might be upsetting, you can't unknow that. So, you have to really think about what information are you looking for, and is this really going to serve me in trying to cope with what's happening. There are lots of wonderful online support groups as well as in-person groups. So, it's good to, you know, check it out, and certainly, you can do your research online, but just a word of caution about thinking about what you're exposing yourself to.

Host: Absolutely. And in summary, what would you say to those joining us about what you're most proud of concerning you and yours at U of M when it comes to dealing with cancer patients through these various steps and obstacles that we've discussed. What do you and yours really hang your hat on when it comes to this?

Patsy Astarita, LCSW-C: Well, in addition to being just proud of the top-notch, cutting-edge clinical care that University of Maryland delivers throughout our UMMS Cancer Network, I'm very proud of how we take care of the person holistically. We need to support individuals and their family, that's a unit. And it's a long journey. There's a lot you're going through. And we know if we're supporting the person, it's going to enable them to get through that treatment, which may be difficult, to process what's happening to them, and to improve their quality of life and have the best possible clinical outcomes.

Host: Well, it is indeed a team effort. Folks, we trust you're now more familiar with support for cancer patients. Patsy, keep up the great work, and thanks so much again.

Patsy Astarita, LCSW-C: Thank you for having me.

Host: Absolutely. And you can find more shows just like this one at umms.org/podcast and on YouTube as well. 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 the Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.