Vital Signs: Recognizing and Managing Distress

Recognizing & managing distress can lead to better outcomes.

By her own admission, Cindy Walsten became fairly obsessed with her condition after she received a diagnosis of ovarian cancer in the fall of 2012. She caught herself staring at a computer screen for hours, compiling a mental database from every scrap of information she could find. Some days, she convinced herself everything was going to be fine. At other times, some invisible dam inside her would break, and she feared she might drown in her own sorrow.

Cancer changes people. Before doctors discovered a malignant growth on her ovary, Walsten was happily enjoying an early retirement at age 55 from civilian service at the Joint Munitions Command in Rock Island, Ill., making travel plans and relishing the extra time with her grandson. Then she noticed some spotting. She told herself it was probably normal. Her doctor told her otherwise: Bleeding after menopause is not normal.

In the hospital following surgery to remove the tumor, a nurse asked Walsten about her mental and emotional state. The medical staff was concerned enough to prescribe antidepressants and suggest ways to relax and meditate. Ultimately,  Walsten conquered her anxiety through the constant, calming presence of her grown daughters and sisters, and regular visits to a Gilda's Club (now Cancer Support Community) support group. "I wanted to hear from someone else who experienced the same thing, and who is alive," she says. "In your head, it's a death sentence. But then you think, 'If they can do it, I can do it.'"

Today, as Walsten approaches the end of her chemotherapy treatment, she says, "I've talked myself out of the deep darkness I was in."

Most of the time, negative emotional responses to cancer, such as vulnerability and sadness, are normal, manageable and temporary. But for more than one-third of patients, cancer instills an avalanche of fear, anger and anxiety that takes over and doesn't go away, intensifying the experience. Experts call this response "distress," and it is an increasing focus of comprehensive cancer care.

Many doctors have come to accept that treating distress will not only improve the quality of life for people living with cancer but will also enhance treatment adherence, hasten recovery times and even lower healthcare costs. In fact, so much support has coalesced around the value of recognizing distress that, starting in 2015, more than 1,500 cancer centers in the nation will need to screen patients for distress to maintain their accreditation with the American College of Surgeons Commission on Cancer.

"Treatment has always been biomedically based. What’s the tumor? What’s the staging? What are the genetic markers?" says James Zabora, who serves as director of the Life with Cancer education and support program based in Fairfax, Va. "Ultimately, we have to say, who is this person we are talking to and how can we enable them to handle this disease?" In short, treating distress means healing the mind as much as the body.

We know from numerous research studies that if we do not offer these patients appropriate treatment, they will suffer psychologically from their illness.

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