Vital Signs: Recognizing and Managing Distress

Recognizing & managing distress can lead to better outcomes.

No matter how, or when, distress is identified, the condition needs to be managed before it worsens. Unfortunately, many cancer treatment centers don’t have the resources to do this, and many insurance companies and Medicaid do not cover counseling or psychologic or psychiatric care. Yet, once clinicians diagnose the condition, they are obligated to address it.

The benefits to quality of life may be obvious, but treating distress goes beyond simply arriving at a better emotional state. Take cancer pain, for example. "Patients with higher levels of depression will give higher pain scores," Zabora says. "The healthcare team might treat the pain, but not identify the underlying depression." He says studies have also found that people who are distressed have a harder time making decisions about their care and have a poorer adherence to treatment.

Patients with higher levels of depression will give higher pain scores. The healthcare team might treat the pain, but not identify the underlying depression.

All of which can increase the cost of care. As an example, Zabora points to a landmark study from the world of cardiology. Researchers writing in Mayo Clinic Proceedings found that, on average, cardiac patients who suffered from distress had costs associated with re-admission to the hospital that amounted to about $7,000 more than patients who were not distressed.

While the economic benefits in cancer patients needs more study, "research in mental illness and within other medical populations shows large savings in medical billing through the treatment of emotional problems, including anxiety and depression, resulting in fewer visits to [general practitioners] and specialists alike," according to research from the University of Calgary and the Tom Baker Cancer Centre in Calgary, Alberta.

Just as there's no single way to treat cancer, there's no one prescription for dealing with distress. Some patients benefit from speaking with a mental health professional, (although some nurses and counselors don’t like the term "mental health" because it incorrectly labels patients) taking antidepressants or anti-anxiety medications, exercising, meditating or even getting a pet. Or, a combination of any of those or other options.

Cindy Walsten never took the antidepressants she was prescribed, as she sensed she was coming out of her dark waters with help from her support network. But she has also stopped trying to make herself go back to being the person she was before cancer. "I'm learning to accept I have a new way of life," she says. "Mentally I'm a different person. I can't think the same way I did before. The thought of cancer is always there."

She says she hopes, one day, whether or not the cancer leaves her body, it will at least leave her mind.

Correction: Due to an editing error, an earlier version of this article described incorrectly that the Commission on Cancer recommended Cancer Support Community's screening and referral program CancerSupportSource. The Commission on Cancer does not endorse particular groups or products. Updated June 24, 2013.

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