Mental Health, Telehealth, And Cancer

Takeaways from 3 months of video tele-mental-health care during cancer treatment amid the coronavirus pandemic.

I grew up during a time when seeking care for mental health was not discussed. Despite cancer and all the trauma that can happen during cancer, I've continued to rely first on my own well-established and pieced-together methods to get through periods of sadness and distress. For instance, I try to eat healthy food, I exercise moderately or vigorously nearly every day and I attempt to be mindful of what I am feeling.

Sometimes that just is not enough.

That happened with me a couple of months before COVID-19 started spreading across the U.S. There have been times (lots of times) since my cancer diagnosis when I could describe my emotions as a tornado of distress, and the addition of one more stressor thrown into that tornado—picture the swirling tornado in The Wizard of Oz— causes me to lose whatever slight control I had. When this happens, people can't really understand why I am suddenly having a hard time keeping things together. A seemingly minor stress is not "minor" when you are living full-time in a high-stress world.

I had just adjusted to the idea of laying out my emotions when we had to move to video telehealth visits. I thought about canceling my next appointment.

But I didn't.

It turns out that video tele-mental-health can be a good substitute for in-person mental health. There are drawbacks, of course: Physical cues may be missed, technology may not be reliable, either person may be uncomfortable on video and interruptions are more likely. But there are also benefits that matter right now and probably have mattered for a long time: physical safety, no need for transportation, ease, and, in my case, a lower co-pay.

It takes some getting used to talking across a video while sharing the difficult emotions that can accompany cancer. My takeaways:

• Location matters: I was more open and honest when talking from my bedroom rather than my work table.

• Minimize interruptions: I shut down everything else on my laptop before the call and left my phone in another room. I closed the door and let anyone else in the house know I didn't want to be disturbed for an hour.

• Tech know-how: Using technology isn't instinctual for me. I make sure to get on the best internet browser, "check-in" early to fix any problems, and adjust volume and video.

• Know yourself: In-person, my appointments were late morning or early afternoon. That didn't work for video calls. At home, I am at my best early in the day and luckily my provider has had time slots that fit with the period during the day when I have the most energy and ability to communicate with others.

• Trust is required: If you've ever been in a virtual meeting, you know how easy it is to become distracted or lose concentration. Good video telehealth demands that this doesn't happen. If I thought my provider was distracted, I would be deeply unhappy with this mode of treatment.

• It's the same: All the emotions that can surface as you start talking openly in-person are still there and exposed. I learned quickly to keep a box of tissues nearby.

• It's not the same: No physical reminders of where you are and who you're talking to can make it seem at times like you're talking to yourself. That is a weird sensation when it happens and could be an issue especially with a provider who doesn't verbally respond.

I hope that video telehealth continues to be an option. Already I have been asked twice about coming in-person rather than making a telehealth appointment. So far, I've stuck with telehealth because it is both safer for my health and easier, and I hope that care providers have also found benefits. I'm sure there are many studies being conducted about benefits and drawbacks to telehealth, here's to hoping they find that multiple options are always best for patients.