Why Cancer Survivorship Can Be the Hardest Part, Psychologist Says

CURE recently sat down with Ian Sadler, clinical health psychologist at the Herbert Irving Comprehensive Cancer Center, to discuss his work supporting patients’ mental health. Nearly half of all patients with cancer will face a diagnosable psychiatric condition during their illness, yet many never receive the mental health support they need. Sadler is working to change that.

As the primary psychologist for the center's psychosocial oncology program, Sadler sees patients on an outpatient basis, working alongside psychiatric nurse practitioners and a consultation-liaison psychiatry team to ensure patients have access to mental health support at every stage of their cancer journey.

Breaking Down the Stigma

One of Sadler's biggest challenges isn't clinical, it's cultural. Despite growing awareness around mental health, stigma remains a significant barrier. Many patients arrive reluctantly, unsure what to expect. His approach centers on reframing the experience entirely.

"This is not about getting into your life history," Sadler tells patients. "You are going through something right now. My goal is just to help you get through it."

He emphasizes patient autonomy, making clear that care isn't open-ended or obligatory. A course of support might be one visit, or three. Patients drive the process.

The Survivorship Paradox

Perhaps the most overlooked phase of the cancer experience, Sadler says, is survivorship. More than 40% of his patients come to him after treatment ends, precisely when many assume the hard part is over.

"Once a patient leaves the treatment team, there's fear," he explains. "There's nothing active being done to address their cancer." The adrenaline that carried patients through treatment can give way to profound anxiety, recurrence fears, and existential distress, and patients often blame themselves for it.

Sadler's role becomes one of normalization and validation. He wants patients and their families to understand that the post-treatment period is psychologically complex, and that struggling during it is not a personal failure.

"A cancer diagnosis is a profoundly lonely experience," he said, "even if you have social support around you."

Seamless Care Coordination

Referrals into the psychosocial oncology program are designed to be frictionless. Oncologists, nurse practitioners, and social workers serve as the frontline monitors, identifying patients who may benefit from support. From there, coordination happens through Epic referrals, direct chats, or email, a system Sadler describes as working smoothly in practice.

For patients navigating one of life's most difficult experiences, that ease of access can make all the difference.

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