Therapy aims to help men with prostate cancer manage anxiety, depression, fear

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

More men are living longer with prostate cancer, thanks to better treatments and better diagnostic aids. Many of these men face anxiety, depression or fear in addition to physical problems. Today, I'm talking about the psychological impact of prostate cancer with Dr. Dorianne Eaves. She's a psychologist from the Psychosocial Oncology Program at the Upstate Cancer Center.

Welcome to "The Informed Patient," Dr. Eaves.

Dorianne Eaves, PsyD: Thank you for having me.

Host Amber Smith: Do you see men right after diagnosis or during treatment?

Dorianne Eaves, PsyD: I can see men at any point along the continuum of treatment, often at initial diagnosis, throughout treatment, or even post-treatment, it's really, whenever they feel like the best support is needed. I can meet patients at any time during that time.

Host Amber Smith: Do you see men along with their partners, or is this usually individual counseling?

Dorianne Eaves, PsyD: I can do both. I can see the patients individually, or after seeing them individually, if they feel like it'd be helpful to add their spouse in or a family member, I can certainly do that as well.

Host Amber Smith: Do most men find you because of a referral from, or a suggestion from their physician?

Dorianne Eaves, PsyD: Yes. The referrals can come from any of their providers, nursing staff, really any time, so often they come through referrals that way.

Host Amber Smith: Well, let's start with anxiety and fear. How do you advise cancer patients to manage anxiety and fear?

And I imagine this applies beyond prostate cancer, but that's probably a pretty common issue, isn't it?

Dorianne Eaves, PsyD: It's very common. That is often what I am seeing people for: for the emotional distress, fear and anxiety that a cancer diagnosis produces, as well as just the treatment, treatment side effects and the difficulties that come with cancer diagnosis and living with cancer.

So I often meet people then, and I tell people all the time that it's a normal reaction to your abnormal situation of a cancer diagnosis and living with cancer. So there's a lot of different things that we can do: meeting --with the patients, different relaxation strategies, coping strategies, finding a way of living with cancer and still a quality of life and well-being that is important to them and within their values.

Host Amber Smith: With prostate cancer specifically, are there common fears that men have?

Dorianne Eaves, PsyD: Yes, I would say that it's just as you were saying earlier, the common cancer diagnosis reaction that comes from for everyone, of the mortality and longevity and what does it mean to have a cancer diagnosis?

What does this mean for my life? For my well-being, for my family, all of those things. And then specifically with prostate cancer, it's the fears and anxieties of treatment. What treatments will look like, treatment options and decisions, as well as the scans and different procedures that happen with diagnoses and treatments, what the side effects will look like and how that will impact them, their life, their families, their relationship, and then also common to cancer as a whole is fear of recurrence; even post-treatment, the regrets, having completed treatment, the decisions made. There's just a lot of things that impact well-being and emotional distress with cancer.

Host Amber Smith: It seems huge because you have these day-to-day issues, how this is going to impact their life, hour by hour, day by day, but also, life-changing, big issues, so yeah, I imagine it's a lot to struggle with. Do you ever have patients who question the cause of their cancer or whether they did something to deserve it?

Dorianne Eaves, PsyD: That is common too. And I often hear it from people who were healthy before cancer, rarely seeing a doctor, rarely being even sick with a cold or flu. and they often feel like their body has betrayed them because they did what they were supposed to. They lived healthy, they were exercising, eating well, so this can be a common reaction, and it's along that continuum of a grief process in reaction to cancer. So we just process through this and we often are hardest on ourselves, so it can be just a reframing approach of what would you tell a friend in this instance? And then also certainly looking back and reflecting on life pre-cancer and what led to a diagnosis, but also trying to reframe and bring them back into the present and what acceptance looks like now with cancer, and acceptance doesn't mean approval of the diagnosis and living with cancer. But what does it look like and how can you still live within your values and a quality of life now, even when all of these changes and life-altering situations come in that certainly don't diminish the distress and grief that comes with a cancer diagnosis.

Host Amber Smith: With prostate cancer, many men will have a multitude of treatment options to choose from, and that alone can feel overwhelming. How do you advise them to just manage the stress of figuring out what's the best course for them?

Dorianne Eaves, PsyD: It is really difficult because these decisions feel very heavy, especially when so much feels out of their control. And it's during a time where you're emotionally distressed and overwhelmed and worn down and then making these really important, heavy decisions. So I think that's often where my role comes into play the most, of meeting the patient where they're at, talking through what the treatment options even are and being that liaison and middle person between their medical team and a care team and the patient and bridging that gap and discussing, OK, well, what are the treatment options? Knowing and seeing if they have a full understanding of that and then processing through that with them and supporting them and seeing what their goals for treatment are, what it looks like for them to have a quality of life. What's important in those aspects. What's important for them in treatment and post-treatment and weighing all the options and figuring out what feels best to them and also bringing in their caregivers, their families, their spouses, and helping support them and using them during these times.

Of having a support person, hopefully being able to go to the appointments with them or being on the phone with them and writing notes and being the ones to ask the important questions that are important to the patient and the family, because it can be a lot of information thrown out at the patient and just an overwhelming time that's difficult to process and even hear everything and even remember the questions that they might have.

So working out strategies for that. And also knowing it's not a right versus wrong equation of making these decisions. It's just what is most important to them and what feels best to them in the moments with that information that they have now.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith, talking with psychologist Dorianne Eaves from the Upstate Cancer Center's Psychosocial Oncology Program.

Sometimes doctors recommend a period of, they call it watchful waiting, where they're tracking the PSA numbers real carefully (prostate-specific antigen is checked in prostate cancer screening and treatment). Is that inherently stress inducing for a patient?

Dorianne Eaves, PsyD: It can be. It's often similar to those times when you're in between treatment, you've completed one treatment and you're waiting for scans to reassess. That can be a very anxiety-provoking time. It's often like if I said, "Don't think about the white elephant in the room," and that's all you can think about.

So this is often a time when I see patients and working through, OK, what fears and anxieties do they have, as well as how can we manage this stressful situation with coping strategies, relaxation? What racing thoughts are coming up for you and how can we manage those?

Because it can be a very difficult time. And then when someone tells you to not be stressed, can just increase that moreso.

Host Amber Smith: How is the depression that some cancer patients experience? Is it different from regular depression?

Dorianne Eaves, PsyD: It can be different in very small, different ways. Oftentimes it might not meet criteria for clinical depression, but grief and emotional distress near depression, and look like depression in a lot of ways.

And then it's also difficult because treatment and treatment side effects can impact mood similarly to depression and anxiety, so there's a lot of different factors playing here. That's also when it's important, when I meet with patients, to have these discussions and during my initial intake, asking the questions of, OK, what symptoms are you experiencing?

How is your mood? And figuring out, is this at a clinical level where medications might be helpful. And that's always a discussion we have and referral options that are discussed to see where to go from there. As well as knowing and validating the patient. And this is a common reaction; grief and emotional distress and depressed mood and anxiety are all common with cancer diagnosis and cancer treatment.

And whether it's clinical versus not, there's still things that we can do in coping strategies and things that are very similar. It might just be medication added if it is to a clinical level that we feel might be helpful to add medications along with therapy.

Host Amber Smith: So there are some medications that can be prescribed that won't interfere with chemotherapy or other treatments?

Dorianne Eaves, PsyD: Correct. Yes, and that's always a discussion we have, whether their medical care team, their oncologists, might prescribe medications or talking with their primary care provider, or if it's to the level of psychiatry services, a referral might be helpful. We can always have those options to discuss.

Host Amber Smith: Now a lot of times, exercise is recommended as a way to help people improve their mood.

But when someone's in treatment for cancer, the fatigue can be severe.Do you have suggestions for what physical activity might be beneficial, but not too taxing?

Dorianne Eaves, PsyD: Yes, I always encourage patients to talk to their medical care team about what activities, like, what is the level of functioning and what activity level they can (achieve), so it's not too straining or, given certain treatments or surgeries or different things, what the activity level should be. And it's often really difficult because people are frustrated that if they were really active before their treatment that now that doesn't look the same, like they used to be able to walk a mile, no problem, or walk five miles or run five miles, no problem.

And just the grief and loss, even with that, and knowing that it is going to look very differently right now and finding what works well for them. And starting small, of even just a five-minute walk, and including family or friends or their spouse to make it a social activity, as well as being creative and finding something they enjoy.

So it's not necessarily like this structured exercise that feels overwhelming, and it can be hard to find this consistent level of movement, and I often see people that are going through that cycle of overdoing or underdoing, given their level of functioning that day or whether they're having a good versus bad day and along that time of treatment.

So it's just being creative and finding these small ways to stay active and noticing. I'll tell people, notice their mood and energy level before they do something and then noticing their mood and activity level after. And that can help with pushing themselves a little bit and finding those five minutes or 10 minutes a day of doing an activity.

Host Amber Smith: Prostate cancer may have side effects of incontinence or erectile dysfunction or other sexual issues. How do you address these with men?

Dorianne Eaves, PsyD: I tell people cancer affects a lot more than just the physical, and this is something certainly physical that is happening and a side effect of treatment, but it also bleeds into, and it impacts, their social functioning, their relationships, their intimacy. So seeing how it's impacting these and encouraging them to talk to their oncologists and urologists and finding treatment and medications and different things that can also help with these things, as well as therapy and things behaviorally that we can do that focus on the relationship and intimacy and finding different things that help with this, in combination with their medical providers. And different things like self-esteem and how it impacts their well-being, and understanding how this impacts them and their partners and maintaining that close, supportive relationship. And I think this is also when I can see couples as a whole and meeting them at their needs.

Host Amber Smith: Do you have some advice for how someone can help support a loved one who has a cancer diagnosis?

Dorianne Eaves, PsyD: I think it's meeting them where they're at. And oftentimes people try to understand or cheer them up, and a lot of times they might not want that. Just seeing what their needs are, meeting them where they're at and also knowing that -- I tell couples all the time -- that it impacts you very differently. You all are going through the same thing, but it's like you're reading the same book, but you're on different pages, and each of you have not read the page that the other one is on. So I think this is where I can come in and support them both, and finding ways, practical ways, of helping and supporting a patient.

And also knowing that a lot of times they still want to maintain their autonomy and their role within the relationship and their independence. So finding ways that they can still have that while also helping and supporting them along the way, too. And it might be, like said earlier, attending appointments with them, driving them to appointments and being that person that's taking notes and asking you the questions that the patient has so that the patient can be in the moment, too.

But it's a very difficult thing to come alongside someone that is going through cancer, cancer treatment, and a diagnosis. So just meeting them where they're at and supporting their needs. And also as a family member and caregiver, knowing that your needs are important to support as well.

Host Amber Smith: Well, I appreciate you making time for this interview, Dr. Eaves.

My guest has been Dr. Dorianne Eaves, a psychologist from the Upstate Cancer Center's Psychosocial Oncology Program. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York. Find our archive of previous episodes at upstate.edu/informed. I'm your host, Amber Smith, thanking you for listening.