Mental Health Support Throughout the Cancer Survivorship Journey

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BRITTANY MCLAREN: When a patient receives a cancer diagnosis,
it often sets off a rapid chain of events
that lead to multiple physical tests, appointments,
and treatments.
But there's another critical aspect of the cancer journey--
survivorship.
At Sutter Health, we view this as a journey
rather than a destination.
Survivorship is not just about reaching an endpoint,
but embracing the ongoing changes.
And we are here to help you every step of the way.
Today, we've gathered members of our Sutter Health Care Team,
Monchel Sharp, social worker in the greater Sacramento area,
Elizabeth Simmons, social worker in the greater Silicon Valley,
Jon Palley, social worker in the greater East Bay,
Angelina Santillan, social worker
in the greater Central Valley, and a very special guest,
Vanessa.
And I'm Brittany McLaren, licensed clinical social worker
and certified oncology social worker
from the San Francisco area.
And I'll be facilitating today's discussion.
First of all, I just want to thank you
all for being here today in this beautiful meditation garden.
I wanted to start the conversation off
by talking about what survivorship is
and what it means to each of you and what
it means for our patients.
Monchel, I'd like to start with you today.
MONCHEL SHARP: OK.
Well, to me and to many of those that we're serving,
survivorship starts at onset of a cancer diagnosis all
the way into the end of life.
It is the ebbs and flows of navigating
through hospital visits, family, everything in between.
ELIZABETH SIMMONS: Yeah, and it's not about any destination,
but it really does become a journey.
I've had so many conversations about internal journeys
as well as external journeys, things
that change within yourself, questions you may be asking,
as well as how does the body change, whether there's
adjustments to be made there and any other limitations or things
that you learn along the way.
BRITTANY MCLAREN: And, Angelina, I
know a big part of survivorship is changing identities
our patients go through, what their identity
was before treatment, during treatment and after.
I'm curious how you've encountered
that working with patients.
ANGELINA SANTILLAN: Yeah, oftentimes what patients
are saying like, I just want to be normal again.
And I do have to let them know that you're
going to be a new normal, and you're still
going to be your amazing self, but it's
going to look different now.
JONATHAN PALLEY: A person goes along in life
and a cancer diagnosis is like, bam, it slaps you in the face.
Survivorship is a word we didn't use to use.
We used to talk about cancer victims.
And so the culture has changed.
There are support groups.
There are ways that people don't feel so alone.
People can embrace an identity as a cancer survivor
now in a way that can be positive.
BRITTANY MCLAREN: And, Vanessa, we're
just so happy and lucky to have you here today
to provide your perspective.
I'm curious to hear from you how that has impacted you
and what your survivorship journey has looked like.
VANESSA: I feel like survivorship,
to me, it's something that starts like after you're
done with your treatment because then you're
trying to survive after.
But it really does start when you get the diagnosis
because I'm in survival mode.
I've got to do what I got to do, do what the doctors tell me,
go to my appointments, go to the scans, get my labs, the therapy,
helping me get there, and realizing that it's a long life
thing.
It doesn't just end when you're done with your treatment.
It continues.
BRITTANY MCLAREN: Yeah.
Thanks, Vanessa, for sharing.
Oftentimes, not only does the patient experience identity
changes, but there's a lot of role changes within the family.
And both for the patient and the family members,
these changes can bring up grief,
grieving the loss of identity, grieving the loss of roles.
Elizabeth, maybe you can start by discussing what is grief.
ELIZABETH SIMMONS: Well, grief encompasses so
many different layers of emotions,
from confusion to sadness to guilt to anger.
And I think the most important element is allowing yourself
the grace and the room to experience them
all, important to let whatever emotion surfaces
in that grieving process to have its expression safely.
ANGELINA SANTILLAN: And there are five stages to grieve.
However, the stages of grief are non-linear.
And people can experience them at different times.
So initially, there's that shock,
and they're just going through the motions,
like Vanessa mentioned earlier, surgery, scans, appointments,
and you're just taking phone calls.
And you're still processing.
And so that's really an ongoing part.
And so it's not that you're not like in denial
to have this diagnosis, but you don't even get that time.
And then there is that anger.
Is there somebody to blame for this?
And then we go into that bargaining.
Like if I wouldn't have got that mammogram sooner
or that colonoscopy sooner.
And then depression, like while grief is normal,
depression can happen.
And we want to be careful that we're paying attention
if we are getting-- if we're isolating,
if we don't have anyone to talk to,
if we don't know how to express emotions.
Sometimes people say like, I don't even
know what depression is, but I'm getting these feelings.
I don't know what they are.
And the last is acceptance.
And that does not by any means mean that the pain is gone.
It's just that how can I make peace with this?
How can I live in the present?
I'm still living, and how can I be mindful of that
and make peace?
JONATHAN PALLEY: When we talk about cancer survivorship
and mental health, emotion is part of mental health.
And they're abnormal emotions that
are normal in the context of cancer.
And there shouldn't be stigma to it.
But as a man, and I deal with a lot of men in cancer treatment
and prostate cancer in particular
and am a survivor of prostate cancer,
most men don't acknowledge depression.
And to try to find a context where
we, as men, can deal with our emotions,
therapy can be helpful.
But men are reluctant to use that because grief
and depression are different.
MONCHEL SHARP: It's a manifestation of grief.
We have the acute grief of this happening, when it's
happening right in the moment.
And then you have the mourning.
You have it coming out in your behavior.
And it might look like anger and frustration.
And then you have the cognitive, like the thoughts,
what's happening?
What used to be?
BRITTANY MCLAREN: Yeah, and even what could have been?
MONCHEL SHARP: What could have been?
BRITTANY MCLAREN: What would your life
have been without this?
You're mourning that.
MONCHEL SHARP: What could have been.
VANESSA: Yeah.
I think I've-- knowing the stages now,
I think I've accepted it.
It was part of me.
It still is, not as much in the forefront.
It's just on the back burner more.
ELIZABETH SIMMONS: I think a lot of us
forget that grief, it changes and shifts and evolves.
But it may stick with us.
And so it's just a matter of, as you're
saying, finding the ways you can cope with it,
finding the ways to grow with it.
BRITTANY MCLAREN: Yeah, and just a matter
of trying out different things and finding what provides relief
to you and provides that coping that you're looking for,
whether it's talk therapy, journaling, going out
in nature for a walk, playing with your dog,
all these things are really going to help folks cope
with what they're going through and just finding what personally
works best for them.
So in addition to grief, another big emotion
that we hear patients experience is fear.
Fear of at time of diagnosis, what
if the treatments don't work?
What if my cancer comes back?
And then we also hear this term-- scanxiety.
Every time I get a scan, my blood pressure
goes up because I'm just so fearful of what
is going to come of it.
Elizabeth, maybe you could share a little bit about that fear
that people experience.
ELIZABETH SIMMONS: Yeah.
You didn't expect this to begin with.
It comes out of the blue.
And so it's natural to think, OK, I'm on a treatment plan.
The goal is a cure, or whatever the goal may be.
But I didn't know it was coming the first time.
So the next time I go get my labs or the next time
I go get a scan, are they going to tell me something else?
I've often referred to it as the shadow.
All of us have one.
And this is one that I try to help folks treat as though it's
a helpful reminder.
It doesn't necessarily go away.
The shadows, we've all got them.
But the idea is, how do we use it to help us and not
make the anxiety elevate?
VANESSA: And one of the big fears
I had was even asking my doctor like, well, what's my prognosis?
I didn't even want to ask that because once he's-- my stage
at the end was stage 2A.
So I'm like, well, how many letters are after 2A?
Like B, C, D, and then stage 3?
But it's just those questions, the fear of knowing.
And I never googled anything because I was just
too scared to even go there.
Like, what's my prognosis for stage 2A?
And so many-- it's just--
it's a lot of fear.
ANGELINA SANTILLAN: And then just that
fear when you hear the word cancer, am I going to die?
Have I planned for my finances?
Or if I have children, we know that death
is something uncomfortable to talk about,
but that we feel comfortable that patients
can talk to their social workers and their care team about that.
JONATHAN PALLEY: Support groups that
are diagnosis specific can be very helpful to just know
that you're not alone and have a confidential, especially
professionally-led support groups.
The cancer support community has a wonderful selection
through the whole Bay Area, Vallejo.
And I think they serve virtually as well
as what they call hybrid.
So some of their meetings are in person and on a big screen,
those that join on Zoom.
BRITTANY MCLAREN: So in this survivorship journey,
a big question that people ask themselves
is, how do I move forward?
How do I go on from here?
How do you help or explain to your patients,
how do you move forward?
ANGELINA SANTILLAN: Adding quality to your life.
Some people, even in the midst of terminal illness,
they can live life as they're living.
They're realizing, wow, it's part of my life,
but it doesn't define me.
JONATHAN PALLEY: Cancer is a time when the life force breaks
through that literally the tissues grow
outside of the way they normally would grow.
And psychologically, it's an opportunity
to look at life in a new way.
MONCHEL SHARP: And being around positive people, right?
No one wants to hear about their diagnosis 24/7.
On one hand, you want to have that support.
And the other hand, support looks like,
let's get out and live.
You want to go to the beach?
I've never been.
And not talking about it doesn't always mean you're
not concerned.
It just means, hey, there's more to life.
And this is one aspect of life.
It's not your life in totality.
BRITTANY MCLAREN: Yeah.
A lot of the things I'm hearing is
practicing radical acceptance of that this
is what's happening to me.
But changing my perspective on it,
accepting that I have this diagnosis,
but how can I reevaluate my values?
How can I shift my priorities back in line
with what those values are?
Have I been living those?
And this provides that opportunity.
Vanessa, I'm curious if that has resonated with your journey
at all.
VANESSA: Yeah, basically everything you guys just
said is something that's gone through my mind
or I've already--
I went through it.
I think we all take stuff for granted sometimes
until it gets taken away from you,
and then you appreciate it a lot more.
Even doing this with you guys, I feel
like I'm moving forward, like getting to talk about it
and maybe help other people that are in the same like situation
I was in a couple of years ago.
BRITTANY MCLAREN: And that was a big motivator for me
to be a part of this video was just
to make sure that our patients are
aware of all the wonderful resources we have.
I mean, it's a One Sutter.
So patients in San Francisco, if there's
a support group with Vallejo with John
and that's a better connection, they have access to that.
Or the Sacramento Valley, I have patients in my support groups
from Sacramento that resonate with what
I'm teaching in my classes.
MONCHEL SHARP: We kind of have a type of wrap around support.
If we don't have the resource ourselves,
we will check about to get that for you.
Coming to Sutter Oncology, it's a unique experience
for that reason.
And it's a place where we are partnering
with you in your health, not looking to tell you
how to live your life.
I want our patients of oncology at Sutter Health
to have comfort in knowing that even
if they don't seek our support right away, we'll be here.
BRITTANY MCLAREN: And talking a little bit more so that patients
are aware of who on their care team they can turn to, Angelina,
could you talk about who people have access
to on their supportive care team?
ANGELINA SANTILLAN: Yes.
You have your nurse navigators who are able to--
that's their name-- navigate through the system
and through the different resources.
You have your social worker.
Also mental health, some of our social workers
are providing mental health counseling for patients.
And some can assist you with those referrals.
BRITTANY MCLAREN: In addition to your nurse navigators
and social workers, you have dietitian, financial counselors,
as that's a big piece in this puzzle, your rehab team,
physical therapy, occupational therapy, spiritual care.
So you just really have this wraparound services.
So we shared a lot of good material, good resources
today that I hope will be very valuable for our patients
as they're going through their experience, their journeys
through survivorship at whatever stage they may be.
I'm just curious what any final thoughts
you may have to share with our patients.
MONCHEL SHARP: Again, if you are here, call one for social work.
We don't necessarily have all of the answers,
but we will assist in getting the support.
And also to know that a diagnosis doesn't mean life
is over, it just means an opportunity
for a new perspective.
ELIZABETH SIMMONS: I think an important piece of all of this
is leaning in to that support, being able to accept the help.
It's hard to do on your own.
So knowing that you've got the support out here, lean in.
ANGELINA SANTILLAN: I think that goes into that there are so
many opportunities to connect with others,
and whether it's others that have been through cancer, that
have been through other chronic illness or challenges in life,
that everyone has it in them to be resilient in times
of challenge.
That's one thing that we're guaranteed in life is set backs,
but we can get through them.
VANESSA: I would just say that you're not alone.
They probably hear that a lot.
But if they are alone, they don't have family or friends,
that they will have someone to support them
during the whole process because--

because you guys are such a good team.

And I'll never forget everyone that helped me in my experience.
You're stronger than you think you are.
JONATHAN PALLEY: This is work that people
don't come to see the social worker when
they come to a cancer clinic.
But we're here to support and to listen.
BRITTANY MCLAREN: There's no one way to feel about this.
All the feels are totally natural and normal.
And you could be 10 years out from your treatment
and still bring up a lot of emotion.
And all those emotions are valid and they're just
a part of the process.
And, yeah, just so happy and lucky to be
part of such a great team that really does magnificent work.
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