Cancer and Depression Telehealth Support

One of the many causalities of the coronavirus pandemic and our enforced separation from one another has been the ability of therapists to connect virtually with patients. For me, and I know this has been a common experience, the work world changed in a flash in March 2020. One day, I had patients in my office, and the next day, we were connecting using telehealth. Fortunately, as is true for most things, we have all gotten better with practice, and it sometimes seems almost normal to be sitting in front of a screen.

Due to increasing pressures on cancer services ... and the current disruption to services due to COVID-19, it is important that we explore different ways to deliver care to those who need it.

Emma Ream, PhD
Director of Health Sciences Research at the University of Surrey

As you would suspect, this has gone better with some people than with others. I have a few long-term patients who basically said: See you when this is over. Most, thankfully, have been willing to hang in there with me as we figure out how to connect with the same relational intensity that we have cherished.

I even have a few patients whom I have never met in person; it is more difficult at the first session to forge a real connection, but it seems that we did well enough. In truth, it is always challenging to truly connect with someone the first time, but I am accustomed to having the benefit of physical proximity and being able to watch body language and feel the human bond.

It has been impossible to compare the efficacy of in-person visits to virtual ones. I have a few patients who have clearly expressed their longing for the old days, the comfort of sharing a space and feeling held. Others, in contrast, have seemed more at ease in their own homes and have perhaps felt safer in some conversations. One colleague, in discussing our changed work environments, commented that there are fewer tears.

A new study from the United Kingdom looked at telephone interventions for cancer patients who are depressed. I don't know how that diagnosis was made, whether the patients were only those taking an anti-depressant medication or included others who reported a low mood. Here is the primary conclusion:

"Due to increasing pressures on cancer services ... and the current disruption to services due to COVID-19, it is important that we explore different ways to deliver care to those who need it," said Dr. Emma Ream, Director of Health Sciences Research at the University of Surrey.

"Telephone interventions delivered by healthcare professionals are one way to do this. Offering care to patients in their own homes is convenient for them, and can make them more comfortable and possibly more open about their feelings when speaking to professionals. They ultimately will reduce foot traffic in hospitals which is very important at the moment in reducing risks of contracting COVID-19 virus. More research is needed to confirm the effectiveness of such interventions," said Dr. Ream.

Dr. Reams and her colleagues reviewed 32 studies that included more than 6,000 participants. Most, if not all, had been done before COVID, so the addition of the pandemic's stress likely makes this intervention even more important. The professionals involved were usually nurses, not necessarily nurses with training in mental health. They used standard questionnaires to address symptoms of anxiety, depression, emotional upset, uncertainty, fatigue, pain, and overall distress among the studied cancer patients. The patients had a range of cancers and situations.

The results were mixed with some improvement in reducing anxiety, fatigue, and emotional distress. The greatest improvement was on decreasing depressive symptoms. Overall, the researchers commented that the value of the telephone interventions was uncertain and needed to be further considered.

My reactions are also mixed. First, I know that following prescribed questionnaires or scripts for conversations around feelings are very different experiences than the more free-wheeling discussion that evolves between a therapist and patient. It seems common sense that any conversation and attention and perceived caring would be more helpful than none. It also seems likely, perhaps I am biased by own profession and experience, that conversations with a cancer-savvy therapist would be more useful.

Although our physical offices are closed, therapists are continuing to work remotely and to be very available for support and treatment. If you are feeling bad, please reach out. BIDMC's oncology social workers can speak with you directly or make a referral to someone outside of the hospital.

One absolute advantage of our current way of working is that geography is much less important. You don't need to find a therapist in your own community but can work with the best person wherever she/he is.