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Treating the Whole Patient

June 23, 2022

It’s exhilarating to build something from scratch–to design and mold it exactly as you want it to be. Smilow Cancer Hospital’s new Psycho-Oncology Program draws on best practices from across the country and within Smilow to provide psychotherapy counseling and support for patients experiencing challenges such as depression, anxiety, insomnia, and fatigue while undergoing cancer treatment.

“There is a high incidence of psychological distress that comes with a cancer diagnosis,” said Shannon Mazur, DO, MA, Assistant Professor of Psychiatry in the Section of Psychological Medicine and one of two care providers leading the new Psycho-Oncology Program. “There are also patients who already had pre-existing psychological conditions that may or may not have been treated. We target the acute symptoms they’re facing related to their cancer treatments with the hope of improving their quality of life and ability to fully access what they need for their care.” When she was recruited to launch the program, Jennifer Kilkus, PhD, Assistant Professor of Psychiatry, knew immediately what her top priority would be for the new initiative.

“It had to be collaborative,” she said. “This is not just a referral service. We want to be as integrated as possible, where we’re communicating with a patient’s oncologist and other members of the treatment team to share feedback about the patient.” Drs. Kilkus and Mazur receive patient referrals from Smilow’s fellow care team members and assess how to best meet the needs of each patient. Some patients may be better suited for group therapy rather than individual therapy. Others may be struggling with challenges not related to their treatment—such as relationship or family issues—that are better addressed by a therapist outside the hospital. “It’s normal to need support,” Dr. Kilkus said. “We can help them figure out what type will be the most helpful.”

Both women felt a strong calling to this line of work. Dr. Mazur had worked in hospice care prior to joining Yale. “I’ve always had this connection to the importance of treating the whole person, not just the symptoms, and making sure we’re providing patients with the best quality of life they can have,” she said. Dr. Mazur balances her outpatient clinic with inpatient consultation services. She helps patients manage their medications for such conditions as depression and anxiety. When patients with psychiatric needs are admitted to Smilow, she reviews their chart with other care team members to see which medications and conditions to be aware of and if the patient would benefit from the Psycho-Oncology Program.

“Because we take a collaborative care approach, we are proactive in trying to get in front of any issues before there is any distress,” Dr. Mazur said. Dr. Kilkus describes her role in the Psycho-Oncology Program this way: “I’m not a psychologist who just happens to work in a cancer center. I’m a psychologist who works specifically with cancer-related issues.” She helps patients adjust to their diagnosis, handle changes in mood, address their fear of recurrence, manage physical symptoms, side effects, and stress, and transition to life after treatment. To guide patients through these challenging phases, Dr. Kilkus draws on cognitive behavioral therapy in her individual psychotherapy sessions.

This approach identifies thought patterns and behaviors that can adversely affect a patient’s well-being and provides solution-focused interventions that patients can use in their daily routines to break the negative cycle and improve their quality of life. For example, if a patient’s fatigue from treatment leads them to stay in bed all day, perhaps they can progress to sitting up in bed, or rising to shower and change clothes. If a patient is withdrawing from loved ones, maybe they could start by talking to one person a day. “If we can pick one small, simple task to do to address an issue, it gives the patient a sense of accomplishment,” Dr. Kilkus said.

Fellows from the clinical psychology internship program have assisted Dr. Kilkus in leading group psychotherapy sessions, which have addressed such topics as mindfulness and cognitive behavioral therapy skills for cancer survivors. Dr. Kilkus reassures patients that what they’re feeling and experiencing in this extremely challenging period of their lives is normal. “There’s a strong narrative in our culture that if you’re struggling, that you’re doing something wrong or need to be stronger or more positive,” she said. “Really, it’s just part of being human. We all struggle when we encounter difficulties. I have the opportunity to really hear them and help them make changes that may serve them better with what’s happening right now in their lives.”

Submitted by Emily Montemerlo on June 28, 2022