Maintaining Mental Health

Mental well-being in patients with cancer

Cancer diagnosis and treatment are life-changing experiences that affect not only physical health, but also have profound effects on psychological well-being, with as many as 50% of patients reporting clinical levels of mental distress.^1,2 Furthermore, the emotional response to a cancer diagnosis can potentially trigger development of psychiatric disorders, including adjustment disorders, depression, and anxiety.²

Accumulating evidence also suggests that the relationship between mental health and cancer-related complications is reciprocal, in that poor mental health can negatively affect disease progression and cancer-related mortality, as well as adversely impacting patient management, quality of life, duration of hospitalization, treatment adherence, and treatment costs.²

Therefore, appropriate clinical evaluation for depression and anxiety is essential to recognize patients in need of support, further assessment, and follow-up care.² The table below highlights the prevalence of depression (22.6%) and anxiety (30.2%) in patients with cancer, categorized by severity based on PROMIS self-report questionnaires.²

Multiple factors were associated with significantly increased risk of depression, including having metastatic disease, history of psychiatric treatment, and being unmarried. Additional risk factors may include being younger than 65 or having a longer disease duration. Disease duration longer than 12 months and certain cancer types—particularly female-specific malignancies (ie, breast and ovarian cancers) were associated with higher rates of anxiety.³

Assessing the psychosocial needs of patients

Clinical assessment of psychosocial needs enables differentiation between mild symptoms and frank psychiatric conditions, informing appropriate treatment strategies and referral pathways. Evidence supports the use of both psychosocial and psychopharmacological interventions in managing cancer-related distress. Targeted psychosocial therapies—such as education, cognitive-behavioral therapy, mindfulness-based stress reduction, counseling, and complementary approaches—have demonstrated effectiveness in alleviating emotional symptoms in patients with cancer.³

Guidelines from the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network recommend the use of validated screening tools to identify unmet psychosocial needs, ascertain symptom severity, and guide treatment planning. The figure below illustrates a comprehensive model to ensure appropriate psycho-oncologic support is provided to patients.³

From Patient to Provider: The Mental Health Burden of Cancer Care

Recognizing and managing clinician burnout is equally important to providing emotional support for patients, as the mental health of healthcare providers not only directly impacts their well-being, but also the care they deliver. Given the rising levels of burnout among oncology providers to alarming rates, there is an urgent need to implement widespread approaches that support the mental health and resilience of healthcare professionals.⁴

Physician burnout caused by prolonged stress can manifest as emotional exhaustion, lack of empathy or negative perceptions toward patients, and a sense of reduced professional accomplishment. The effects are pervasive, potentially resulting in increased medical errors, lower patient satisfaction, and compromised quality of care. Burnout also contributes to physician turnover and attrition which, in turn, may impact access to care and exacerbate disparities in availability of care.⁴

In a 2023 survey-based study conducted by ASCO, the prevalence of burnout among U.S oncologists was significantly higher than what was previously reported in a similar study from 2013 (59% vs 45%).^4,5 Results of this study are shown in the figure below

A range of factors can lead to burnout, spanning societal, cultural, structural, and organizational domains. These include excessive workloads, administrative burdens, limited autonomy over scheduling, and lack of organizational support.⁶If not addressed, the crisis surrounding clinician burnout will have far-reaching consequences that hamper patient access to care, increase healthcare costs, hinder preparedness for public health emergencies, and worsen health disparities.⁶

Addressing clinician burnout

To reduce burnout among staff, oncology practices can foster their commitment to workforce well-being. This includes reviewing and updating policies so that employees feel safe and supported when seeking care for physical, psychological, or substance use concerns. Ensuring access to high-quality, confidential mental health services is essential. Practices can also prioritize building community and connection among staff to counteract loneliness and isolation. Investing in preventive care and social support can create a healthier environment for all health workers.^6,7

Tackling oncologist burnout requires a multifaceted approach that also addresses systemic contributors. By eliminating low-value tasks, optimizing team structures, and promoting work-life balance, oncology practices can cultivate healthier, more sustainable work environments. Identifying specific stressors among individuals within practices is another important step toward preserving clinician well-being and maintaining high-quality patient care.^4,8

The “Get Rid of Stupid Stuff “(GROSS) initiative has been proposed to reduce unnecessary burden from daily clinician workloads by eliminating wasteful tasks associated with electronic health record (EHR) systems, which have been implicated as a significant source of administrative burden for clinicians.⁸

Customizing EHR systems based on specific user feedback may alleviate unnecessary documentation. The GROSS initiative provided a framework for oncologists to personalize documentation tools, identify and eliminate unnecessary administrative tasks, and improve efficiency of necessary documentation. The table below demonstrates an example of how the GROSS framework can be implemented.⁸

The ASCO Ethics Committee Roundtable Burnout Experts have proposed three recommendations to facilitate evidence-based solutions to address burnout among oncology care providers:

Provide oncology-specific educational resources for oncologists in their early careers
Assess burnout and well-being based on quality metrics
Encourage research on oncology clinician burnout

In addition, centers can employ tools like the Mini Z survey and Maslach Burnout Inventory to assess burnout among clinical staff. Evaluations should be performed across the board to evaluate workplace stressors and potential solutions to ameliorate and prevent burnout.⁸

For more information, please visit the Survivorship Resources for Oncology Providers section at Additional Resources for Oncology Providers

Education & Resources by Tumor Type

Guidelines for Care

Skin Cancer Champions Community