One of the biggest problems I have seen in my patients is that they are told by relatives, friends, and sometimes even medical professionals to be strong. \u201cBe strong. Things are gone. Things are not going to come back.\u201d It may come from a place of love and care, which is how we tend to talk to family members, but it has a completely reverse effect on the patient. It tells the patient that they need to be strong and don\u2019t need to share what they\u2019re going through. They have already gone through so much in this journey. Their lives have been disrupted, there is already so much disruption happening because of the disease, and they start blaming themselves. They do not share, and this grows.<\/p>\n
How does this show? It shows up as sleepless nights. When they come in for their follow-ups, you\u2019ll notice they\u2019re tired. You\u2019ll ask them a simple question, \u201cHow are you?\u201d and they\u2019ll just say, \u201cI\u2019m fine.\u201d But behind that \u2018fine,\u2019 there is sleeplessness and there is tiredness.<\/p>\n
Fear of recurrence is something we need to dive deep into, and it needs to be addressed much earlier by the doctor or a team of doctors. This is where I would suggest oncologists and psycho-oncologists come together to determine whether the problem is real: whether the sleepless nights the patient describes are due to a drug adverse effect, or whether the patient is simply ruminating and thinking a lot.<\/p>\n
Physical anxiety markers like palpitations, insomnia, and gastrointestinal distress closely overlap with treatment toxicities and steroid adverse effects. What guidance or screening adaptations do you recommend for oncologists and care teams to differentiate true psychological anxiety from physical drug effects?<\/p>\n
Most therapies and treatments in oncology have adverse effects, often multiple adverse effects. Most of the time, patients are aware of this, but as they go through treatment, they may be taken by surprise at the magnitude of the problems they face. This is a very realistic issue. Like I said, when you go for the first treatment or first cycle, you\u2019re always surprised. Maybe you\u2019ve heard about the adverse effects, and the anxiety is at a minimal level. Once you go through it, it becomes a conditioned response.<\/p>\n
This is where the oncologist and psycho-oncologist need to intervene together. As I proposed, the questions are: What was the timing of the symptoms? When did the palpitations happen? With some drugs, like dexamethasone or other steroids, you are going to see adverse effects such as palpitations or insomnia. To separate the 2, you need to look at the timing. You need to dive deep into exactly when it happened, how the patient relieved it, and whether it was happening beforehand.<\/p>\n
Patients need to be educated well beforehand, so they understand what is going to happen after the first cycle and as they progress through the next cycles. The differentiation comes from the medical oncologist and psycho-oncologist working together, knowing exactly how the patient was before treatment started and what happened after the first treatment, and determining whether it is a drug adverse effect or whether it\u2019s happening because of anxiety.<\/p>\n
For example, some patients will start having palpitations just before a chemotherapy session. \u201cGod knows what will happen today. Last time I fainted,\u201d or, \u201cLast time I was feeling uneasy. I was feeling extremely dizzy. Can it happen again?\u201d These are the symptoms we should dive deep into. We should specifically ask patients to come and tell us about them and let them know that this is very normal. If we do that, we can address it much earlier.<\/p>\n
Your paper highlighted conditioned anticipatory symptoms, such as chemotherapy-induced anticipatory nausea. Why is addressing these treatment-induced responses critical, and how should the oncology team collaborate with mental health providers to manage them?<\/p>\n
Nausea with chemotherapy is very real. It is a very real phenomenon. After the first cycle is over, you will see many patients anticipating nausea. They\u2019ll eat light food, and at times they won\u2019t eat at all, just from thinking about it the night before. I had a patient who came in and said, \u201cI have not eaten since last night because I believe I\u2019ll have nausea.\u201d That\u2019s not right. You\u2019re going in for chemotherapy, and you\u2019ve not eaten. We do suggest that patients take something, such as juices. This is exactly where we need to dive deep into these symptoms and help patients understand that this is going to happen, but it\u2019s not going to happen every time.<\/p>\n
The patient should be aware of what\u2019s going to happen to them. They should not be taken by surprise with the second or third cycle, thinking, \u201cI didn\u2019t expect this to happen.\u201d They should expect it: \u201cYes, I will feel nauseous. When I go into the hospital, I\u2019m going to feel like that.\u201d This is where guidelines would make it much easier for the patient to address this problem, rather than not eating, eating light, or anticipating nausea that may not happen. Maybe it doesn\u2019t happen the second time. Maybe the dose is changed, or maybe this time antiemetic doses are higher and given earlier compared to last time. Those are things the medical oncologist will take care of. But if we address this much earlier, it will spare the patient a lot of discomfort, and we would probably be able to complete the treatment.<\/p>\n
You outline clear population-level spikes in anxiety, such as the transition at treatment completion or the period before surveillance imaging, like the scan anxiety you mentioned before. How can clinical practices systematically flag and support patients during these specific transitional windows?<\/p>\n
Onco-anxiety is something that doesn\u2019t go away with the cancer, and that\u2019s a very real factor. When a patient goes for their very first scan or investigation, when they have a probable diagnosis of cancer, this is one of the most difficult times for anyone. This is when patients most commonly ask me, \u201cWhy has this happened to me?\u201d The fear of getting cancer is much bigger than getting the cancer itself; it\u2019s the fear of what it would change in their life. They jump straight to the last stage. It might not even be cancer, but they have been thinking about it. This is normal, especially when there\u2019s no history and it\u2019s the first time someone is facing a diagnosis.<\/p>\n
Scan anxiety is very much expected. If there\u2019s a lump in the body, the doctor should anticipate it and tell the patient, \u2018This is the kind of thing you\u2019re going to go through. It may not be real.\u2019 If we address the problem right at the initial stages, it will make things much easier for the patient. I could give examples of patients who have had sleepless nights until they get their CT scans, and then you find out there\u2019s no cancer at all. It could be some other disease. It could just be a benign lump. You may go for a fine-needle aspiration or a biopsy and find out it is normal. Scan anxiety specifically needs to be addressed much earlier, by a psychologist together with a medical oncologist, so that the patient is well prepared. Keeping the patient prepared and informed is very important.<\/p>\n
Again, there cannot be general guidelines. Anxiety that fits you will not necessarily fit me; it\u2019s completely different. Your past experiences, the way you\u2019ve handled anxiety, any chronic anxiety, and your behavior patterns will change the way it presents. This is exactly why it cannot just be referred to somebody. It needs to be worked on together, and there needs to be a guideline or framework that makes it easy for the team to come to a common conclusion about exactly what the patient is going to go through. It should not be too late, and it should not be too early, where we scare the patient by saying, \u201cYou\u2019re going to feel this,\u201d and make it seem like something very big. You should not end up doing that. That\u2019s why this needs to be structured, so we can address the problem in a much more organized way.<\/p>\n
Looking ahead, where does physiological measurement fit into this framework, and what are the next essential research steps needed to validate onco-anxiology in clinical trials?<\/p>\n
When we talk about physiological measures, especially HRV and the scores that come into play, using them independently to diagnose anxiety, or to say whether a patient is anxious or not, is not the right way. Much more work needs to be done there, and a lot of research needs to go into exactly how we use them. In my experience, measures like HRV need to be done serially. A single evaluation would not be enough, because every patient is different, and every patient\u2019s reaction to cancer is going to be different. They need to be done in a series so that we see a pattern, and once we make sense of these patterns, we can determine the right treatment, the right kind of solution to provide, whether that would be enough, and if not, what the next steps are.<\/p>\n
These guidelines need to be developed, and trials specifically are where I would want people to collaborate and work on this, because the patient is already going through a lot with the disease and the treatment itself. This is where the patient loses themselves. If we can address this entire structure and run the right kinds of clinical trials through collaboration, we will be able to find solutions that make things lighter and simpler for patients. They will be able to cope much better, compared with simply believing that one size fits all, which would not really solve the problem.<\/p>\n
One experience I\u2019ll share is that the patients who look the strongest and firmest are often the ones holding things back. They are pretending to be strong, and a lot is going on in their minds\u2026We need to stop pushing patients to be strong and start having them address their problems and speak about them, and doctors need to ask the right questions.<\/p>\n
This is where clinical trials should come in: What are the right questions to ask at each stage? Like I said, there will be a different set of questions for the first cycle than for the second cycle. After treatment ends, and with scan anxiety at first diagnosis, the questions are different again. These need to be addressed individually, and trials specifically designed to address this would build a much better, stronger structure for onco-anxiology, one that solves the problem rather than just creating another score or another parameter that sits in the file without solving the problem for the patient.<\/p>\n
Reference<\/p>\n
Jain C. Onco-anxiology: a proposal for an anxiety-focused, longitudinal framework within cancer care. Front Psychol. 2026;17:1939608. doi:10.3389\/fpsyg.2026.1939608<\/p>\n","protected":false},"excerpt":{"rendered":"One of the biggest problems I have seen in my patients is that they are told by relatives,…\n","protected":false},"author":2,"featured_media":638184,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[163,85,46],"class_list":["post-638183","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-health","tag-il","tag-israel"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/638183","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/comments?post=638183"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/638183\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media\/638184"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media?parent=638183"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/categories?post=638183"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/tags?post=638183"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}