Adding Mental Health to Therapy for Cancer Patients
One in an ongoing series
Like many patients with cancer, family physician Janis Rubin, MD, needed mental health support to help her navigate the distress of disease and chemotherapy.
Although her treatment team at Einstein Medical Center Montgomery was compassionate and supportive, they weren’t able to provide what she needed the most when she was overtaken by depression after her second round of chemotherapy: the name of a therapist who could treat her. For that, she was on her own.
“With all you’re going through during chemotherapy, at that point, I didn’t have the initiative to find my own therapist,” she says. “It’s difficult for a distressed patient to embark on the task of finding their own therapist.”
Dr. Rubin later started discussions with her oncologist, Madiha Gilani, MD, about developing a program to include professional therapy as part of the treatment plan for cancer patients at Einstein Montgomery.
Counseling Support From Day One
“I felt all along that mental health support should be part of the care plan from the day your primary care doc says, ‘Your scan is bad’ and refers you to an oncologist,” Dr. Rubin says. “I think anyone who gets a cancer diagnosis is going to be depressed.”
Thanks to a grant from the Albert Einstein Society, the program to fund psychotherapy for cancer patients at Einstein Montgomery has come to fruition. The Albert Einstein Society is an internal foundation that funds innovative programs and research projects throughout Einstein.
Madiha Gilani, MD, Dr. Rubin’s oncologist, acknowledges that mental health care is “indispensable” for cancer patients, one-third of whom will develop psychiatric disorders, such as depression and anxiety, during treatment.
“Patients who have good mental health care do much better than patients who don’t, as far as outcomes of cancer treatment are concerned,” Dr. Gilani says. “If our patients are mentally healthier, it makes them more able to focus on doing the right thing for themselves.”
How the Program Works
Dr. Gilani has recruited two private psychiatric practices to provide subsidized mental health care for a pilot population of 80 patients who score high on a depression screening questionnaire, which is given periodically to patients to evaluate their mental health.
The practices are run by psychiatrists, with eight to 12 psychologists on their team. They have agreed to see patients who are referred for treatment within three or four days. They will provide a combination of virtual and in-person care, depending on the patients’ preference.
The fees, which have been reduced for program participants, will be paid directly to the therapists by the oncology department.
“An opportunity to fulfill this unmet need will take the care of our cancer patients to a much better level for them,” Dr. Gilani says.
“It is not only the cancer medications that matter. Mental and emotional strength and support play a huge role for our patients to be able to endure all that cancer brings with it, including its treatment and more.”
For now, the service will be provided only to patients without insurance coverage for mental health services. Patients with insurance will be provided a list of qualified therapists, so they don’t have to find a practitioner on their own.
Cancer, Counseling and Retirement
Eventually, Dr. Rubin found her own therapist when she was overwhelmed with anxiety after her chemotherapy treatment ended in July of 2021. The treatment was a great help.
Still, the aftermath of cancer and chemotherapy caused Dr. Rubin to retire in June – years sooner than she’d planned – after 40 years of practicing family medicine. For one thing, she continues to have fatigue. And chemotherapy left her with compromised immunity, making her susceptible to COVID and other infections.
Dr. Rubin will continue to be physician liaison for the mental health project, spreading awareness about the program and providing oversight for patients taking medication provided by a psychiatrist.
“Therapy helped me focus on what’s important in my life. It had to do with mindfulness and living the now and not worrying about the future,” Dr. Rubin says.
She’s gratified that she helped make that same experience available to other cancer patients struggling with the life-changing diagnosis.
“My dream is to make sure that mental health is part of the care plan from the get-go,” she says.
Photo: Janis Rubin, MD