Psychological distress a consequence of, contributor to cancer treatment delays
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Psychological distress about a cancer diagnosis may be associated with patients deliberately delaying the start of treatment, according to study findings.
Those delays also appeared to increase psychological distress, results showed.
In the qualitative study, researchers conducted one-on-one interviews with 22 people with cancer and 12 health care providers.
Although patients generally felt driven to initiate treatment immediately due to fear, many identified this same fear as a factor in intentional treatment delays.
“Being diagnosed with cancer is obviously a very difficult experience for people. There’s a lot occurring medically and psychologically between the time of diagnosis and the start of treatment,” researcher Zachary Frosch, MD, MSHP, assistant professor in the department of hematology/oncology and member of the cancer prevention and control research program at Fox Chase Cancer Center, told Healio. “We wanted to better understand what people are experiencing during this time, how it impacts their engagement with their care team, and how some of these issues might be better addressed to facilitate timely cancer care.”
Healio spoke with Frosch about the bidirectional relationship between psychological distress and treatment delay, as well as what clinicians can do to help their patients overcome these psychological barriers and alleviate distress.
Healio: How did you conduct this study?
Frosch: We conducted semi-structured interviews with both patients and members of the care team. We had an interview guide that contained questions about particular areas of interest, but it also allowed time for participants to freely share their own experiences.
We identified the members of the care team based on the disease sites they work in, and we had a co-investigator from each disease site who helped us build that list. Patients were invited to participate based on a number of factors, and we conducted 30-minute interviews with those who were interested, based on the interview guide.
Healio: What did you find?
Frosch: Our study had three main findings. First, patients often felt a real urgency to start their cancer treatment and suffered psychological distress while waiting for it to begin. Second, our participants identified different sources of delays in care, one of which was psychological distress. They frequently identified fear as a barrier to initiating therapy. This suggests that fear can play a role both as a consequence of treatment delays and as a driver of them. Third, participants suggested that having a better understanding of what was to come in their care might help alleviate these fears.
Healio: What are the potential implications of these findings?
Frosch: Recognizing that fear is a potential reason for treatment delays is very important. It’s well established that logistical issues such as insurance approvals and transportation issues can delay care, but those aren’t the only potential factors. It’s important to recognize that what’s right for one situation might not be right for another. We had participants who talked about delaying treatment for a week or so to allow them to attend an important family event, which can be entirely appropriate. On the other hand, we heard about patients who avoided taking the necessary steps toward treatment due to fear, which could be detrimental.
Healio: What are some strategies physicians can implement to help patients confront and overcome these fears?
Frosch: The patients we surveyed indicated that education and anticipatory guidance from their care team and peers could be helpful in enabling them to overcome these psychological barriers to treatment. They suggested that having knowledge about what was going to happen during their treatment regimen could be helpful in dispelling the fears that might delay treatment.
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For more information:
Zachary Frosch, MD, MSHP, can be reached at Fox Chase Cancer Center, 333 Cottman Ave., Philadelphia, PA 19111; email: zachary.frosch@fccc.edu.
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