Onco-psychology: Helping people manage cancer-related distress

By Mayo Clinic staff

Clinical psychology develops treatments to help people with mental illness manage distress. Onco-psychology uses similar distress-management principles to improve health outcomes for people coping with stress related to cancer and its treatments.

"The focus of onco-psychology is to reduce suffering and help people focus on enjoyment and quality of life, even though they're undergoing cancer treatment," says Shawna Ehlers, Ph.D., a Mayo Clinic clinical health psychologist. "There's also good evidence that doing so improves traditional outcomes like recurrence and survival."

Dr. Ehlers and her colleagues are building an onco-psychology program at Mayo Clinic based on a set of principles to ensure high-quality care that they call best evidence science translation (BEST). The team recently conducted a study applying its BEST principles in a real-world, comprehensive cancer care setting. The results were published in June in the Journal of the National Comprehensive Cancer Network.

Cognitive behavioral therapy for cancer distress

One tool commonly used in onco-psychology to manage distress is a type of talk therapy called cognitive behavioral therapy. Clinical trial results have shown that cognitive behavioral therapy for cancer distress (CBT-C) reduces stress, increases healthy lifestyle behaviors and may even help prevent cancer recurrence and improve survival.

CBT-C teaches people with cancer the skills to challenge unhelpful thought patterns, improve behaviors associated with those thought patterns, better manage their symptoms, reduce stress and communicate their needs to loved ones.

But patients typically don’t have access to CBT-C outside of clinical trials, and it hadn’t been tested in real-world cancer care settings. For their study, the research team at Mayo Clinic offered CBT-C to a broader group of patients receiving care at Mayo Clinic Comprehensive Cancer Center. "We have amazing trials testing these services in behavioral laboratories," says Dr. Ehlers. "We're testing those trials in the cancer care setting so we can identify how to adapt these services for more complex, real-world practice settings."

In the first phase of their research, the team sought input from care teams on how to adapt the CBT-C model studied in clinical trials for more widespread cancer care. The researchers then adapted the CBT-C model for use in the Cancer Center, expanding it to include patients with any cancer diagnosis, reducing the number of CBT-C sessions conducted and revising some of the content of those sessions.

In phase 2 of the study, researchers continued to adjust their new CBT-C model based on feedback from therapists and patients.

Implementing a new CBT-C model

Phase 3 of the research used the adapted CBT-C model that Dr. Ehlers and her team had created, making it part of the comprehensive cancer care provided at Mayo Clinic. In this phase, cancer care team members ordered a cancer stress management consultation through the electronic health record for their patients. After the consultation, eligible patients were invited to participate in the CBT-C program.

Throughout the study period, 100 patients enrolled in CBT-C, and 60 of those consented to participate in the research. All 60 participants completed 100% of the CBT-C content. Dr. Ehlers and her team measured the ease and convenience of these program components: providing CBT-C to patients, recruiting patients to participate and their continued participation, the participation of cancer care providers, and patients’ survey responses.

When surveyed, more than 98% of study participants said they would recommend this service to family and friends with cancer.

To better meet the needs of cancer patients unable to travel, Dr. Ehlers and her team next plan to study the effectiveness of CBT-C when provided virtually.

Expanding onco-psychology services

Research demonstrating the benefits of cancer distress management has led many cancer centers to offer onco-psychology. At Mayo Clinic, onco-psychology services are now available on a small scale.

Dr. Ehlers and her team are preparing to launch a larger comprehensive onco-psychology program at Mayo Clinic later this year. The team will build the new program around the BEST principles they developed and will integrate onco-psychology services within the care provided by Mayo Clinic Comprehensive Cancer Center.

"We're excited to be bringing this important service to more people with cancer," says Dr. Ehlers. "The evidence is strong that onco-psychology can significantly reduce stress and improve the quality of life for these patients."

Learn more

Learn more about managing cancer-related stress by reading these articles:

• "Cancer diagnosis: 11 tips for coping"
• "Emotional recovery after cancer treatment"
• "Cancer and mental health: Coping with the burden of your diagnosis"
• "Integrative oncology: Lifestyle medicine for people with cancer"

Take an online cancer stress management course from Mayo Clinic’s Stephen and Barbara Slaggie Family Cancer Education Center.

Join an online support group for people with cancer on Mayo Clinic Connect.