How to address mental health issues in people with cancer during COVID-19

Macmillan Cancer Support offers well-being advice for patients and nursing teams dealing with treatment delays, isolation and disrupted routines due to COVID-19

Macmillan Cancer Support offers well-being advice for patients and nursing teams dealing with treatment delays, isolation and disrupted routines due to COVID-19

Difficulty sleeping may be a sign that a patient has mental health issues
Difficulty sleeping may be a sign that a patient has mental health issues Picture: iStock

New research by Macmillan Cancer Support reveals that more than one third (40%) of people receiving cancer treatment in the UK in the run-up to the current lockdown, were worried that the disruption caused by COVID-19 could reduce the likelihood of their treatment’s success.

The pandemic has been particularly difficult for people with a cancer diagnosis

Additionally, our survey of 2,900 adults found one in four (24%) people living with cancer feel that they will not be able to return to normal activities until there are no new cases of the virus.

Worryingly, almost one in five (19%) have been left feeling depressed because of COVID-19.

The ongoing impact of COVID-19 has had a serious emotional toll on people living with cancer from feelings of isolation to delayed or cancelled surgery and treatment.

Macmillan speaks to people with cancer day in and day out, and we are hearing how this has been the most worrying time to get a cancer diagnosis in recent history.

It has never been more important for cancer teams to be aware of the mental health and well-being of their patients.

Spotting signs of mental health problems

Observation, assessment and communication skills are invaluable when assessing a patient’s mental health. Observing how someone appears, their responses to questions or what they are saying about how they feel, can help to identify emotional well-being needs. The signs and symptoms of mental illness can vary and can affect emotions, thoughts and behaviours, as well as manifesting as physical responses.

A good starting point is to be aware of the five signs of mental illness:

  1. Worry and/or anxiety
  2. Sadness of irritability
  3. Extreme mood changes
  4. Social withdrawal
  5. Changes to eating and sleeping

Sometimes, eliciting this kind of insight or information can be difficult, and using a tool, such as the Generalised Anxiety Disorder Assessment, can be helpful.

Developing a script to prompt a patient can be a useful screening aid to help decide whether a referral for psychological support is required.

Detecting mental health issues during a virtual consultation

Adjusting to virtual and phone conversations during the pandemic means that spotting signs of mental health issues in patients can be more challenging. Therefore it is important to remember to:

  • Be present and allow yourself to be emotionally available during consultation
  • Use appropriate open questions
  • Listen without interruption and judgement, and employ active listening skills such as paraphrasing and reflecting patients’ feelings
  • Empower the patient by asking how they have successfully coped with similar challenges in the past
  • Express empathy in a genuine, natural manner, thereby fostering a stronger relationship with the patient.

There’s no sure way to prevent mental illness, however nurses can provide tools to help understand stress, increase resilience and boost self-esteem.

Encourage use of social supports by signposting to virtual groups and advice lines, such as Macmillan’s Telephone Buddies or Support Line or encourage patients to speak with friends and family. Feeling connected to something or someone is vital to remaining emotionally and physically well.

You could teach or signpost to breathing or mindfulness exercises. For example, say to your patient: ‘Close your eyes. Take four deep breaths. Focus on the sound of your breath. Imagine that you are in a place where you feel calm and safe. Connect to the emotions that you are experiencing.’

Physical activity can help to improve mood, so encourage your patients to explore this. Some charities and healthcare providers will have online exercise groups, such as Macmillan’s Move More initiative. Even a local walk can help.

A daily routine can help maintain good mental health

Recommending your patient sticks to a routine can also be beneficial. In these uncertain times, creating a routine can help maintain stable mental health. This should also include attending routine check-ups or visits to care providers.

Above all, advise patients to take good care of themselves: sufficient sleep, healthy eating and regular physical activity all contribute to good mental health. Advise patients to talk to their care provider if any of these areas are affected and to seek help early as mental health conditions can be harder to treat if the person waits until their symptoms worsen.

During these challenging times when healthcare professionals are under enormous pressures, it is easy to forget to look after yourself.

It is vital to remember that you cannot pour from an empty cup and Macmillan’s emotional health and well-being hub for professionals has lots of resources you can access to help you look after your well-being and manage your self-care too.

RCNi well-being centre

Further information