Moderator Jessica Vanderlan, PhD, a clinical psychologist at Siteman Cancer Center at Barnes–Jewish Hospital and Washington University School of Medicine, and Co-Chair of the NCCN Guidelines Panel for Distress Management, opened the plenary session by asking the panelists at the NCCN 2025 Annual Conference to reflect on the role mental health care plays in oncology care. “It is important to take a look at mental health side-by-side with a cancer diagnosis,” stated Amy Corveleyn, MSW, LICSW, Oncology Social Work Manager, Dana-Farber Cancer Institute. Panelists emphasized that those most in need of assistance tend to be the least likely to ask for it. They also pointed out that people whose social/emotional needs are addressed have better adherence to treatment, are more likely to complete the full course of treatment, tend to have lower mortality rates, and have a higher likelihood of returning to work. Caregivers and health professionals may also experience significant benefits when psychosocial care is integrated into oncology care.
Mental Health in Oncology Care
Mental health concerns and challenges interfere with an individual’s ability to get through cancer treatment, and the appropriate management of these concerns by a psychosocial oncology care professional will make it easier to allow a patient to continue treatment. “One of our most important roles [as psychosocial oncology professionals] is to help our oncology colleagues help their patients get through cancer care,” said Jesse R. Fann, MD, MPH, Medical Director, Psychosocial Oncology at Fred Hutchinson Cancer Center, and Professor, Department of Psychiatry and Behavioral Sciences, University of Washington.
Comprehensive cancer care includes mental health care, and the panel agreed that care of the patient’s psychological well-being should be as important as the cancer treatment and a patient’s physical health. “[Psychosocial oncology care] is when we look at a whole person and a whole patient; it’s the most patient-centered approach to be thinking about someone’s mental health history, where they are currently,” said Ms. Corveleyn. Studies have shown that distress levels increase at cancer diagnosis. “We also have learned that people who have preexisting mental health issues may be more likely to struggle…, and that has an impact on their outcomes,” she added.
Assessing and Addressing Mental Health Distress
Psychological responses to a cancer diagnosis vary among patients but can include grief (ie, mourning the loss of the person they were before the cancer diagnosis), fear and vulnerability (ie, uncertainty about the future, survival, and life posttreatment); and physical and cognitive symptoms (eg, pain, fatigue, and memory problems). Persisting or worsening physical or cognitive symptoms could be manifestations of depression or anxiety, and all can affect any individual regardless of any preexisting history of depression or anxiety. A workup may not show clear physiological explanations for physical symptoms, which should raise the clinician’s suspicion for contributing psychological factors.
Challenges and Barriers to Care
Identifying patients with distress can be challenging; furthermore, how to manage distress can present further challenges, along with monitoring distress and adjusting treatments across the cancer care continuum when therapies don’t go as planned. NCCN defines distress as an unpleasant experience of a mental, physical, social, or spiritual nature that can affect the way people think, feel, or act. Tools such as the NCCN Distress Thermometer can help to normalize and encourage discussion of psychological or personal issues without the stigma that can sometimes cause patients to avoid talking about their own mental health concerns.
Despite increasing awareness, barriers to the diagnosis and appropriate care of distress persist. “Let’s just say we have to remove the stigma,” said Stephanie Samolovitch, MSW, Founder and Executive Director, Young Adult Survivors United, a nonprofit support group offering emotional, social, and financial assistance to young adults with cancer, survivors, and caregivers. Ms. Samolovitch will celebrate her 20th anniversary as a leukemia survivor in August 2025.
Dr. Vanderlan noted that distress and mental health concerns among individuals with cancer often go underreported. Although addressing personal issues such as fertility or financial concerns can be challenging, she emphasized that asking these difficult questions about an individual’s mental health are critical. Ms. Samolovitch added that community-based resources such as Young Adult Survivors United are available to alleviate some of the burden on staff in the cancer care center.
Individuals with preexisting conditions such as substance use disorder or mental illness and other comorbidities may experience feelings of shame, commented Ms. Corveleyn. For this and other reasons, it is essential that the multidisciplinary care team—including psychiatrists, psychologists, social workers, and other mental health providers, as well as oncology clinicians, advanced practice providers, and nurses—let their patients know they are supportive of all their needs.
Models of Care
Identifying distress, monitoring mental health, initiating treatment, and continually addressing the psychosocial health of patients are crucial steps to the successful care of individuals with cancer. The panel agreed that NCCN has done good work creating practice guidelines for distress but cautioned that effectively managing distress after it is identified in a patient can be challenging.
“Evidence-based practice guidelines are amazing, but there are barriers to implementation,” stated Dr. Fann. “It’s like having a great medication, but not having the right delivery method, the right capsule,” he remarked.
Tools such as the Distress Thermometer and the patient health questionnaire (PHQ-9) and generalized anxiety disorder (GAD-7) questionnaires to track depression and anxiety are helpful. However, time constraints in busy clinics often preclude a clinician’s ability to effectively assess distress routinely at each visit.
An interdisciplinary psychosocial program offers the most effective approach to support, with models such as the interdisciplinary collaborative care model and age-friendly care frameworks providing strong foundations for building such programs.
Collaborative Care Model
Dr. Fann shared that thinking about models to help cancer centers of diverse makeups and staffing with mental health care is a passion of his. “An interdisciplinary model is really the best model—a model where each discipline works closely and in coordination with each other, where the sum is greater than the individual pieces,” he said. “The most evidence-based [interdisciplinary] model is called ‘the collaborative care model,’ which really is a team-based approach that takes multiple disciplines and makes sure that they work together,” explained Dr. Fann.
In her role at Dana-Farber, Ms. Corveleyn and her colleagues are implementing the collaborative care model and using validated instruments to monitor outcomes over time. “Our model uses palliative care, psychiatry, psychology, social work as…the first-line assessors of the patient. This approach gives patients a sense of security,” she explained. With such an approach, patients can have their concerns addressed directly with a mental health care professional, who can then share relevant information with the patient’s clinical care team. This avoids the need for patients to repeat their concerns about distress or mental health to multiple health professionals.
These instruments and measures support and assess the effectiveness of evidence-based interventions in the collaborative care model that allow the psychosocial oncology care team to measure a patient’s distress during visits to the clinic and make necessary treatment adjustments. This team can then let the medical team know that a patient’s pain is under control or the patient’s depression is worse or better. The collaborative care model reinforces the patient-centered approach to care for individuals with cancer.
Ms. Corveleyn remarked that the benefits of the collaborative care model extend to the psychosocial team as well. “You’re not worrying alone. Everyone on the interdisciplinary team is there to support one another, which can be very powerful,” she shared.
The panel acknowledged that resources vary across cancer centers and among urban, rural, and suburban settings of care. In some rural areas, for example, there may be more limited resources such that their interdisciplinary care model will look somewhat different from a clinic with more resources. Nevertheless, the goal is still the same, whether a patient is speaking with a nurse navigator, case manager, social worker, psychologist, or psychiatrist. All have the patient’s best mental health in mind.
Dr. Fann focused on the importance of flexibility in centers with possibly limited resources. For example, one of the outcomes of the COVID-19 pandemic was the increase in telehealth, which can be especially beneficial at centers where there may not be a psychiatrist available. “So, you must be creative. You want to use what resources you have to be able to deliver those core principles of good evidence-based care,” he said.
Age-Friendly Care Models
The older adult cancer population is growing, and healthcare systems must recognize their unique care needs, including potential limitations in function and activities of daily living. “These [limitations] impact mental health, and that impacts how they normally see their need to thrive or lack thereof. So, when we conduct geriatric assessments, where we look at fall risk or comorbidities, medication…any potential risk for polypharmacy, anything that may impact their cognition or mental health in addition to the cancer treatment, we need to address what is meaningful to the individual patient,” said Tamryn Fowler Gray, PhD, RN, MPH, Assistant Professor, UNC School of Nursing. Addressing what matters most to the individual patient is essential; although the cancer treatment may be effective, it could negatively impact other meaningful aspects of daily living for older patients, which could impact the mental health (social isolation, depression, anxiety, and stress) and overall quality of life of older adults with cancer.
Mental Health Care Outcomes
The panel discussed the numerous positive outcomes that result from mental health interventions and care for patients with cancer. “We know [and the literature shows] that when we are continually assessing and addressing the mental health needs [of patients], then we are going to see an improvement in overall health-related quality of life,” Dr. Fowler Gray explained. “We’re also going to see improved coping mechanisms, increased resilience, decreased anxiety and distress, and fewer depression symptoms.”
Addressing the mental health needs of patients can also benefit the health care team. “When mental health needs are managed, we can see that as clinicians. Our patients and their caregivers are feeling better and more in control,” Ms. Corveleyn said. “That has a direct impact on how [health care professionals] view the work we do, which has a direct line to reducing burnout and improving communication within our teams.”
Dr. Vanderlan added, “a very practical piece of that impact to the team is sometimes fewer phone calls, fewer chats, because the patient’s anxiety is better handled by somebody specialized in that area.” And this, in turn, added Dr. Fann, can also lead to fewer visits to the emergency department, fewer hospitalizations, and decreased health care costs.
Help for Caregivers, Too
The panel addressed the importance of recognizing the needs of caregivers—those who are in the room with the patient or calling in for the visit remotely. Caregivers may have questions about the patient’s care that they are reluctant to ask, so it is essential for the care team to address them as well.
“Caregivers do so much work—unpaid work—but they are caring for the patients we share day in and day out,” commented Dr. Vanderlan. “Some studies show they have higher anxiety than the actual patients. So, if we depend on these individuals to care for the patients we also care for, we need to do a better job of addressing their needs, too.”
Survivorship Transition
Patients may be especially in need of psychosocial support when treatment ends. This is a time of complex emotions and changes in a person’s role as family member, coworker, or spouse, and learning how to manage these feelings and changes can be especially tough.
“I have talked with patients, and they literally go in their car and cry their eyes out, because they have no idea what just happened, what’s the next step,” said Ms. Samolovitch.
“Emotions are very complex and complicated,” shared Dr. Vanderlan. “One may be gratitude [for getting through treatment] in one moment, and it can turn to anxiety and grief in the next moment.”
Along with changes in personal goals and aspirations, some patients may see this period of transition as a chance to make some general health behavioral changes. For example, a patient might comment about their desire to stop smoking, and that’s another area where psychosocial care can offer support. “One of the most satisfying things as a clinician is to see that this monumental event in someone’s life has guided them to do something different and something new that could be wonderful,” Ms. Corveleyn commented.
