Managing Emotional Care Challenges in Cancer Treatment

Holly Stewart, PA-C, Supportive Care APP Manager, Palliative, Rehab and Integrative Medicine Department, University of Texas MD Anderson Cancer Center, Houston, Texas presented a discussion on tips and strategies for navigating emotional care challenges across the cancer journey.

She highlighted many strategies, including monitoring moods and habits, utilizing the SPIKES protocol, and following the “3 Good Things” practice. This discussion was presented at the 2025 Oncology Learning Network APP Institute meeting, 

Transcript:

Hi, my name is Holly Stewart. I am a physician assistant at the University of Texas MD Anderson Cancer Center, where I work in our palliative care/supportive care department. I was recently invited to do a talk on navigating emotional challenges across the cancer journey. 

I'm going to do a quick overview. Hopefully this is appealing to you because as we're seeing, cancer is becoming more of a chronic illness, and as that happens, we're continually seeing this rollercoaster of emotions as the disease [trajectory] occurs. Some of the emotional challenges that we see frequently, that are even quoted on sites such as the National Cancer Institute, are feelings of being overwhelmed, fear, worry, stress, anxiety, sadness, possibly depression. You can even get swings of hope, as well as gratitude. 

But then also there's the psychosocial challenges that come up with this, and that could be the deterioration of self-concept. Body image may be disturbed due to whatever's going on, it's head and neck cancer or a breast cancer. There could be concerns with sexual troubles, maintaining social relationships, and there's many things that go into causing major stressors for the patient. And it's not only just for the patient. Cancer is a journey in that it affects the whole family. And so it also brings in the caregiver into this as well.

With that being said, the stats around emotional distress, there's no perfect way to ascertain, because a lot of the symptoms of cancer kind of overlap with depression—so when you think of fatigue, or poor sleep, or anorexia, those are things we commonly think of with depression as well. So how do we tease that out? 

But there have been some good studies that pretty much report around 30% approximately, for both depressive symptoms as well as anxiety symptoms, in our cancer patients. So it's important that we're checking in with our patients and asking those questions. Often, I think there's so many new strategies for cancer treatment that it's very easy just to get caught up on: what's the next thing that we're going to treat it with? But we don't take full circle with what the patient's going through. 

And so, really asking them, how is their quality of life? A way I like to do that is just tell me about your daily activities for the past week. It really gives me some good insight into what's going on. There are some validated tools on symptom management. We currently use the Edmonton Symptom assessment system. There are also great tools in trying to dig a little deeper, different strategies for delivering bad news, such as the SPIKES protocol, as well as a newer one if you're interested in looking further into that. 

But the important thing is that you ask those questions and that you're connecting with those patients and making sure that we're still focusing on holistic care. When we kind of talk about resiliency, whether it's for our patients or caregivers, I always say, let's not forget the basics, right? Movement, taking a nap if that's possible, even if it's just for a 15-minute downtime during the afternoon, hydrating, asking for help if you need it. A big thing with us, because of course we’re palliative, and so we see a lot of complicated and possibly sad cases, is that we debrief with our team, too.

If we solve something that was hard to really process, that's something that you need to talk about with your team members and kind of get that out. It helps to clear the air. Just wrapping up on a simple good practice is, and that could be good for the patient as well as caregivers, as well as healthcare providers, is a philosophy. It's a movement called “3 Good Things.” It's where within a half hour before bed, but thinking of just 3 good things that happened during the day and how you were a part of it. This has been shown to clinically improve stress and sleep. There's even some science that actually shows that it may be even as beneficial as taking an SSRI. 

To wrap up, emotional health is very important in the way that we deal with everything else going forward. If you're not coping well, you're not sleeping well, and then things just don't seem to go well for the days going forward. And so, addressing these things with our patients is vital. If there's any questions, concerns, we'd be happy to reach out more. Thank you.

Source: 

Stewart H A. Navigating Emotional Challenges Across the Cancer Journey. Presented at Oncology Learning Network APP Institute; December 18 - 19, 2025. Virtual.