Mental health challenges can accompany the physical challenges that people with cancer face, from diagnosis through treatment and into survivorship. And unfortunately for some people with cancer, the mental health aspects are often overlooked. As medical director of psychosocial services at NYU Langone Health’s Perlmutter Cancer Center, Asher D. Aladjem, MD, focuses on helping people cope with cancer and mental illness, two of the most stigmatized conditions that anyone might be burdened with.
Dr. Aladjem’s approach is to treat a person’s symptoms, not their psychiatric diagnosis, and he sees his role as trying to help both patients and their oncologists understand the symptoms he is treating. If he prescribes a psychotropic medication, for example, the goal is to treat sleep disturbance, loss of appetite, or feelings of helplessness or hopelessness.
“In the presence of life-threatening illness, the interface of psychotherapy and medications has a balance that differs from patient to patient,” says Dr. Aladjem, also a clinical associate professor in the Departments of Psychiatry and Population Health at NYU Grossman School of Medicine. “Sometimes it is better to stabilize the patient on medication; then, when they become less depressed, they can engage in psychotherapy better. I take an evidence-based approach to tailor the treatment plan to the patient’s specific situation to be able to provide effective treatment.”
Before joining Perlmutter Cancer Center, Dr. Aladjem was a psychiatric consultant at NYC Health + Hospitals/Bellevue for both its primary care clinic and cancer center. In 1995, he cofounded with Allen S. Keller, MD, associate professor in the Departments of Medicine and Population Health at NYU Grossman School of Medicine, Bellevue’s Program for Survivors of Torture, which assists individuals and families subjected to torture and other human rights abuses to rebuild healthy, self-sufficient lives. Dr. Aladjem finds parallels between survivors of torture and people with cancer.
“I think both areas are very similar in terms of how a traumatic event or a cancer diagnosis can disrupt a person’s life significantly,” Dr. Aladjem says.
Dr. Aladjem’s role at Perlmutter Cancer Center includes advocating for patients with their clinicians. The people that Dr. Aladjem treats might have a history of substance use as well as mental illness. There is a common misconception, Dr. Aladjem says, that these individuals are less capable of managing life adversity. On the contrary, he says, these individuals might need different interventions. They might have a higher tolerance to psychotropic medication, need more pain medication, or need a variety of different medications. Traditionally, he says, people with a history of mental illness and substance use have been marginalized with significant inequity in the healthcare delivery system.
Dr. Aladjem also works to shift the burden of seeking psychosocial services away from patients. Healthcare providers, he says, need to try to elicit any psychological distress that is disturbing for their patients in terms of their compliance and their engagement in their treatment. As an example, he cites the resistance that some patients have to participating in clinical trials because they don’t want to be “guinea pigs.” As a result, these patients do not benefit from the best possible treatments because of this stigma. Dr. Aladjem conducts outreach efforts in communities with low socioeconomic status in which people experience inequities and barriers to care to educate them on the benefits of participating in clinical trials and to reassure them that they will be treated with the best care available.
Burnout among healthcare providers who provide care to people with cancer is another area that Dr. Aladjem addresses in his practice. He offers debriefing and support sessions to help reduce stress in providers.
“For oncologists who treat certain cancers, the ongoing loss of patients can be traumatic in many ways,” Dr. Aladjem says. “There is a perception that doctors develop a shield and no longer feel the pain of losing a patient, but that has not been my experience with many of the providers I have worked with. If these feelings are not addressed or there is no outlet for them, the risk of burnout is always there.”
Dr. Aladjem emphasizes that he does not force patients to have psychotherapy and only prescribes psychotropic medications when patients are in agreement about wanting to take medication. Helping people navigate the twin stigmas of cancer and mental illness is challenging, he says, but the experience of treating is rewarding and yields better outcomes.
“People with cancer and their providers need to be aware that feeling anxiety, sadness, or hopelessness or helplessness are common reactions, and accessing the psychiatric services that might help them manage those feelings better would serve them well if they are able to go beyond the stigma that is often associated with mental conditions,” Dr. Aladjem says.
“People often tell me, ‘Oh, I don’t like to come here.’ And my response to that is, I would have been very worried if you told me that you like to come here because most people would rather live their lives not knowing that this place ever existed,” Dr. Aladjem says. “But if they have to be here, I can make their lives a little easier.”