Beyond Diagnosis: Mental Health and Breast Cancer

Podcast Transcript

Dr. Scott Steele: Butts and Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Dr. Scott Steele: Hi again everyone, and welcome to another episode of Butts and Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery and the President of Main Campus here at the Cleveland Clinic in beautiful Cleveland, Ohio. And today, I'm absolutely thrilled to have Dr. Kathleen Ashton, who is a board-certified Clinical Health Psychologist in the Breast Center of the Digestive Disease Institute here at the Cleveland Clinic, and today we're going to talk a little bit about beyond the diagnosis, and that's mental health and breast cancer. Dr. Ashton, thanks so much for joining us on Butts and Guts.

Dr. Kathleen Ashton: Thank you for having me.

Dr. Scott Steele: We always like to start off with a little bit about your background. So, tell us where you're from, where'd you train, and how'd it come to the point that you're here at the Cleveland Clinic?

Dr. Kathleen Ashton: Well, I'm an Ohio native, so I'm here from Northeast Ohio, and I trained at the Ohio State University. So, I am a huge Buckeyes fan, and I'm back in Cleveland.

Dr. Scott Steele: That's absolutely fantastic, and THE Ohio State University, I love that. So, today we're going to talk a little bit about mental health and how that impacts breast cancer patients, so to start, could you give a little bit more to our listeners about the psychological services that are offered to patients at the Breast Center here at the Cleveland Clinic?

Dr. Kathleen Ashton: Absolutely. There are three psychologists here at the Breast Center. That includes myself, Dr. Alex Murray, and Dr. Kim Oney, my amazing colleagues. And we are both here at Main Campus, Fairview on the west side, Hillcrest on the east side, and now Strongsville on the south side, as well as virtual visits. And then we work closely with other professionals, including psychiatry and social work at Taussig Cancer Center.

Dr. Scott Steele: That's fantastic. Obviously, you're well aware that a breast cancer diagnosis can be absolutely life-changing at any age. As breast cancer patients begin the process along this, what are their steps that they are going to encounter? What does that look like for them, and what are some of the mental health challenges that you find they may experience?

Dr. Kathleen Ashton: Well, for any patient, getting a cancer diagnosis tends to be really scary. So, it's normal for patients to feel anxious, sad; so, there's normal adjustment to the diagnosis but some patients have more significant symptoms, especially patients who might've had some depression or anxiety before may really find themselves in a lot of distress. It's important to recognize some of those symptoms early and to get the help that you need along the way.

Dr. Scott Steele: So, "Truth or Myth?" Truth or myth: mental struggles related to breast cancer can present at any time after diagnosis?

Dr. Kathleen Ashton: That is absolutely true. So, what we often see is that patients are really distressed right at the beginning when they first get their diagnosis, but sometimes once they start treatment, really, they feel like they're doing pretty well. They feel a little more in control and they're looking at a checklist of actions. So, surgery, check. Chemotherapy, check. Radiation, check.

It's often at survivorship where we see more intense emotional reactions. People, once they slow down enough to think about what's happened, sometimes find themselves overwhelmed. So, we do see patients at all steps along the way, including survivorship.

Dr. Scott Steele: So, digging that a little bit more, I've seen patients myself, obviously not breast cancer, but colorectal cancer, that have that very stoic, "I don't need mental health and I don't need this," and almost every patient experiences that. So, when would you say that a breast cancer patient should seek psychological care, even if they don't feel that they're feeling it? Is it good to do that preemptively?

Dr. Kathleen Ashton: Absolutely. I think any patient can benefit from seeing a psychologist. So, even patients with very normal adjustments, sometimes we can help them recognize their strengths. We can help them work on coping skills to help them in even very brief treatment. We're talking three or four sessions that are helpful. But patients who are showing more significant signs, panic attacks, difficulty functioning, not enjoying life, even suicidal ideation, those are more serious issues that really need more intense treatment. And we can see patients more frequently who need more specific treatments.

Dr. Scott Steele: So, I'm a breast cancer patient that's listening out there, and I either have an appointment to come see you or I am a little bit scared of being able to do that. So, what can they expect when they have their first meeting with you?

Dr. Kathleen Ashton: Yeah, so we typically will meet one-on-one. It's a nice private office. We'll be discussing their journey. It's a really good chance for patients to talk about what this has been like emotionally for them, and I think it's nice to be able to do that with someone outside your family. Often, patients don't want to burden their family members or friends with what they're feeling. So, it's nice to have that private time to really explore what this has been like for them, as well as ask about how it's affecting other areas of their life, work, their home life, and we'll talk about their mental health. They'll talk about their strengths and coping skills, and then we'll come up with a plan in that first session and even introduce a few tools to get them started.

Dr. Scott Steele: So, walk me forward over time. How does that change, if at all, as the patients see you more and more?

Dr. Kathleen Ashton: Usually, we're going to target very specific interventions. Seeing a psychologist in a medical center does not look like what you've seen on TV. You're not lying down on the couch week after week for hours. It's very skill focused, talking about behaviors and thought patterns and different interventions that they can do. We give homework, and then we also offer group treatments along the way, as well. For example, in survivorship, we have a survivorship program, it's called Breast Cancer STAR survivorship, tools, and resources. It's a virtual group program, five weeks. And again, it's very targeted towards teaching patients' skills that they can use for the rest of their life to deal with their cancer diagnosis.

Dr. Scott Steele: That's fantastic. You've mentioned this term twice now, "survivor." Can you talk a little bit about what that survivor is and what it means to breast cancer patients?

Dr. Kathleen Ashton: Yeah. Patients all define survivorship differently, and not all of them love that term. But, for most of the time when we're talking about survivorship, we're talking about patients who are done with their active treatment, and they're really more in the maintenance phase. For breast cancer patients, often that's the first year after they're diagnosed. They're moving into maybe just taking a daily medication versus recovering from surgery or chemotherapy.

Dr. Scott Steele: So, is there any data out there that psychological treatment can help prevent recurrence?

Dr. Kathleen Ashton: There actually is data that looks at specifically cognitive behavioral treatment. It's often called cognitive behavioral stress management. That has been shown to lengthen time to recurrence and influence overall survival. Now, the mechanism behind that is not completely clear. It could be adherence to treatment, it could be reducing inflammation related to stress, but we do know that it impacts both physical as well as mental health definitely can improve quality of life and anxiety and depression.

Dr. Scott Steele: We know that cancer affects not only the patient but everybody around them in terms of their support structure. So, are psychological services offered to family members in addition to the patients themselves?

Dr. Kathleen Ashton: We know that caregivers are very much affected by cancer diagnosis, as well, and their mental health can also be affected. We don't have enough providers to treat every patient's family, as well. But they're welcome to come with patients. They often pick up on some of the tools that patients are learning, and we maintain a really robust referral network.

Dr. Scott Steele: That's fantastic. Walk me through in terms of treating mental health conditions of breast cancer patients here at the Cleveland Clinic. Is there anything on the horizon that we can look forward to?

Dr. Kathleen Ashton: I think technology's going to be really important in scaling our efforts. We just don't have enough providers to treat all the patients that want our services, so we're really looking to technology to expand how many patients we can reach. Our virtual group programs are a good example of that. And then we have some fantastic virtual resources, including a series of podcasts. One of our Fellows recorded recently a number of podcasts on mindfulness that any patient can access at any time for free. That's at the Cleveland Clinic website, clevelandclinic.org/breastcancerrelaxation, all one word. So, any patient can access those at any time, and we're hoping to get as many services as possible out to our patients.

Dr. Scott Steele: That's fantastic. And now it's time to get to know you a little bit better with our quick hitters. So, first of all, what was your first car?

Dr. Kathleen Ashton: My first car was a Pontiac Sunbird that I inherited from my sister. It's very reliable. I used it very frequently to go back and forth between Columbus and Cleveland.

Dr. Scott Steele: Fantastic. And what is your favorite meal?

Dr. Kathleen Ashton: Hmm, my favorite meal? I just went to Italy this summer, so I'm going to have to say probably a carbonara pasta.

Dr. Scott Steele: Fantastic. And if you didn't go to Ohio State University, where would you have wound up then for college?

Dr. Kathleen Ashton: I can't imagine going anywhere except Ohio State. True Buckeye.

Dr. Scott Steele: Yeah. I'll take that as University of Wisconsin. Then finally, tell us something that you like about being in Northeast Ohio.

Dr. Kathleen Ashton: I love fall. I am so looking forward to the change in season and the beautiful colors we have here.

Scott Steele: Fantastic. Can you give us a final take-home message for our listeners about this?

Dr. Kathleen Ashton: My take-home message would be that if you or someone you know is diagnosed with breast cancer, don't hesitate to ask for a psychologist or a mental health professional to be part of your team. It can really help you to have a better quality of life with your cancer and learn some skills that will help you along the way.

Dr. Scott Steele: That's absolutely fantastic. And so, to schedule an appointment with a breast psychologist, or to meet with Cleveland Clinic's multidisciplinary team of breast cancer providers, please call our Cancer Answer Line at 866.223.8100. That's 866.223.8100. Dr. Ashton, thanks so much for joining us on Butts and Guts.

Dr. Kathleen Ashton: Thank you so much for having me.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts and Guts.