An NCI-designated Comprehensive Cancer Center
By Kevin Chesley | July 9, 2018
Psychological care for cancer patients and their caregivers is critical.
Kimberly Shapiro, M.D. - Profile Photo Kimberly Shapiro, M.D.
City of Hope’s emotional safety net keeps spirits up and hope alive with compassionate care and personal communication. Kimberly Shapiro, M.D., assistant clinical professor in the Department of Supportive Care Medicine at City of Hope, is familiar with the exhausting regimens and unique challenges that cancer patients face and is an expert in finding ways to deal with them.

Very Normal … And Treatable

Shapiro reminds patients that they are not alone. Many face the powerful negative feelings that a cancer diagnosis brings every day.
Depression and anxiety in cancer patients is common,” Shapiro said. “This high-risk population is already undergoing physical and mental stress. One in four experience a depressive episode during treatment.”
Cancer changes everything about a patient’s life. “If there’s already a depressive or anxiety disorder on board, cancer can worsen it. These patients have to go to a job, take care of kids, their spouse, their home life. A cancer diagnosis can be devastating on all fronts. It’s normal to experience depression and anxiety about your diagnosis, treatment and prognosis — but it’s also treatable,” Shapiro said.

When to Seek Help for Depression

Though these feelings are understandable, sometimes more intense support is needed.

“A mental health professional should be involved when depressive symptoms become a syndrome: When you have difficulty sleeping and eating; when you are feeling excessively hopeless or helpless,” Shapiro said. “If you have no energy or ability to concentrate. If patients become withdrawn, not interested in things they love, or are having feelings of panic and obsessive thoughts. This is when we want to intervene and get a patient treated quickly.”

The High-Anxiety Factor

The same concerns about depression extend to anxiety: “Feeling nervous about a cancer diagnosis is normal. I would never pathologize that,” Shapiro said. “Anxiety becomes an issue if the patient is persistently worrying, and worrying about worrying. Obsessing about things, having difficulty making decisions, feeling excessively irritable, sweating and panicking throughout the day. Psychiatrists and mental health professionals get concerned when anxiety interferes with a patient taking care of themselves, their relationships and life in general.”

The Question of Positive Attitude

Many believe that adopting a positive attitude can overcome depression and anxiety. Shapiro believes that is a good start, but it can’t fix the problem.

“I would never discount that. Positive attitude and prayer can help. It’s a wonderful thing if you’re optimistic and hopeful, but it’s not enough. That is not my opinion. It’s scientifically proven in medical literature. These symptoms become overwhelming, and just trying to shake it off won’t work,” she said.

The Many Forms of Treatment

Once a problem is diagnosed, there are many options for care. “Medications, such as antidepressants and things that target sleep, can help. Individual, group, short-term or targeted psychotherapy can change the brain just as much as medications. Healthy diet and vitamins help, and therapists have been getting interesting results with hypnosis. Exercise gets your endorphins going, improving mood and decreasing anxiety. Yoga, meditation and breathing exercises have scientific data backing their ability to calm down panic.”

You Can’t Give From an Empty Cup

Another concern for Shapiro is social support for a patient’s caregivers. “A patient’s outcome is better if the village around them cares for their stress, too. There’s a high incidence of depression and caregiver burnout. A family should communicate their feelings, practice self-care and visit support groups.”
City of Hope — and in particular the Sheri & Les Biller Patient and Family Resource Center — has resources for the family and patients alike. “It’s a wonderful place. Everyone should communicate their needs and feelings to our robust supportive care department of psychiatrists, social workers, therapists and group leaders,” Shapiro said. “No one is alone.” 
To connect with fellow cancer fighters and caregivers, join our Hopeful online community today. is a space for everyone who has been touched by cancer to share their stories, make connections and offer support. It also features weekly healthy recipes and news about groundbreaking treatments.

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