Cancer Care Connections
Cancer Care Connections
Supporting the Person, Not Just Treating the Cancer
When cancer enters the room, clarity can vanish. We dive straight into that moment—what gets heard, what gets lost, and how mental health care can restore focus when everything tilts. With medical oncologist Dr. Nina Balanchivadze, palliative care psychiatrist Dr. Kyle Lavin, and patient Melissa, we map the real terrain: shock at diagnosis, sleepless nights, caregiver overload, survivor guilt, and the quiet dread behind “staying strong.”
Dr. B explains how she balances tumor biology with human reality, using both formal screening (PHQ-9, GAD-7) and subtle cues to catch distress early. She names the burdens some patients undergo: identity shifts from hair loss, financial strain, and the emotional cost of being “the fighter.”
Dr. Lavin opens the door to a different standard: a collaborative care model that brings a care manager and consulting psychiatrist onto the oncology team. The result is faster access, tailored brief therapies, careful medication choices that avoid cancer drug interactions, and measurable improvements in depression, anxiety, and quality of life.
Melissa’s story shows the stakes. A rare diagnosis, rapid referrals, and leading-edge immunotherapy didn’t spare her from fear or uncertainty. What changed everything was timely, plainspoken support from professionals outside her family who could navigate the system, push for results, and teach practical tools. Together, they make the case for a culture shift: treat mental health as the fourth pillar of oncology, offer it from day one, and remove the stigma so help arrives when it’s needed most.
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Cancer Care Connections is the official podcast of Virginia Oncology Associates. For more information, visit us at VirginiaCancer.com. or find us on Facebook or Instagram at Virginia Oncology Associates.
Intro:
Welcome to Cancer Care Connections. Joining us today are medical oncologist Dr. Nina Balanchivadze, palliative care psychiatrist Dr. Kyle Lavin, and patient and advocate, Melissa. Together, we explore what often gets lost in the chaos and how mental health care can restore focus when everything tilts. In this episode, we dive into that moment—the shock, the sleepless nights, and the quiet dread behind ‘staying strong.’ Dr. B shares how she balances tumor biology with human reality, using both formal screening and subtle cues to catch distress early. Dr. Lavin introduces a collaborative care model that brings mental health to the oncology team from day one. And Melissa’s story reminds us why this matters—because even cutting-edge treatment can’t erase fear without timely, plainspoken support.
Cheryl: 0:56
We spend quite a bit of time on this show talking about breakthroughs and new treatments, but today we're talking about something that doesn't always get enough attention, your mental health. Dr. Nina Balanchivadze is back with us, and we have two other guests with us today, Dr. Kyle Lavin, a palliative care psychiatrist, and Melissa, a cancer patient, to talk about why the mental side of fighting cancer matters just as much as the medicine. To the three of you, thank you for joining us today.
Dr. Lavin: 1:25
Excited to be here. Thank you.
Dr. B: 1:27
Thank you.
Cheryl: 1:27
I'm gonna start with Dr. B. And Dr. B, can you just talk to us from your perspective; why addressing mental health is just as important as treating the cancer itself.
Dr. B: 1:40
Thank you for having me again. And I'm very excited to talk about this topic as I'm very passionate about addressing mental health because in reality, cancer does not exist in isolation. It impacts the whole person. There is emotional distress, there is anxiety, and there is depression that can come with the diagnosis. And it can affect everything. You know, it can affect sleep, it can affect appetite, it can affect treatment adherence, and it can affect overall resilience of the person we're treating. So if we only focus on treating the tumor rather than healing, the outcomes are just not the same. We'll be missing a huge part of healing the person rather than just treating the tumor. So that's really why I think treating the cancer and supporting mental health, they go hand in hand. And one influences the other every single day.
Cheryl: 2:42
This is such an important topic. And I have the benefit of seeing all three of your faces. And I'm looking at you, Melissa. I can see, understanding and feeling that what Dr. B is saying is true. Can you talk with us about your experience and how you feel this focus on mental health is so important in your recovery?
Melissa: 3:06
Sure. And I really appreciate the opportunity to be here and talk about this because I feel like it's a chance for me to give back and help people that might be coming into a new cancer diagnosis. You know, as Dr. B was speaking, I was thinking back to the sleepless nights. I'm a stress eater. So when I'm stressed, I eat and the importance that that has on my overall health and inflammation, which feeds the cancer and all of that. I think that, like she said, a medical diagnosis doesn't happen in isolation. It's a whole person approach. And if I didn't have the support to turn to somebody who's an expert in behavioral health support for somebody with cancer, I'd be trying to Google it and find my way. I'm a social worker by trade. So I know about therapy. I know about behavioral health, but I didn't know what that meant in relation to my diagnosis. And it was so helpful to have somebody who understood and could anticipate the things that I was going to hit up against. Like, what do I say to my children? What do I say to my 92-year-old mother? How much do I tell her? And I'm the one who's the caretaker. I'm the caretaker of work, at home, and everything. How do I make that shift and find support for myself? So I don't understand doing just the medical part without addressing the behavioral side as well.
Cheryl: 4:30
And yet I imagine as we turn now to Dr. Lavin, you see that all the time. You see people who try and just focus on the medicine, the radiation, the drugs, and don't think about the mental side of this. So, can you talk a little bit about your experience as a psychiatrist working with patients with cancer?
Dr. Lavin: 4:54
Yeah, for sure. And again, I'll echo the thank yous for being here. It's just incredibly heartwarming to have a group of people who are being thoughtful and thinking about how we can do better. I've been lucky enough to be on faculty as a palliative care psychiatrist at UNC, where we have pretty good supportive care resources. But even there, at one of the top 10 cancer hospitals in the country, the ability for all patients who have cancer to access the support they need is difficult, right? The cancer diagnosis turns your entire world upside down. And the stats show that more than 70% of patients with cancer have some sort of mental distress, ranging from adjustment disorder to depression and anxiety. But this idea, Melissa, that I heard you talk about, right? How am I going to navigate this? Am I having to question my mortality? I mean, those things take a toll. And to not have that addressed and to be able to get the support that people need makes it much more difficult not only to navigate life, but to access cancer care, to get on your cancer treatment, to attend your appointments. Our mental health system is broken at baseline. And so being able to try and extend access to behavioral health, to community oncology practices through this model, the collaborative care model, that I'm happy to talk about more later is really powerful to be able to address those needs and be more proactive than reactive so that people living with cancer can not only have a better quality of life, but a better cancer treatment experience.
Cheryl: 6:32
I definitely want to talk more about that as we go forward. And Melissa, you had something you wanted to say?
Melissa: 6:38
Yeah, I'd like to add too, that having a resource who's outside of your team, outside of your bubble, that you can talk to about what's going on as a cancer patient. You know, they're not gonna treat you with kid gloves. They're not gonna whisper cancer. They're gonna talk about it. And that I found incredibly supportive and helpful and necessary to be able to just deal with the reality of the situation. Somebody I didn't need to tiptoe around, or they didn't need to put on kid gloves was really helpful for me.
Cheryl: 7:09
There's a phrase that I've heard over the years, it is what it is. And I never used to like that phrase, but in this case, it sounds like that's what you needed.
Melissa: 7:21
I think that's spot on. Yes, it is what I needed. And even with the medical side of the house, like Kyle said, cancer diagnosis just turns your world upside down. It's almost like you're going down the road and you come to a T and you either have to go left or go right. And, you know, you choose which way you're gonna go. But having support to make those informed choices and not based on emotional reactions or old patterns of emotional reactions and being open to support and everything, I think is crucial for being able to deal with your new reality. So it is what it is on Tuesday, is not the same on Wednesday after you get that diagnosis.
Cheryl: 8:03
I want to bring in Dr. B because Dr. B, you may be that person who is the first person to say something about a diagnosis or something life-changing for this patient. So I'd love to get your take on how you, as an oncologist, can measure mental health during a visit. And it starts, I imagine, with that first conversation.
Dr. B: 8:29
Yes. And these conversations are very difficult. You know, one day can change your life, honestly. And that's why I tell my patients, a cancer diagnosis is life-changing, but it's not life-defining. You know, as you said, it is what it is and we just have to take what we have. We take the physical diagnosis, and just like we treat cancer, we have to kind of think about everything else that comes with that person, whether it's mental health, sometimes it's finances, sometimes it's other barriers that our patients face, because cancer diagnosis, is a monster in itself. It's not just the treatments, but everything else, the downstream, how it affects the person physically and holistically, and how it affects everybody. You know, some may think it's vain, but losing your hair, it's not just the hair, it's how your children see you. And that sometimes is the hardest thing for my young patients because they don't want their children to perceive them differently. And having hair is part of identity. So there are so many layers measuring mental health. And first is thinking about it. So thinking about the person and just not honing in on the diagnosis, which you shouldn't do. Because you get the diagnosis and my goal is in a visit to tell them about the diagnosis, the prognosis, the treatment options, just so many medical facts. But at the same time, I want to approach this person as a person and not just a diagnosis. So we have tools that we use. These are kind of specialized tools that we can measure anxiety and depression. GAD is one of the scores that we use. We use PHQ. These are kind of acronyms to measure depression and anxiety. But then we also look for subtle cues. So, you know, how is this person looking? Or are they talking too much or are they talking too little? You know, sometimes it's that really withdrawn person we worry about, but sometimes it's the other way around. You know, sometimes we've instilled in patients that this is a fight and you got to fight, and everybody thinks they have to go, go, go, and they're just kind of failing and falling apart inside. So it's not always that quiet person. It could be that person who is outspoken and is out there giving talks and trying to motivate others, but you know, these are the subtle clues that we think about. We have both formal ways to assess anxiety and depression, but then the subtle clues that physicians have to think about to pick up on as we build very strong relationships with our patients as they continue to come and visit us.
Cheryl: 11:33
I will say that as a family member of patients who have been in the hospital, so I'm talking personally. I've had family members and friends in the hospital this past year, knowing that someone like you and oncologists, doctors care so much. That is so important. And I think that's something that people should be able to hear as they're going through a really difficult time trying to support a loved one in the hospital, going through any kind of diagnosis; hearing that doctors care. That's really, really important. And so I want to get your idea, Dr. Lavin, about how you then support that patient, the patient that Dr. B is working with, how do you come in and support them and help them through this pretty difficult time?
Dr. Lavin: 12:23
I think that the access to care is so difficult, right? And that Dr. B is incredibly thoughtful about identifying these needs and thinking about how we screen for it and how we recognize it. And then unfortunately, once we identify those needs, we then need to have the resources to be able to support those patients. And that's where, unfortunately, a lot of times as we're talking to community oncology practices, the current state is that they identify a need. Maybe they don't identify as many as they want or should, but then they send a referral to the community, and the patient has to wait six months, is so overwhelmed that they don't actually access the resources. And I think that's what I've appreciated so much about our partnerships, Cerula Cares partnership with VOA, but specifically Dr. B, is that we become a trusted partner and extension of the oncology team. And so when patients are referred, we talk about service fatigue, right? Here you have this emotional fatigue, emotional overwhelm, but then there's this service fatigue of so many appointments. If we don't make access to this supportive care as easy as possible, then patients aren't going to be able to do it. So we partner with VOA to be able to get these referrals within 24 hours, to be able to see patients within five days. We then have a care manager who is trained in these cancer-specific needs. We've created sort of a structured 16-week program with meetings every other week. It's flexible to meet the mental health needs, but it's really designed to walk patients through the mental health experience, the practical needs, the emotional needs, the treatment side effects that we know that people are going to experience and try to wrap as much support around as possible. And through the collaborative care model, it allows me to supervise a large panel of patients. It improves access for patients by 15 to 20 fold by being able to have an expert who understands the way that psychiatric recommendations interact with cancer treatment, to understand cancer side effects and is this depression or is this the side effects from the cancer, and be able to work directly with people like Dr. B and have the referral come from them so that we can trust each other and the patient believes that this is a program that is really invested in humanizing the experience, like we've been talking about.
Cheryl: 14:38
So, it's called Cerula Care.
Dr. Lavin: 14:40
Yep.
Cheryl: 14:41
You're talking about this collaborative care model. What exactly does that mean for a patient? What does that mean? And then, of course, my next question will be to Melissa as a patient who's been able to take advantage of Cerula Care. What does that mean for her? But for you, Dr. Lavin, can you just talk to us about what that exactly means for a patient?
Dr. Lavin: 15:01
Yep, totally. So the collaborative care model was founded out of the University of Washington. It's an evidence-based model with over 90 trials that have shown that patients get better faster with this type of care rather than traditional sort of psychotherapy where patients are going once a week with indefinite interventions to try and improve their mental health. It's really focused on using evidence-based therapies to help patients problem solve and to navigate the stress by using these screening tools that Dr. B mentioned so that we know that if patients aren't improving, we can quickly switch their treatment plans. If people are improving, we can know how and when to help them transition back to sort of a more standard quality of life. And it consists of the consulting psychiatrist working closely with the oncologist; working with a care manager who is the one that's seeing the patients on a regular basis to provide the therapeutic interventions and the brief therapies that allow patients to get better. And we've seen really outstanding results. You know, there's worry that in the cancer population, when some of these stressors aren't modifiable, that people may not get better as quickly. But we've seen a decrease in depression over four months of greater than 60%, an improvement in anxiety of greater than 50%, and an improvement in quality of life as well. And so, you know, that's just really powerful. That's the theoretical model, but Melissa, I'd love to hear sort of how you experienced it and what it was like for you.
Melissa: 16:25
Yeah, sure. I am really happy to be able to share this story because I can say that I don't think you can talk about access to care enough. I'm a social worker by profession. That's what I do. And I know that it's really difficult. Ever since COVID, it's really difficult to find somebody in a counselor clinician in the community who's got time and space available to see you. And, you know, you might wait six weeks, two months, six months to be able to get to your first appointment. And there's no saying that that person specializes in working with a patient with cancer. So access, I think, is absolutely key. The other piece is that the coaches that I have worked with, they understand the process from the beginning; from the start of the fuzzy front end where your world's been turned upside down and kind of what stages to expect along the way. When I was freaking out about not getting my PET scan results, and that was going to drive the entire rest of my care plan, they were there to help me and they actually were able to push and navigate through the system, which is one of the main stressors that I felt and still feel frankly, to this day, is the medical system. You have to be your own advocate and you have to have a strong support network. But even sometimes that's not enough. And at times where I've thrown up my hands and said, I can't, for whatever reason, I can't get this authorization from this doctor to go to this one. The support people are there to say, "Let me try. Let me get in there and take this over for you." Then I'm able to let go and not stress about that, which means a night of sleep, which means that impacts my quality of life and my stress levels and everything. So from where I sit as a patient, it's almost as crucial of a part of the care team as the medical folks that I'm talking to. I really do believe the behavioral health support just makes everything smoother. The system's tough enough. So if I need a champion or an advocate in my corner, even to talk me down when I'm stressed out, whatever it might be, they're there. And so I take full advantage of them.
Cheryl: 18:32
It's like two sides of a coin. And so I want to bring in Dr. B to weigh in on this discussion and maybe some of the barriers that keep people from getting the help that they need. Dr. B, what do you have to say?
Dr. B: 18:46
Yeah, you know, the patients face system issues. And we as physicians face system issues too. That's why I believe that collaborative care and integrated care is important because in the world of the internet and AI and everything else, you would think that things would be so seamless and connected, but that's not the case. You know, my medical record system is completely different from a neighboring practice who might be even housed in the same facility. They have a different record system. So even trying to connect the dots and get the information back that I need in a timely manner, is not always possible. Now, if you have a collaborative care model, I speak with the psychologist, I speak with a psychiatrist, and they actually talk to me and ask me, Dr. B, you're using tamoxifen, for example, as a drug. We know that there are a lot of interactions with other medications. This is the medicine that we are proposing to use. Do you have any reservations? So I feel like there is this truly a collaborative model where there are conversations back and forth, and we're not left with just faxes and kind of communication without ends. So, you know, it's still happening at different specialty levels. So I'm not saying that outside collaborative care model, it doesn't exist, it definitely exists, but it takes a lot more effort and it's a lot more error prone. And a lot can be missed in translation when you're not directly collaborating and directly talking. Cancer care is truly multidisciplinary, and that's how we approach it. It's like when we discuss and have tumor boards, we talk. There's a radiation oncologist, there is a pathologist, radiologist, medical oncologist, surgical oncologist. So mental health, in a similar way, just needs to get integrated somehow in the patient care plan.
Dr. Lavin: 21:02
Yeah, I love, love hearing you say that. I mean, my vision, right, is you've got three pillars of cancer care...to make mental health truly a fourth pillar where we all believe that this needs to be addressed and we think creatively about how to best provide that.
Dr. B: 21:14
Absolutely. And even when we talk about recognizing mental health, it's tough. You are in a busy practice, seeing patient after patient. It's hard to pause sometimes and come out of the doctor mode that's treating the cancer and think about mental health. If we have a more integrated process where there is kind of like a collaborative path where mental health gets assessed by people who are qualified to do so, it may help more patients. And at the end of the day, the hope is to improve the outcomes, both physical and mental health outcomes. And we do have a lot of barriers. Access to care was mentioned; so getting to appointments. And then time fatigue was mentioned, which is huge because patients come and see me, they come for labs, they come for treatment. So it's like adding another appointment to an already busy packed life. A lot of patients are mothers, grandmothers, they are partners, they are executive directors. So they go to meetings and they have life that's happening. So I tell people it's not life-defining, but yeah, it's hard not to say that because life evolves around cancer care. So there is access and then there is stigma, which unfortunately exists. And again, I don't mean to keep repeating myself, but the media and everybody is just saying you got to fight this, and you are a fighter. So it's almost like we're telling people it's not okay to be vulnerable, and you have to be vulnerable. You know, it's not always that strong and the fighting. And we do fight, but sometimes you got to step back and say, what are some of the things that can be done? So detaching the stigma out of mental health can help the barriers. There's a financial barrier too. Patients worry about another copay, as the bills start piling up, there are copays for visits, there are copays for drugs and imaging. It's just a lot to take in. So just thinking about these and addressing as a collaborative model, I think, can go a long way.
Cheryl: 23:34
Dr. B, so many things that you said resonated. And I'll just mention one thing that you mentioned here is, as a family member of a patient, that's me, you want your family member to fight. And sometimes they can't because they need support, right? And so that's kind of what you're saying is the fight may not be possible without getting support in other ways. I wanted to actually touch base with Melissa and just get an idea of what this looked like for you. So Dr. B mentioned some barriers. Dr. Lavin's talked about the collaborative care and support that is available, but I'd love to get an idea of how this worked for you; as a caregiver yourself, as a busy mom, everything is happening in your life. You have a career, and all of it is falling on you. How did this fit into your recovery and helped you get to where you are today?
Melissa: 24:37
Well, I had a very rare cancer diagnosis. It was metastatic Merkel cell carcinoma, which is a rare and aggressive skin cancer that I found by absolute circumstance or happenstance, I should say. I was lucky that I caught it when I did and I started getting treatment. But I will tell you, as soon as I went to my first oncology appointment, and the doctor was saying that I would probably need to go to Hopkins or Sloan Kettering for treatment, as soon as she said that, I stopped hearing. I could not process any more information. Thank goodness I had a friend with me, which is something that I would advocate strongly for, is that people have, if not a friend, a relative, a note taker, even just to take notes, really, but to be there because she could hear what I couldn't hear. That was my first day of, you know, okay, this is not a joke. This is big deal stuff. And also, the planets aligned. I had somebody that I knew from high school whose husband worked with the Merkel cell team at Hopkins. So as fate would have it, I got in for an appointment at Hopkins in two weeks. So that was incredibly fortunate. They're doing immunotherapy, which is the leading edge treatment rather than chemo and radiation. So I was, again, blessed that I could do that instead of going through chemo and radiation. I had three 30-minute infusions that I had zero side effects. So it was a very, what's the word, dyssynchronous experience, where I knew I had something that was gravely impactful on my life. I mean, it could kill me. And at the same time, I didn't feel anything. I didn't hurt. I didn't have chemo/radiation sickness. My hair wasn't falling out, so it was a very strange experience. And I'm still trying to struggle with that. Then I had surgery. The immunotherapy did its job and it reduced the tumors. I had surgery and was up recovering for a long time. And all throughout this, I was able to, you know, have the support of my care manager to kind of walk me through the process. So I'm not going to jinx myself. I feel like I had cancer light, sort of, because I didn't have the full-blown, awful experience with chemo and radiation and everything else. But I still had the moments of facing your mortality. And I was thinking while Dr. B was talking, that the very first day you get your diagnosis and you stop hearing, to me, that's the time when part of the care plan should be all right, you've just had this giant thing turn your life upside down, we're here to support you. Here's how we're going to do this. And having that from day one, I think just makes sense because I don't know how anybody could navigate or go through a diagnosis, whatever kind of cancer it is, without having their world flipped over and thinking, all right, okay...I'm working full time. I have a private practice. I am a volunteer. I'm a mom, I'm a daughter. How do I fit all this in? And appointments, appointments, appointments. It's overwhelming. So you really do have to reconfigure and redefine your schedule, your priorities, what your ability is, what you're able to do. I'm not one to sit around, so it was hard for me to stop doing, doing, doing, and having somebody to talk through about the challenges of making that transition to a place where I was focused on my health.
Cheryl: 27:55
Would you say that that conversation for you, Melissa, happened right away? Or did you seek it out? How did all of that come together?
Melissa: 28:05
It was Dr. Watson, who's my oncologist here in Virginia, asked me if I would be interested in engaging with Cerula Care because I was talking to him about how stressed I was about having to get this PET scan result. He knows Dr. Lavin, so that was the connection there. And I jumped at the chance, absolutely.
Cheryl: 28:24
And Dr. B, how does that work for your patients?
Dr. B: 28:28
Yeah, I just wanted to echo what Melissa said because, you know, when people hear about the diagnosis, you expect the worst, because frankly, you just don't know. We've all watched movies where people get a cancer diagnoses, they get gravely sick and they're throwing up the entire time, all of their hair comes off and they look very sick, then you get diagnosis. Thankfully the treatment options are becoming more targeted and less toxic. Then you get this guilt, you know. So I've had patients, you know, I specialize in treating breast cancer. Thankfully, we have a lot of different treatment options that might not be as toxic compared to some other cancers. And then there's guilt, you know, or a sense that family members look at you and they see your hair is still there and you're not throwing up every night and they think everything is okay. I hear people's family members mention, oh, she doesn't even look like she has cancer. And while it's great and it's meant well, it's almost heartbreaking to me because yeah, they have cancer and they're dealing with this diagnosis, and there is a lot of internal turmoil that's going on. So there is that perception versus internally what's going on. And no matter what one says, no matter how it's free of side effects, it's still cancer directed treatment. You still have to sit in that infusion area, you still got to have IVs, there are still rare potential side effects. So just the thought about those can be quite stressful and can be life-changing. It still affects people at multiple levels, physical and mental. Then there is also the survivor's guilt. It's hard to say the word cure in oncology, we use the word remission or no evidence of cancer. And then you just kind of the worry, it doesn't end there, you know. So that mental health does not end with the surgery that removes cancer, or it doesn't end with the bell that you ring at the end of chemotherapy. It's just lifelong because you're wondering anytime there is a headache, or anytime there is a little twinge, you wonder, what if it's back? I see patients; they come through on their surveillance visits and they see a waiting area full of people. They don't look well, they look sick, they look distressed, and they say, I feel guilty walking through that because I could be one of them. So mental health has different dimensions. Even if one is cured or hasn't suffered from the side effects of treatment, it's still very relevant at every stage of the disease.
Dr. Lavin: 31:14
Yeah, I'm just so thankful for you bringing up that survivors guilt. We almost need a whole separate conversation on that. It continues for so long, and the psychological impact is long-lasting after the cancer experience. And in some ways, you know, Melissa, I heard you describe this cancer light, even that you had sort of the best case scenario, you're the best equipped of anyone as a social worker to navigate the process, and yet it was still incredibly distressing for you.
Melissa: 31:38
And so it's still, I mean, I still struggle with do I have cancer? Is it gone? I'm ready to turn that page. My body is not ready for that, and my head is still not wrapped around that.
Cheryl: 31:52
Dr. Lavin, I think this is a great time for you then to share how is supporting someone with cancer different than treating depression or anxiety? And how can we be supportive? How can we help the people we love?
Dr. Lavin: 32:07
It's a big question, but you know, I think that how we as a community can help the people we love is having these powerful conversations of recognizing that this is an issue that we need to be thinking about, recognizing that there are so many barriers. From a patient perspective to access care. From oncologist perspectives who are overwhelmed with the day-to-day life. So, you know, having these conversations to be able to encourage people to access care is really important. And then the way that I've sort of developed this program and the way that I've trained, I mean, again, you need specialty psychiatrists who are able to understand how to differentiate between depression that's caused from cancer, the differentiating of the way we diagnose depression. Four of the nine core symptoms are incredibly common in cancer. Whether it's insomnia, whether it's difficulty concentrating, whether it's weight loss, weight gain, like that's so common with the cancer experience that we need to understand from a psychiatric perspective what's really driving this. And do we need to use other medications to treat these cancer symptoms, or do we really need to delve into the underlying mental health to improve that so that those symptoms will go away? And, you know, that's the way our program's designed and the medications we use are very well tolerated. But as Dr. B mentioned earlier, if it's done in this siloed way where no one knows what's going on, the community psychiatrist is prescribing a medication that interacts with the tamoxifen that makes it less effective, and the cancer treatment isn't as effective. And so being able to have this integrated model where there's clear communication that the oncologist has a trusted partner, that they're able to decide which medications are most appropriate, I think is really powerful and important. You know, it's changing the culture, addressing stigma, and then really focusing on this cancer-specific care. And for us, right, like the patients that we recommend a medication, it's only 10 to 15% of the population. So the other 80 to 85% we're focused on these cancer-specific challenges that we've already talked through and the non-pharmacologic or non-medication measures of even just deep breathing, of mindfulness, of exercise, those are really powerful and they're really specific to the cancer experience and helping empower patients to have those tools to pull out of their toolkit so that they're empowered to navigate the symptoms that come along and the stress that comes along. I think is really important.
Cheryl: 34:37
How long has Cerula Care been working with Virginia Oncology Associates?
Dr. Lavin: 34:42
Dr. B, I think it's almost over two years now. We started uh Cerula Care on January 1st of 2023. I think that is when we saw our first patient. So it's two and a half years or so.
Cheryl: 34:55
Dr. B, are you able to share some stories of the difference in patients before Cerula Care and after? Any stories that can help all of us see the power of this support that patients are now getting?
Dr. B: 35:13
Yes, and without giving away any patient-related information, I have definitely seen improvement in adherence of treatment appointments. I've seen improvement in depression scales and anxiety levels. And actually, when we looked back to re-evaluate interval improvements in this scores, we did find significant changes. And we're not truly at liberty to discuss these as we'll be presenting these findings at a large breast cancer conference in San Antonio this winter, but I will definitely be releasing these results when appropriate so others can see that there is evidence behind it. It's not just saying, oh, I feel great by just talking to somebody. You know, these are actually results that are backed by serial measurements and we're hoping that we not only show that the collaboration works, but also instill hope for patients where we're normalize integrating mental health resources in treating somatic or physical symptoms and treating cancer. That's my hope.
Cheryl: 36:26
I want to go back to this idea that we were talking about earlier: stigma. And how do you address stigma, both around cancer and around mental health, that might keep patients from seeking the help that they need?
Melissa: 36:38
I'm working hard at trying to answer this from the patient perspective. I feel like I'm an outlier because I've spent my career in therapy. So I hope I don't have a stigma. But for me, it just seems like the natural approach. It seems like mental health or behavioral health support should just be part of the care plan. If you don't call it out as, oh, you're suffering, so let's add this onto your care plan. I think if it's part of the package at the front end, maybe it helps remove the stigma. It's just kind of, this is how it goes. This is a life-changing diagnosis, so we expect that you're going to struggle. And in order to prevent that from getting out of hand, here are some things that we can do to support you. So kind of making it normal, I think would help normalize. And I do think in general, stigma to seeking out mental health support has decreased a lot, especially since COVID, and especially with younger people. I don't know how that fits in with the demographics of cancer diagnoses, but I kind of think, if your world's turned upside down, you might as well grab any life preserver somebody's throwing you, pick it up, and run with it. And that might be a way forward.
Dr. Lavin: 37:46
Yeah. I mean, I just want to echo that, right? I think that making it normal to offer these services and certainly not forcing it upon people, but knowing that when you get this diagnosis, this is part of the care plan that you're able to access it, you know, it makes it feel less like a stigma. It's a larger conversation about how do you shift and change culture. But our American culture is so good at winning, at fighting, at being the best, at, you know, doing all the research to help try and cure cancer, which is so important. And at the same time, unfortunately, that doesn't leave space for recognizing that sometimes we can't win. And the language I use, is that we're always going to fight, and with mental health support, we're going to fight in a different way. These are different tools that we're going to use in my work with palliative care. Unfortunately, sometimes we can't cure cancer and we can't fight to win, but we're still going to fight to make every day as meaningful as possible. We're going to fight to make sure that you have those relationships and you have the time to do this legacy work and time to create meaning and, make one of the hardest and one of the most difficult experiences of your life as meaningful and powerful as possible. So, you know, I think that again, normalizing and offering it earlier on, trying to recognize that it's okay to fight in a different way. And it's not a sign of weakness, it's a sign actually of strength to be able to recognize that this is something that I could benefit from. It's not a sign that I'm doing something wrong or I've failed as a patient.
Melissa: 39:13
I would like to add that having somebody to be able to have those incredibly painful and exposing conversations with about your mortality, who's not somebody like your mom or your kids or your brother or whatever. It's an outside person who you can talk about your biggest fears. What if this goes bad? What if I'm not gonna make it? You know, what if I get through this and then I've got two years left? How do I handle that? That's invaluable to be able to have somebody that you can just be raw with and yet you don't need to try and protect their feelings while you're doing the work that you need to do.
Cheryl: 39:55
It's one of those things, as you're describing it, Melissa. It's not something you think you need until you have it, and then you realize how invaluable it is. Right.
Dr. B: 40:08
Sometimes physicians need help too. So, you know, we're not always trained on addressing mental health properly. While I can talk to somebody about the staging and prognosis and I'm confident about what I'm saying, I tiptoe around asking about how are you really feeling? Do you feel depressed? Are you safe? I just feel uncomfortable asking these questions. So for physicians, getting that help and getting those resources early on would help us too. So we come out of our comfort zone having mental health conversations in the same way as we use very highly potent medications that have multiple different, you know, mechanisms of action and such. And I have no problem talking about these medications, but then talking about medications about depression and anxiety, it just kind of gets me in the uncomfortable zone. So even for physicians, it's important to normalize seeking professional help when needed for their patients so we can get resources as early as possible and have a partner in the care team that addresses mental health.
Cheryl: 41:18
To the three of you, thank you for your vulnerability and your expertise. This is such an important conversation. And as a wrap-up, is there something you'd like to leave with our audience. What would you like to say to them about this important conversation as we as we say goodbye?
Cheryl: 41:36
Dr. Lavin, I'm going to start with you.
Dr. Lavin: 41:38
I want to recognize that this is hard, that there are a lot of barriers and there are a lot of challenges. And I also want to say that we can do this, right? We've got wonderful patients like Melissa who are speaking up, wonderful oncologists like Dr. B who are recognizing the need and the importance for this. And we've got these pretty cool models like collaborative care and innovative things that we're trying to do with Cerula Care, where despite some of the systemic challenges and barriers, that if we work together as patients, as providers, as a community, and advocate for these resources, we can really make a difference. So, as hard as it is to be vulnerable, to ask for help, I would encourage patients to speak up, ask your oncologists about it. For the providers, as scary as it may seem to open a can of worms that you're not trained in and comfortable in, think about looking for creative ways to find partners. I'm always happy to talk to people to have these conversations through. Cerula Care can be a resource, but you know, working together to recognize this is hard and that if we do it together, we can change the way that people living with cancer are accessing supportive care and behavioral health services.
Cheryl: 42:44
How about you, Melissa?
Melissa: 42:46
I can't remember the exact words I think Dr. B said earlier, but I would like to say that the cancer does not define me, but I am a person living with cancer. And that's a big shift away from having everything so focused in on just the cancer and surviving and getting through to okay, no matter what my prognosis is, I'm not just that. I'm still me with this thing.
Cheryl: 43:10
How about you, Dr. B?
Dr. B: 43:13
Fortunately, as our treatment modalities improve, our length of life expectancy grows for almost, if not all, cancer types. Quality of life is important. And as we have longevity and as our hope is, if we can't cure cancer, in some cases, we turn this into kind of like a chronic disease where it becomes treatable, where you can tame the cancer, so to say, it's important to consider every aspect because quality of life matters, not just physical. I would encourage all patients and caregivers to be proactive and think about that. It's not just any one little thing. Cancer treatment is a team sport, you know, and it's very collaborative and it's truly multidisciplinary. It's like building a puzzle where each piece has to fit. This puzzle might be different for each of you, but you need the bigger picture. So it's not just seeing a tree or two trees. You need to see the whole forest. So keeping that in mind, be proactive, bring it up to your physician, and just think about mental health as part of the journey.
Cheryl: 44:30
Such an important conversation. We are not alone. And as we've been discussing this entire time, Cerula Health and Virginia Oncology Associates are providing solutions as we continue this discussion relating to mental health and cancer recovery. So I just wanted to say thank you, Dr. Lavin, Dr. B, Melissa. Thank you for sharing your stories and your time. This episode can be shared. You can share it through the podcast app that you're listening to this on, and make sure the people who should hear it get the opportunity to hear. Thank you all.
Melissa
Thank you.
Dr. B
Thank you.
Dr. Lavin: 45:09
Thanks to you for creating a platform to talk about this. I really enjoyed the conversation.
Exit: 45:16
Thank you for joining us today for Cancer Care Connections. Cancer doesn’t just challenge the body—it challenges the mind. And mental health care can change the experience. If today’s conversation gave you insight or hope, share it with someone who needs it. Remember: mental health is not a luxury—it’s a pillar of care.
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