Randi Sparks, 67, has survived cancer.
That in itself is a miracle.
After she was first diagnosed with breast cancer in 2008, members of her family one by one got their own diagnoses. Her father, Jim Sparks, and oldest brother, Jimmy Sparks, died in 2015. Her twin brother, Robbi Sparks, died in 2017, and her mom, Joan Sparks, in 2019. They all had different cancers. There were more people in the family with cancer, seven in total.
“I’m the only one that made it to remission,” Sparks said.
That remission lasted for a while — until her cancer returned in 2019 as a large mass on her chest wall. She has received radiation treatment and different chemotherapies to shrink the tumor. The cancer has spread to her collarbone and a lymph node. She has fractures in her spine that don’t heal because of the treatments.
Sparks does not believe she would have the kind of peace she has about her cancer if she had not started seeing a social worker weekly.
“You have this grief, of shock,” she said of when she received her new diagnosis just 10 months after her mother died. “You feel like you’ve been on a merry-go-round and feel like you just got flung off. I just fell.”
Now, every Wednesday morning, Sparks spends an hour talking to social worker Maygen Hansard. Together, they help Sparks process the past four years of cancer treatments. They talk about what she needs to have the best quality of life, and they do legacy planning: how she wants to talk to her son about her terminal illness and what things she wants to enjoy while she has this time.
Mental health’s connection to cancer treatment
Last week, the U.S. Preventive Services Task Force issued recommendations that all adults ages 64 and younger be screened for anxiety by their primary care doctor, their obstetrician/gynecologist or another doctor, even if they have not had a prior anxiety diagnosis.
Many oncology practices have started to add mental health questionnaires during patients’ doctor visits in recognition that the months and years of cancer diagnosis and treatments can be a particularly anxiety-filled time. In a survey of 150 of its patients, Texas Oncology found that 70% said they experienced symptoms of depression and 65% reported symptoms of anxiety. among other issues.
Texas Oncology created mental health resources for patients online and stepped up efforts to connect patients with mental health counseling.
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Stephanie Broussard, the director of social work and palliative care at Texas Oncology, said that “cancer affects their whole system. It’s not just a physical disease. It is impacting the mind and the emotional well-being. … We can’t take care of the physical well-being without caring for the mental needs.”
Dr. Patricia Ganz, an oncologist specializing in breast cancer for more than 40 years who teaches at UCLA’s Fielding School of Public Health, said: “The mind and the body are connected, … we don’t cut off at the neck. If somebody is not mentally coping well with whatever is going on, they are going to have much more difficulty getting through arduous (cancer) therapy.”
Sue Wendelin, an Austin licensed marriage and family therapist at Thriveworks and a 14-year breast cancer survivor, said, “I would not have made it without my husband and my therapist.”
Often, she didn’t feel comfortable talking to friends or even her husband about what she was feeling. “My therapist was my only safe place,” she said.
“There were times I was really depressed,” she said. “I was anxious all the time. … My therapist was invaluable.”
She has since been the therapist for several women with breast cancer and one with lung cancer. “You are their wingman,” she said.
Which patients will need help?
How a person copes with cancer is not related to the severity of the illness, Ganz said. Instead, she sees a link to a history of anxiety or depression, as well as where they are in their lives.
“It’s much more difficult for younger patients,” Ganz said. The diagnosis is unexpected, she said. Often, they don’t have any friends or peers who have experienced cancer whom they can reach out to for support. They also don’t tend to have the lived experience of getting through a previous crisis, she said.
Dr. Aimee Mackey, a breast surgeon at Texas Oncology, looks for mental health warning signs with each patient from the first visit.
“Cancer treatments in general are really hard on patients, and they often put up a strong front,” Mackey said. “You have to pick through a lot, but you talk to them for 15 minutes in the office, and you usually get a pretty good sense of how they are doing mentally.”
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Looking for the warning signs
Broussard watches for these warning signs:
- Withdrawing from something they normally enjoy.
- Withdrawing from family members or social groups.
- A sense of hopelessness or helplessness.
- Sleeplessness or sleeping too much.
- Feeling emotional numbness.
Connecting people with support is essential. Mackey often connects patients with similar backgrounds, with their permission, and she points them to resources such as the Breast Cancer Resource Center.
Mackey found that her patients who are involved in their treatment and connected to people “do much better.”
Sometimes part of treatment is helping patients with some of the mental and physical symptoms such as insomnia, anxiety, stress and fatigue by using techniques such as mindfulness, yoga, acupuncture, tai chi or cognitive behavioral therapy.
Ganz did a study on connecting younger women with breast cancer to mindfulness. Many of the women she recruited for the study were several years out from their diagnosis and were severely depressed. The mental health impact “doesn’t end when the treatment ends,” she said.
Often, it can be worse later as the support network that got them through the treatment starts to fade. They still have lasting side effects and a changed body. They feel as if they are expected to be doing better. And they worry about cancer recurrence between visits.
“If they are getting back to things they used to do, that’s generally a promising sign,” Mackey said.
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Getting through the grief
When Sparks started working with Hansard, the social worker said, “she came to me in the midst of grieving her family members, but also grieving the recurrence of her diagnosis and advance prognosis and transitioning into a palliative approach to care. She would be living with this for the rest of her life. That’s where we started.”
For Sparks, having those weekly meetings helped her understand that “I was not only grieving my family, but grieving my old self,” she said. “There’s a lot of grief process that you go through.”
Hansard has learned a lot from Sparks. “She’s one of the most courageous women I’ve ever met,” Hansard said. “She has such a beautiful soul. She is just empathetic to a T. She loves fiercely.”
Sparks writes the staff at the clinic notes, makes them handmade soap and leaves them chocolates.
Hansard works with Sparks on creating the space to cry, to be honest about treatment and quality of life, and to decide when enough is enough.
It’s not all sad. Hansard has brought a lot of joy, a lot of light, Sparks said: “She’s teaching me how to take care of myself on the hard days. I listen to music.”
Sparks has learned that laughter really helps. Sparks and Hansard share a dry sense of humor. Sparks jokes, “My bad hair days are what I created with a wig.”
Sparks’ body image has changed. The mental health therapy has helped her have more confidence in her appearance. “I can stand tall that I have an illness,” Sparks said.
Hansard works with Sparks on advocating which treatments she wants and doesn’t want.
“That’s what we hope for patients, for them to feel comfortable and confident in the decisions they are making so they won’t have any regrets,” Hansard said.
Hansard helped her be stronger, Sparks said, so she can be strong for her son Dusty as he faces the possible loss of his mother.
“I’m facing a situation, unless God has a different plan and we get a miracle, which is always a possibility,” Sparks said. “I don’t want to shut that door either.”
Cancer patients and mental health
To quantify the amount of anxiety and depression felt by its patients, Texas Oncology interviewed 150 patients across Texas and in Arizona, Nevada, Oklahoma and New Mexico. Its study found:
- 70% said they experienced symptoms of depression.
- 65% said they experienced symptoms of anxiety.
- 50% said they felt less attractive.
- 42% said they felt less confident.
- 37% said they did not feel comfortable in their skin.
- 43% said they felt unprepared for the physical side effects of cancer.
- 56% said they felt unprepared for the mental health side effects.
How can loved ones support cancer patients?
Stephanie Broussard, Texas Oncology director of social work and palliative care, advises family members and friends to help people with cancer by doing these things:
- Let them lead the conversation.
- Create a space for conversation when they are ready.
- Stay present.
- Let them talk about things other than cancer.
- Cry with them and allow them to be scared.
- Help them with practical things such as errands, groceries and meals.
- Help them continue to do the things they love and that are part of a routine.
