I’m a clinician so I do all the services related to mental health care in cancer patients in general and also with breast cancer patients. As my observation, the prevalence of distress, anxiety, depression in cancer patients in Vietnam is really significant. Not only breast cancer in the early stage when they have stress, anxiety and fear, during all along with the cancer treatment journey they have many problems. At some critical points of the cancer treatment journey, like the advanced stage or when the patient has recurrent stage, or they prepare for the surgeon, they begin to train the protocol treatment, they have a higher risk of mental health problems. So we need to be involved in the cancer care for the patients like that.
In a report in the Vietnam National Cancer Hospital, we did a study in 300 cancer patients, including breast cancer patients. We noticed the prevalence of psychological distress in the cancer patients is nearly 60% and the prevalence of anxiety is 27% and depression is 46%. Especially nearly 10% of these cancer patients have severe depression with a higher risk of suicide – it’s significant figures we need to concentrate in the cancer care.
What can be done to tackle psycho-social issues for cancer patients?
Actually, the Vietnam National Cancer Hospital is one of the biggest oncology hospitals in the northern area of Vietnam. We have 10,000 inpatient beds and nearly 500 patients come to have an exam for cancer every day. So we have to face the increasing needs of the cancer care and also the mental health care for this vulnerable population. But we have only one psychiatrist, it’s me. We used to have one psychologist but they quit because of the COVID pandemic was a lot of stress.
After the pandemic we built a team we called a psycho-social care team with me, a psychiatrist, with three social workers and two doctors, part-time doctors, to join the team to take care of the patients with mental health care problems or high risk. We trained the nurses who have a very close activity with the patients and the families. We trained the nurses and the healthcare staff in each department how to identify psychological signs in the cancer patients. We trained them how to give or deliver simple psycho-education and even the group psychotherapy for some targeted groups like lung cancer or the peer support model for the breast cancer patients. They got some promising results and recognition, not only from the policy makers but also the board of the hospital and also some experts at the national and international level. I think that there’s room for us to develop and take care of breast cancer patients in the mental aspects.
How do you apply these models?
We have a lot of patients with the risk of mental health problems but they don’t know what is the mental health care problem. So we always start with education – how to reduce the stigma and reduce the resistance of the patient to talk about the emotional aspects when they come to the oncology hospital. We train the social worker and nurse, from the very first communication with the patient, and give that the feeling of normal to talk about that. We also use some very short screening questionnaires to give to the patient that they can fill in in the waiting time, they have a lot of waiting time if they come to the hospital for a long day to take an examination and do some techniques and treatment. So we collect the forms after the patient administered according to their objective feeling. After they have the very preliminary result from the screening they will classify what is a high risk group, what is a moderate risk, also a low level of risk of depression and anxiety or sleep disorder. Then we focus on the severe and moderate risk level of psychological problems. If the patient has time and they have assessed to the team they will have… it may be me, the psychiatrist, if I have time, or a nurse or a social worker who was trained to talk about the patient, to give the psycho-education and also to share and give the supportive communication with the patient to better satisfaction and better awareness about mental health care on the cancer journey.
Do you have any advice for other healthcare professionals?
In the SEABCS conference I had a talk about the mental health care problems in Vietnamese cancer patients. I also shared a model about peer support. Because in the low and middle income countries the number of psychiatrists or psychologists taking care of the cancer patients is so low. We like a lot of healthcare workforce in general, even in the oncology, so mental health care is something that is so different. We see that struggle and we want to focus more on the task shifting and the peer support, the community-based support for the cancer patients, that we use a very low resource but we can assess more patients. Early detection prevents an intervention for the patient from the very early stage of the problems, then they reduce the burden of the specialists like me.
In the future, not only in Vietnam but maybe in any country like Vietnam, the lack of resources with taking care about how to give more access and have more policy to care for the patients with cancer with low cost and time and higher effectiveness. Task shifting is basically that specialists like me, we train the non-specialists. Anybody who is dedicated and cares for the cancer patient and is willing to join and learn and help the task shifting with the social workers and nurses in the case hospital, the Vietnam National Hospital, they really care about the patient but they don’t have time, they don’t have skill. So we need some specialists to guide and supervise and go along in the very first steps and then they will have a relationship, a good relationship, with the patient along the cancer treatment journey and they can be a peer support. Peer support is a model in which an experienced woman who overcame the cancer treatment will come back and learn the skill of how to help the others. The peer support we do in the Vietnam National Cancer Hospital, we have the name Stronger Together, that the woman with breast cancer and gynaecological cancer after one year of treatment and they don’t have distress or severe distress, and they will come back and learn the skill and knowledge about the psycho-social support for the cancer patients, then they will be the mentors. The mentors with experience will come back to the hospital and approach the new patients who were diagnosed very newly with cancer, breast cancer patients or gynaecological cancer patients, within one month. The totally new, shocking, stress, anxiety, fear of death, a lot of things, overwhelming psychosocial burden. This newbie will be guided and followed and also taken care of by the mentors who are women with experience of overcoming cancer.
The peer support is so meaningful because the network of the patient living with cancer is so significant. When the patient with experience of this cancer, they have a voice, have something to share, this works actually more convincing, compared to the doctors or nurses or something else, saying to the new patient. They can share the same feeling, they believe in the experience of the mentor and they can feel the spirit of the survivor after the breast cancer. The spirit is the energy that takes the new patient, comes along with the different stages of the cancer treatment journey. So it’s an effective and sustainable way to have a lot of breast cancer women out there who have no access to mental health care services. Because in Vietnam actually the stigma with mental health problems is high and a lot of patients have the problems mentally, they have no chance to come to the psychiatric hospital, they have no motivation to share and they don’t know how to self-help. So the network of the patients with the same feeling of experience, it’s very meaningful for them. It can be in the forum, the virtual media, or some group on the social apps and they can share information, experience; they can share emotionally. I think it’s a very promising approach.
What are some of the psycho-social aspects of breast cancer management specific to Vietnam?
Breast cancer patients have a very specific psychological journey because the breast cancer patient is something, not only the breast, it’s an organ related to the image of woman. In Asian countries, and especially Vietnamese culture, the woman has many emotions. They also have the pride that I’m a woman and I feel very huge and great to be a woman. But if I have a cancer and they have to remove the breast, it’s something so insulting and something that really hurts, not only physically but also the spiritual and emotionally. The patient in Vietnam, the breast cancer patient, they are adapting with the new artificial breast and new techniques to recover the confidence of the woman living with breast cancer. But it’s not common. So to the majority of the breast cancer patients the burden of psychological and emotional aspects is really large.
During the cancer journey the women have to face a very specific stage of the high risk of stress and they need specific intervention or support. So psycho-social support should be based on trust so it’s very hard for me, a specialist or a doctor, an oncologist, a psychiatrist, to come and share the very inner, hidden, very deep emotions in a woman but it’s easier if it’s the same patient in the same room, the same age and maybe from the relatives, from a sister group and maybe from a different person, outside the hospital. They feel safe and they feel trust and they can share in the psycho-social support for breast cancer. That’s the reason why we focus on the peer support and the community support, it’s approachable to these kinds of patients.
