Cancer presents significant physical and mental challenges to patients. Therefore, psychological assessment is important following a cancer diagnosis, as well as during and after chemotherapy. In cancer treatment, the goal of healthcare providers, including pharmacists, should be to deliver holistic care that addresses important aspects of patients’ health, with particular emphasis on their psychological readiness to combat their diseases. This article reviews published literature from Google Scholar and PubMed to examine the relevant pharmacotherapy and psychotherapy approaches to managing psychological issues in cancer patients. This article also discusses how pharmacists can be integrated into cancer patients’ mental health care, while highlighting the potential benefits and challenges associated with this approach. We conclude that the integration of pharmacists into psychological care and support for cancer patients holds promise due to their knowledge of cancer chemotherapy, their ability to improve their knowledge about psychological care, and their capacity to collaborate with other healthcare professionals in cancer treatment.
SmithHR. Depression in cancer patients: pathogenesis, implications and treatment (review). Oncol Lett2015 Feb 9; 9: 1509–1514.
2.
HinzAHerzbergPYLordickF, et al.Age and gender differences in anxiety and depression in cancer patients compared with the general population. Eur J Cancer Care2019 Jul 9; 28: e13129.
3.
Van BeekFEWijnhovenLMAHoltmaatK, et al.Psychological problems among cancer patients in relation to healthcare and societal costs: a systematic review. Psychooncology2021 Jul 6; 30: 1801–1835.
4.
LocherCMeierSGaabJ. Psychotherapy: a world of meanings. Front Psychol2019; 10: 460.
5.
BowerJE. Behavioral symptoms in patients with breast cancer and survivors. J Clin Oncol2008 Feb 10; 26: 768–777.
6.
PitmanASulemanSHydeN, et al.Depression and anxiety in patients with cancer. Br Med J2018 Apr 25; 361: k1415.
7.
JittlaPGrahamDMZhouC, et al.EPIC: an evaluation of the psychological impact of early-phase clinical trials in cancer patients. ESMO Open2022 Oct; 7: 100550.
8.
BrunckhorstOHashemiSMartinA, et al.Depression, anxiety, and suicidality in patients with prostate cancer: a systematic review and meta-analysis of observational studies. Prostate Cancer Prostatic Dis2020 Sep 25; 24: 281–289.
9.
LiuHGaoXHouY. Effects of mindfulness-based stress reduction combined with music therapy on pain, anxiety, and sleep quality in patients with osteosarcoma. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)2019; 41: 540–545.
10.
VelikovaGMordenJPHavilandJS, et al.Accelerated versus standard epirubicin followed by cyclophosphamide, methotrexate, and fluorouracil or capecitabine as adjuvant therapy for breast cancer (UK TACT2; CRUK/05/19): quality of life results from a multicentre, phase 3, open-label, randomised, controlled trial. Lancet Oncol2023; 24: 1359–1374.
11.
RossSBossisAGussJ, et al.Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol2016; 30: 1165–1180.
HooglandAILechnerSCGonzalezBD, et al.Efficacy of a Spanish-language self-administered stress management training intervention for Latinas undergoing chemotherapy. Psychooncology2018; 27: 1305–1311.
14.
LeporeSJRevensonTARobertsKJ, et al.Randomised controlled trial of expressive writing and quality of life in men and women treated for colon or rectal cancer. Psychol Health2015; 30: 284–300.
15.
CormiePGalvãoDASpryN, et al.Can supervised exercise prevent treatment toxicity in patients with prostate cancer initiating androgen-deprivation therapy: a randomised controlled trial. BJU Int2015; 115: 256–266.
16.
WiggenraadFBolamKAMijwelS, et al.Long-Term favorable effects of physical exercise on burdensome symptoms in the OptiTrain breast cancer randomized controlled trial. Integr Cancer Ther2020; 19: 1534735420905003.
17.
TakanoTMatsudaAIshizukaN, et al.Effectiveness of self-help workbook intervention on quality of life in cancer patients receiving chemotherapy: results of a randomized controlled trial. BMC cancer2021; 21: 588.
18.
Van der GuchtKMelisMAhmadounS, et al.A mindfulness-based intervention for breast cancer patients with cognitive impairment after chemotherapy: study protocol of a three-group randomized controlled trial. Trials2020; 21: 290.
19.
CharalampopoulouMBacopoulouFSyrigosKN, et al.The effects of pythagorean self-awareness intervention on breast cancer patients undergoing adjuvant therapy: a pilot randomized controlled trial. Breast (Edinburgh, Scotland)2020; 49: 210–218.
20.
GalvãoDANewtonRUChambersSK, et al.Psychological distress in men with prostate cancer undertaking androgen deprivation therapy: modifying effects of exercise from a year-long randomized controlled trial. Prostate Cancer Prostatic Dis2021; 24: 758–766.
21.
MaoJJFarrarJTBrunerD, et al.Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor-related arthralgia: a randomized trial. Cancer2014; 120: 3744–3751.
22.
ArandaSJeffordMYatesP, et al.Impact of a novel nurse-led prechemotherapy education intervention (ChemoEd) on patient distress, symptom burden, and treatment-related information and support needs: results from a randomised, controlled trial. Ann Oncol2012; 23: 222–231.
23.
HanSZhangLLiQ, et al.The effects of laughter yoga on perceived stress, positive psychological capital, and exercise capacity in lung cancer chemotherapy patients: a pilot randomized trial. Integr Cancer Ther2023; 22: 15347354231218271.
24.
El-JawahriALeBlancTWKavanaughA, et al.Effectiveness of integrated palliative and oncology care for patients with acute myeloid leukemia: a randomized clinical trial. JAMA Oncol2021; 7: 238–245.
25.
HuriMHuriEKayihanH, et al.Effects of occupational therapy on quality of life of patients with metastatic prostate cancer. A randomized controlled study. Saudi Med J2015; 36: 954–961.
26.
CarayolMNinotGSenesseP, et al.Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the “APAD1” randomized controlled trial. BMC cancer2019; 19: 737.
27.
NewtonRUTaaffeDRSpryN, et al.Can exercise ameliorate treatment toxicity during the initial phase of testosterone deprivation in prostate cancer patients? Is this more effective than delayed rehabilitation?BMC cancer2012; 12: 432.
28.
WitloxLVelthuisMJBoerJH, et al.Attendance and compliance with an exercise program during localized breast cancer treatment in a randomized controlled trial: the PACT study. PloS one2019; 14: e0215517.
29.
Dos SantosMHardy-LégerIRigalO, et al.Cognitive rehabilitation program to improve cognition of cancer patients treated with chemotherapy: a 3-arm randomized trial. Cancer2020; 126: 5328–5336.
30.
SerfatyMKingMNazarethI, et al.Manualised cognitive-behavioural therapy in treating depression in advanced cancer: the CanTalk RCT. Health Technol Assess (Winchester, England)2019; 23: 1–106.
31.
MaguireRMcCannLKotronoulasG, et al.Real time remote symptom monitoring during chemotherapy for cancer: European multicentre randomised controlled trial (eSMART). BMJ (Clinical Research ed)2021; 374: n1647.
32.
AbbasQAroojNBaigKB, et al.A clinical trial of cognitive behavior therapy for psychiatric comorbidity and quality of life with Cancer Patients during Chemotherapy (CPdC). BMC psychiatry2022; 22: 222.
33.
IzumiKIwamotoHYaegashiH, et al.Androgen replacement therapy for cancer-related symptoms in male: result of prospective randomized trial (ARTFORM study). J Cachexia Sarcopenia Muscle2021; 12: 831–842.
34.
KornblithABLanLArcherL, et al.Quality of life of older patients with early-stage breast cancer receiving adjuvant chemotherapy: a companion study to cancer and leukemia group B 49907. J Clin Oncol2011; 29: 1022–1028.
35.
SavardJMoussaHPelletierJ-F, et al.Effects of omega-3 supplementation on psychological symptoms in men with prostate cancer: secondary analysis of a double-blind placebo-controlled randomized trial. Cancer Med2023; 12: 20163–20176.
36.
VegaJNAlbertKMMayerIA, et al.Subjective cognition and mood in persistent chemotherapy-related cognitive impairment. J Cancer Surviv2022; 16: 614–623.
37.
YeXLuDChenX, et al.A multicenter, randomized, double-blind, placebo-controlled trial of shuangbai san for treating primary liver cancer patients with cancer pain. J Pain Symptom Manage2016; 51: 979–986.
38.
YangYWuJLiH, et al.Prospective investigation of intravenous patient-controlled analgesia with hydromorphone or sufentanil: impact on mood, opioid adverse effects, and recovery. BMC Anesthesiol2018; 18: 37.
39.
YamaguchiTMoritaTShinjoT, et al.Effect of parenteral hydration therapy based on the Japanese national clinical guideline on quality of life, discomfort, and symptom intensity in patients with advanced cancer. J Pain Symptom Manage2012; 43: 1001–1012.
40.
MoritaTChinoneYIkenagaM, et al.Efficacy and safety of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan. J Pain Symptom Manage2005; 30: 320–328.
41.
JiangSLiangHLiuZ, et al.The impact of anlotinib on brain metastases of non-small cell lung cancer: post hoc analysis of a phase III randomized control trial (ALTER0303). Oncologist2020; 25: e870–e8e4.
42.
WangJYXuLZhangRX, et al.Traditional Chinese medicine for cancer pain. J Chin Integr Medicine (in Chinese)2011; 9: 129e34.
43.
ArdizzoneABavettaDGaroML, et al.Impact of the cognitive–behavioral approach and psychoeducational intervention in breast cancer management: a prospective randomized clinical trial. Healthcare2022; 10: 629.
44.
Van BeekFEWijnhovenLMAJansenF, et al.Prevalence of adjustment disorder among cancer patients, and the reach, effectiveness, cost-utility and budget impact of tailored psychological treatment: study protocol of a randomized controlled trial. BMC Psychol2019; 7: 89.
45.
KlikovacTDjurdjevicA. Psychological aspects of the cancer patients’ education: thoughts, feelings, behavior and body reactions of patients faced with diagnosis of cancer. J Buon2010; 15: 153–156.
46.
TurnerJKellyBClarkeD, et al.A randomised trial of a psychosocial intervention for cancer patients integrated into routine care: the PROMPT study (promoting optimal outcomes in mood through tailored psychosocial therapies). BMC Cancer2011; 11: 48.
47.
MisonoSWeissNSFannJR, et al.Incidence of suicide in persons with cancer. J Clin Oncol2008 Oct 10; 26: 4731–4738.
48.
PengYNHuangMLKaoCH. Prevalence of depression and anxiety in colorectal cancer patients: a literature review. Int J Environ Res Public Health2019 Jan 31; 16: 411.
49.
NippRDRuddyMFuhCX, et al.Pilot randomized trial of a pharmacy intervention for older adults with cancer. Oncologist2018; 24: 211–218.
50.
GohELabelleSChanA. Implementation and evaluation of a shared care model between oncologists and pharmacists for breast cancer patients at a Canadian regional ambulatory cancer centre. J Oncol Pharm Pract2024; 30: 622–627.
51.
ZhangLMcLeodHLLiuKK, et al.Effect of physician-pharmacist participation in the management of ambulatory cancer pain through a digital health platform: randomized controlled trial. JMIR Mhealth Uhealth2021; 9: e24555.
52.
Mohd-SidikSAkhtari-ZavareMPeriasamyU, et al.Effectiveness of chemotherapy counselling on self-esteem and psychological affects among cancer patients in Malaysia: randomized controlled trial. Patient Educ Couns2018; 101: 862–871.
53.
UmmavathyPSherinaMSRampalL, et al.Outcome of chemotherapy counseling by pharmacists on psychological effects and self esteem among oncology patients in a government hospital in Malaysia. Med J Malaysia2015; 70: 131–141.
54.
Rubio-ValeraMChenTO’ReillyC. New roles for pharmacists in community mental health care: a narrative review. Int J Environ Res Public Health2014 Oct 21; 11: 10967–10990.
55.
MelnykBMHoyingJHsiehAP. Workplace wellness: from resiliency to suicide prevention and grief management. Cham: Springer, 2023.
56.
GoldstoneLWDiPaulaBAWerremeyerA, et al.The role of board-certified psychiatric pharmacists in expanding access to care and improving patient outcomes. Psychiatr Serv2021 Jul 1; 72: 794–801.
57.
KirschbaumMPetersonGBridgmanH. Mental health first aid training needs of Australian community pharmacists. Curr Pharm Teach Learn2016; 8: 279–288.
58.
GermanAJohnsonLYbarraG, et al.Assessment of pharmacists’ self-reported preparedness to provide pharmacotherapy services to individuals with psychiatric disorders. Ment Health Clin2018; 8: 1–6.
59.
ScheerderGDe CosterIVan AudenhoveC. Pharmacists’ role in depression care: a survey of attitudes, current practices, and barriers. Psychiatr Serv2008; 59: 1155–1160.
60.
AwadMFurdichKWebbD. Patient satisfaction with pharmacist-led chronic care management services combined with medication synchronization. Am J Health Syst Pharm2023; 80: 1350–1356.
61.
CrokeACardwellKClyneB, et al.The effectiveness and cost of integrating pharmacists within general practice to optimize prescribing and health outcomes in primary care patients with polypharmacy: a systematic review. BMC Prim Care2023; 24: 41.
62.
AdamsJAAdamsAJKlepserME. Pharmacist prescriptive authority for acne: an evidence-based approach to policy. Innov Pharm2021; 12: 11.
63.
McShinskyRVolodarskyRRyanO, et al.Association of pharmacist interventions with adherence upon targeted anticancer oral therapy initiation. J Clin Oncol2023; 41: 7576.
64.
XiaoJWangQTanS, et al.Analysis of patient medication compliance and quality of life of physician-pharmacist collaborative clinics for T2DM management in primary healthcare in China: a mixed-methods study. Front Pharmacol2023; 14: 1098207.
65.
MohamedSVialletALamandV, et al.Effectiveness of a pharmaceutical consultation in the care of cancer patients receiving oral anti-cancer therapy: PHACON study. Alexandria, VA: American Society of Clinical Oncology, 2023.
66.
RichardsonCLBlackDLindseyL, et al.Community pharmacies as a place for informal carer support in mental health and wellbeing. Int J Clin Pharm2023; 45: 1302–1306.
67.
RomneyMRobinsonRFBoyleJ. Mental health pharmacists: increasing necessary mental health service delivery. Fed Pract2022; 39: 106–108.
68.
CarpiniJASharmaAKubicki EvansM, et al.Pharmacists and mental health first aid training: a comparative analysis of confidence, mental health assistance behaviours and perceived barriers. Early Interv Psychiatry2023; 17: 670–680.
69.
GuYMuXZhangY, et al.The effect of Patients’ psychological contract with pharmacists on medication adherence: a qualitative study. Patient Prefer Adherence2023; 17: 547–555.
70.
FentieAMHulukaSAGebremariamGT, et al.Impact of pharmacist-led interventions on medication-related problems among patients treated for cancer: a systematic review and meta-analysis of randomized control trials. Research in Social and Administrative Pharmacy2024; 20: 487–497.
71.
TanakaKHoriATachiT, et al.Impact of pharmacist counseling on reducing instances of adverse events that can affect the quality of life of chemotherapy outpatients with breast Cancer. J Pharm Health Care Sci2018; 4: 9.
72.
CalogeroSCaleyCF. Supporting patients with mental illness: deconstructing barriers to community pharmacist access. J Am Pharm Assoc(2003). 2017; 57: 248–255.
73.
Dineen-GriffinSVargasCWilliamsKA, et al.Cost utility of a pharmacist-led minor ailment service compared with usual pharmacist care. Cost Eff Resour Alloc2020; 18: 24.
74.
MarraCJohnstonKSantschiV, et al.Cost-effectiveness of pharmacist care for managing hypertension in Canada. Can Pharm J (Ott)2017; 150: 184–197.
75.
PhillipsLCENguyenHGengeTL, et al.Effectiveness and cost-effectiveness of an intensive and abbreviated individualized smoking cessation program delivered by pharmacists: a pragmatic, mixed-method, randomized trial. Can Pharm J (Ott)2022; 155: 334–344.
76.
BissettSMSturrockACarrozzoM, et al.Is the early identification and referral of suspected head and neck cancers by community pharmacists feasible? A qualitative interview study exploring the views of patients in North East England. Health Expect2023; 26: 2089–2097.
77.
NotmanFPorteousTMurchieP, et al.Do pharmacists contribute to patients’ management of symptoms suggestive of cancer: a qualitative study. Int J Pharm Pract2019; 27: 131–139.
78.
BienertAMeierKKokishevaA, et al.Impact of COVID-19 on mental health of oncology health care workers and interdisciplinary collaboration: results of surveys in 2021 and 2022. Eur J Oncol Pharm2023; 6: e00044.
79.
WastesonEBrenneEHigginsonIJ, et al.Depression assessment and classification in palliative cancer patients: a systematic literature review. Palliat Med2009 Oct 13; 23: 739–753.
80.
AnnunziataMAMuzzattiBBidoliE, et al.Hospital Anxiety and Depression Scale (HADS) accuracy in cancer patients. Support Care Cancer2020; 28: 3921–3926.
81.
MilliganFMartinezFAalSHMA, et al.Assessing anxiety and depression in cancer patients. Br J Nurs2018 May 24; 27: S18–S23.
82.
BhaktaPHunzekerZEGudipallySR, et al.Screening for anxiety and depression in cancer patients using PHQ4. J Clin Oncol2022 Jun 1; 40: e18629–9.
83.
BlumLAkourAEl-DenS, et al.Mental health care: a handbook for pharmacists. The Hague: University of Huddersfield Research Portal. International Pharmaceutical Federation (FIP), 2022.
84.
HattonKBhattacharyaDScottS, et al.Barriers and facilitators to pharmacists integrating into the ward-based multidisciplinary team: a systematic review and meta-synthesis. Res Soc Administr Pharm2021 Feb; 17: 1923–1936.
85.
MohammedEKhanalSJalalZ, et al.Perceived barriers and facilitators to uptake of non-traditional roles by pharmacists in Saudi Arabia and implications for COVID-19 pandemic and beyond: a qualitative study using Theoretical Domain Framework. J Pharm Policy Pract2021 Feb 24; 14: 25.
86.
RakvaagHSØreideGEMelandE, et al.Complementing or conflicting? How pharmacists and physicians position the community pharmacist. Pharm Pract (Granada)2020 Sep 1; 18: 2078.
87.
UrslakREvansCNakhlaN, et al.Peripartum mental health and the role of the pharmacist: a scoping review. Res Soc Administr Pharm2023 May 11; 19: 1243–1255.
88.
GroverSAvasthiANischalA. Ethical and legal issues in psychotherapy. Indian J Psychiatry2022; 64: 47–61.
EdemekongPFHaydelMJAnnamarajuP. Health Insurance Portability and Accountability Act (HIPAA) [Internet]. Treasure Island, FL: Nih.gov. StatPearls Publishing, 2024. https://www.ncbi.nlm.nih.gov/books/NBK500019/.
91.
Under TRICARE C on the Qualifications of PPMHCS, Board on the Health of Select Populations, Institute of Medicine. Requirements related to the practice of counseling. www.ncbi.nlm.nih.gov. Washington, DC: National Academies Press (US), 2010.
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