Social Worker Spotlights Efforts to ‘Destigmatize’ Mental Health Support in Cancer


Nicole Peeke, LCSW, ACHP-SW, emphasizes the importance of an integrated oncology care plan and that mental health care should be incorporated as a standard of care.

Patients with cancer face challenges accessing mental health resources despite experiences high rates of severe mental and emotional distress, according to Nicole Peeke, LCSW, ACHP-SW with regard to a recent survey data collected by the Cancer Support Community.

Nichole Peeke, LCSW, ACHP-SW, a licensed clinical social worker at Patients, Partners, and Providers Working Together: A Strengths-Based Brain Cancer Program

Nichole Peeke, LCSW, ACHP-SW, a licensed clinical social worker at Patients, Partners, and Providers Working Together: A Strengths-Based Brain Cancer Program

Peeke, a licensed clinical social worker at Patients, Partners, and Providers Working Together: A Strengths-Based Brain Cancer Program, spoke with CancerNetwork® about how these findings reflect her experiences with patients and how there may be challenges in incorporating an integrated care approach in smaller practices.

Approximately 60% of 600 survey respondents with cancer were never referred to a mental health professional by their cancer care team. Moreover, about 2 of 5 patients who actively sought such care never received any and one-third of patients did not receive any professional counseling for mental health concerns. In total, 41% of respondents reported receiving medication for anxiety and 34% were receiving medication for depression.

“Having access to mental health resources alongside cancer care—in terms of cost containment for physicians and health insurance—[could be valuable]. If integrated care could be a standard of care, if mental health could be incorporated as an insurance benefit—even if it's a social worker, a patient navigator, or psychology services—I would love that. There is a robust amount of data available that support that.”

CancerNetwork®: What were the key findings of this study?

Peeke: What sticks out to me [from these findings], especially as a clinician, is the need to continue to normalize mental health [care] alongside medical care and to [reduce] barriers to access. The study findings show that people still have difficulty accessing mental health treatment. Some of that [has to do with] stigmatization. But there are also logistical barriers. Alongside the attitudinal barriers, it’s also difficulty to get an appointment with a therapist, or to find a therapist [with the appropriate specialty].

Many patients have said they would like to find someone who specializes in chronic medical issues or psycho-oncology, but even [finding] a general practice is difficult. Because of the pandemic, there are a lot more people now [receiving] mental health care, and many therapists have opted out of being in-network for insurance. Finances are a barrier for a lot of people who want a therapist.

The research shows that we need ti=o have continued conversations and accessibility.

How should oncologists or other members of an oncology care team take these mental health factors into account when treating patients?

Physicians and their staff to treat the whole person, most oncologists I’ve worked with are good at seeing the whole person, and knowing that patients’ thoughts and feelings matter. But for whatever reason, they’re not always having that conversation with the patient directly.

It doesn’t take up much time for physicians or nurses to engage in some of that [by asking], “How are you feeling today? How have you been coping? We want to be aware of any challenges you have.” [It’s important] from the get-go to have those conversations—to not feel like you’re just treating the cancer but that it’s part of the integrated care that person receives.

In my experience, even bringing up wisdom from past patient experiences can really help destigmatize a lot of fear or hesitancy that patient brings up. If the physician brings it up, it really normalizes [these conversations]. That’s a really good way to incorporate that into medical care.

How could these findings be incorporated into a multidisciplinary care plan?

I’m a fan of the multidisciplinary care plan.

[However], in smaller oncology practices—a private or solo practice—I don’t know how easy it is for a physician or nurse to do a lot of multidisciplinary care. I’ve always thought about that type of patient. I work in a comprehensive cancer center; I’m blessed to be integrated into [a multidisciplinary plan] along with several supportive care services, [including] child life, spiritual care, and psychiatry /psychology. But in a private practice or if someone doesn’t have access to mental health resources, Cancer and Mental Health is a great website because a physician or care provider can say [to a patient], “There’s this website and I have some fact sheets. Here’s this information.”

A physician can start the conversation and say, ‘Contact your insurance. This is the best way to start a mental health referral.’ Or you could refer them to a social worker or cancer advocacy organization in your community.

Where do you feel research could be focused from here to push the needle forward in mental health?

There are many ideas to streamline mental health care in cancer. Integrated care [is critical], as I do see the benefit of that in a comprehensive cancer center. Anecdotally, when patients have [access to] supportive care services…the support helps with adherence with mental health and coping. I would love for that to be available to anyone going through treatment.

If that could be a standard of care—if integrated care could be a standard of care—mental health could be incorporated as an insurance benefit. Even if it’s [through] a social worker, a patient navigator, or [any kind of] psychology services, if that’s seen as the standard of care, I would love that. There’s a robust amount of available data supporting this.

[We should be] nationally recognizing that [integrated care] does have an added benefit, not just to patients, but to everybody involved.

What do you hope oncology professionals take away from our conversation?

Having these [mental health] conversations [is so important] because so many patients trust their physicians. If they can deliver their life-saving cancer care, think about the weight it holds when they discuss how [the disease] affects that patients’ thoughts, feelings, and family members. This is the best type of psychosocial care you can deliver when you’re thinking about the whole person.

I would ask providers to consider incorporating questions about [mental health] alongside cancer treatment: “How are you? How are you coping with this? How has this been for you and your family?” I think they sometimes fear that [conversation will] get outside of their realm [of expertise], or they’ll feel like a therapist, but it doesn’t have to be that way. It’s [as simple as asking] how things are going for them as a person, and [helping them] find the resources and support needed.

Also, the Talk About It initiative is great. It’s putting [these issues] in the public sphere. The initiative makes it feel as though the conversation is out in the open and less stigmatized. It's wonderful when that type of high-level involvement is shown to patients, because it really does lend that sense of [how] important it is that these companies recognize it that should feel comfortable talking about it.


New Talk About It resources aim to accelerate integration of mental health into quality cancer care. News Release. BeiGene. February 3, 2023. Accessed February 3, 2023.

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