This post was updated by ASCO staff on July 13, 2022.
Tanya J. Peterson, MS, is credentialed with the National Board of Certified Counselors. She is a regular contributor to the mental health website, Choosing Therapy. She has written 4 self-help books for anxiety as well as 2 guided anxiety journals. Her books empower people to create a quality, mindful life despite challenges.
For people with cancer, the disease impacts not just your body and physical health, but also your total well-being and mental health. Cancer is all-encompassing and can interfere in your relationships and all the roles you play in life. It can also have an impact on your productivity, financial stability, your hopes and dreams for the future, and much more.
Mental health is affected at every stage of cancer treatment. It’s affected the moment you receive the diagnosis, then throughout treatment, and even after you’ve completed treatment. Therefore, proper mental health support is vital. Yet for people with cancer, going to in-person therapy appointments is often difficult. Online therapy is emerging as a valid, effective alternative form of mental health treatment for many people, including those facing cancer.
The importance of therapy in mental health treatment for people with cancer
Psychotherapy, often called “talk therapy” or simply “therapy”, can be a component of palliative care or supportive care, which is a range of support and services to manage the effects of cancer on your life. Palliative care teams often include social workers and/or other mental health professionals to help people deal with the emotional upheaval and stress of cancer and its treatment. Therapists and counselors can deliver their services in person or online to increase overall quality of life for people with cancer.
Cancer causes numerous mental health challenges, including:
Stress, including symptoms of post-traumatic stress disorder (PTSD)
A sense of loss
Anxiety and depression are common in people before, during, and after cancer treatment. According to the National Behavioral Health Network for Tobacco & Cancer Control, up to 25% of cancer survivors experience depression and up to 45% experience anxiety. Further, people undergoing cancer treatment have an increased risk of suicide, from 2 to 3 times that of the general population. This increased suicide risk is attributed to feelings of hopelessness, loneliness, grief, anxiety, limitations in life, and lack of social support.
If you feel you’re in crisis and cannot reach your doctor or a loved one, call the National Suicide Prevention Lifeline at 1-800-273-8255 or dial the code "988" (available in the United States).
The mental health consequences of cancer can further interfere in your medical treatment and prognosis because they can contribute to:
Social withdrawal and isolation
Decreased self-care, including poor diet and exercise
Missed doctor appointments and medical treatments
These issues can disrupt treatment and recovery and may impact your survival. According to the Journal of the National Cancer Institute, cancer patients who experience depression have a 19% higher death rate than those who aren’t struggling with this debilitating mental health challenge. Further, studies are showing a strong link between mental health and cancer survival.
Therapy, therefore, is an essential part of palliative care for those living with cancer. Unfortunately, there are barriers to getting in-person therapy for many people with cancer.
Difficulties receiving in-person mental health help when you have cancer
For those with cancer, therapy can enhance quality of life, reduce stress, and help improve self-care, all of which can help make medical treatment more effective. Unfortunately, only around 5% of people with cancer receive the mental health help they need, according to the National Comprehensive Cancer Network.
Barriers to in-person therapy include these factors and more:
Fatigue, which makes it difficult to leave the house to meet with someone face-to-face
Travel burdens, such as distance and expense
Time required to get to and from therapy
In the past, these burdens often meant that someone couldn’t receive the mental health help they needed. But emerging online therapy services are changing how people with cancer can access mental health care.
How online therapy can benefit people with cancer
For people with cancer, online therapy is both convenient and safe because you get to remain at home in your sanitized environment away from people who might be sick. This is important during and after chemotherapy or other treatments that weaken your immune system.
A review of 65 research reports also found that online video therapy effectively treats a wide variety of mental health challenges, from specific mood and behavior disorders to general life stressors. Given that people with cancer face stressors that can be extreme and because they have an increased risk for anxiety and depression, online therapy—particularly through video conferencing—can offer effective support and relief of psychological symptoms.
What to expect during an online therapy visit
If you have an online therapy session, you’ll work with a credentialed mental health professional. Most services require therapists to have graduate degrees and be licensed in their state. Sometimes, communication is done via messaging where the patient and counselor aren’t interacting together at the same time. Often, though, you get to connect directly with a therapist in real-time via chat, telephone, or video conferencing.
Chat visits. In a chat, you and your therapist will send messages back and forth instantly. You and your therapist can ask each other questions and respond right away. Your therapist can give you feedback and help you brainstorm solutions to problems you may be experiencing. While you don’t hear each other’s voices or see each other’s faces, the conversation flows without interruptions. This format allows the 2 of you to be responsive to each other. An advantage of this format is that you often have a written record of your conversation to use as a resource between sessions.
Phone visits. A phone conversation offers the advantage of being able to hear your therapist’s voice. Likewise, your therapist can hear yours. Sometimes, a person’s tone and other aspects of nonverbal conversation are missed when messages are only written. Some people find a phone conversation to be more personal than written chats.
Video conferencing. When you have a video conference with a therapist, you see them and hear them as if they were in the same room as you. You connect with a computer or a smartphone and use a video conferencing platform like Zoom, Teams, FaceTime, Skype, or another platform used by the therapist’s office. When meeting with the therapist, these platforms will be secure to ensure privacy. If you’re not used to talking with someone using a video format, doing so can feel a bit awkward at first. Your therapist, though, will help you feel as if you’re meeting in person without screens between the 2 of you.
The cost and coverage of online therapy
The cost of online therapy varies widely, and each platform offers its own unique packages. Typically, clients can select from a few package options that offer a set number of 30- or 50-minute sessions. Packages offering 4 to 6 sessions with a therapist is common. Pricing can vary depending on the company and the type of package you select. Payment for the package is usually expected in full upfront, but you may be able to have a free trial period. The trial period often lasts 1 week. This gives you the opportunity to discover how the service works and to meet with a therapist to see if online therapy is right for you.
Many insurance companies do not cover online therapy. However, as research continues to point to the effectiveness of these services, some insurance companies are beginning to cover at least a portion of the cost. Talk with your insurance company to see if online therapy is covered.
If you were recently diagnosed with cancer, are in treatment, or have completed your treatments and are experiencing depression, anxiety, stress, or symptoms of PTSD, online therapy might be something to consider. You may also consider online therapy if you are experiencing relationship problems, financial difficulties, or other challenges to your well-being. Your primary care physician or your oncologist may have additional resources and information to share with you. Other members of your health care team might also be able to discuss therapy options with you. They may able to advise whether online therapy is right for you.
With professional mental health support, you can reclaim your mental health and equip yourself to improve your physical health, too. Cancer changes lives, but it doesn’t have to lessen the quality of your life.