Introduction

Mental health disorders are frequently reported among people living with cancer in Australia, ranging from 16 to 31%.^1-3 This is often characterised by symptoms of depression, anxiety and adjustment disorders that can exert a negative impact on treatment adherence, quality of life and even survival.^4,5 Psychological distress is commonly associated with cancer and can impact mental health.⁶ International studies have shown that 30–40% of people diagnosed with cancer experience psychological distress, which leads to a decrease in treatment compliance, medical satisfaction and quality of life.⁷ This policy aims to specifically address the mental health needs of people affected by cancer who experience psychological distress during cancer care or beyond into survivorship.

Understanding the experiences of psychological distress among people diagnosed with cancer can help ensure access to appropriate support to reduce the long-term negative impact on their health.⁴ However, recognition of psychological distress among people affected by cancer can be limited if symptoms do not reach clinically diagnosable levels to be classified as a mental illness.⁸ If left unaddressed, psychological distress can impact an individual’s capacity to engage in cancer treatment decisions and tolerate or adhere to treatment and may impact care outcomes, as well as impact their family and carers' mental health and wellbeing.⁹ Pre-existing mental health conditions (e.g., depression, anxiety and substance use disorders) can predispose individuals to ongoing mental health challenges and impact their cancer care. A person-centred approach with close collaboration between cancer care and mental health teams is needed to ensure previous or ongoing psychological distress and mental health issues are considered in the support needs of people with cancer.¹⁰

Consideration should be given to the need for mental health support for families and carers of people affected by cancer. Carers play an important role in providing emotional and psychosocial support, but this can also impact their own self-care and mental health.¹¹ Carers of people with cancer are at a high risk of mental health issues and report experiencing high levels of anxiety, particularly parents caring for a child with cancer.^{12, 13} Carers may experience psychological distress but often prioritise the needs of the person with cancer over their own needs.¹¹ Therefore, interventions should not only address the psychological distress experienced by the person with cancer, but also by carers.¹⁴

Forms of psychological distress experienced by people with cancer include anxiety, depression, feelings of abandonment, loneliness, grief, fear of cancer recurrence and changes to personal identity.^{8, 15, 16} Psychological distress can arise from physical symptoms or treatment side effects, practical and social issues, or existential concerns eliciting fear, worry, or depression.¹⁷ In cases of advanced disease and end-of-life care, this can present as existential distress, which may include experiences of dignity-related distress, death anxiety and demoralisation.¹⁸

Psychological distress can be exacerbated or ameliorated by other social determinants of health, including age, geographical location, social support, employment, socioeconomic status, spirituality, and mental health.^{8, 19-23} These factors together are considered the psychosocial impact of cancer and encompass psychological distress alongside the physical, spiritual, and emotional effects of cancer that impact wellbeing (see Figure 1).^{14, 24, 25}

Figure 1: The psychosocial impact of cancer on an individual.^{14, 24, 25}

Appropriate interventions are required for people with cancer, and cancer services should identify psychosocial factors that impact an individual’s experience of psychological distress.^{14, 26} Addressing individualised support needs is reflected in a stepped care model. This approach includes a continuum of support that allows the selection of a range of evidence-based interventions with varying levels of intensity to match the individual's evolving psychological distress needs and preferences (see Figure 2).²⁷

Figure 2: Stepped care model of mental health support in cancer care.²⁷

Stepped care models should include low-intensity interventions, such as self-help education, counselling, psychological support and psychotherapy in different formats (including face-to-face group, individual and family therapy and digital) that have been demonstrated to address the psychological needs of people with cancer.^27-29 Interventions focused on addressing the psychosocial impact of cancer can reduce the risk of psychological distress and could be a cost-effective early intervention to prevent long-term negative impacts on mental health.²⁶ Personalised support for people affected by cancer should acknowledge any factors that will have a psychosocial impact and also proactively assess and address psychological distress.¹⁴ This could include factors such as symptoms, physical, social, psychological and sexual functioning, impact on relationships, informal care needs provided by family/friend, supportive care needs provided by healthcare professional, health care experiences, health behaviour, financial toxicity and occupational experiences.²⁰ Higher intensity interventions include referral to mental health services as appropriate (e.g., psycho-oncologists, psychologists, psychiatrists), social workers, and peer-to-peer support.