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one-hour consult that includes a fam- ily member or caregiver, if possible, is often enough to set patients on the path to a firmer behaviora l hea lth footing, although follow-up appointments may be necessary to confirm compliance with specific recommendations. "I'm more of an action therapist than a talk therapist," DiScipio says. "I don't see patients for a protracted periods of time when only suppor t or "venting " is the goal. I see patients when they're in crisis — when there's an immediate need and a measurable and meaningful outcome. I regularly ask patients to tell me about their sleep, diet and exercise habits, and then I ask them to take certain actions to change their lifestyles, which can help in coping with the mental health effects of cancer." A NOVEL VIEW OF THE MENTAL TOLL OF CANCER A prolific scholar, DiScipio has authored a book and more than 50 professional articles. Currently, he is working on a scientific manuscript that presents a multifactorial view of the behavioral health disruption that occurs with a cancer diagnosis. He likens such a diagnosis and its aftermath to post-traumatic stress disorder (PTSD) — he calls it "cancer-traumatic stress disor- der" — and has identified three factors that patients may experience: + Anxiety and negative affect — This factor is characterized by an inability to relax or cease worrying as a result of what DiScipio calls the "anticipatory anxi- ety" of cancer diagnosis and treatment. Patients may, for example, struggle to not worry about what their next imaging test or medical appointment will reveal. + Fatigue — In his research, DiScipio found that of the 10 percent of cancer patients who score high on a screening instrument for depressive illness, 80 to 85 percent experienced symptoms of fatigue and difficulty with sleeping. + Intrusive thoughts — These are similar to the flashbacks that individuals with PTSD may experience, DiScipio says. Intrusive thoughts can occur during dreams or waking hours. Examples include thoughts such as: "What's going to happen to me?" "Is my cancer going to metastasize?" and "How can I deal with pain?" A HOPEFUL VIEW OF THE FUTURE DiScipio is encoura ged t hat g reater awareness of cancer's effects on men- tal health is spreading throughout the medica l community; he cites recom- mend at ion s i n re c ent yea r s by t he Nationa l Academy of Medici ne a nd American Society of Clinical Oncology to incorporate mental health care into oncology. He is also excited about intro- ducing patients to clinical trials and the potential of new treatment paradigms, such as immunotherapy. For a professiona l who has devoted his adult life to helping patients, it is the day-to-day interactions with them that provide the greatest sense of fulfillment. "Cancer isn't discriminating — it affects an extraordinarily diverse population, so I see people from many wa lks of life," DiScipio says. "No one should have to face cancer alone." n How Clinicians Can Help W ILLIA M DISCIPIO, PHD, Dip.Psych, psychologist at New York Cancer & Blood Specialists, says primary care physicians and specialists can do their part to ensure individuals with cancer receive the behavioral health services they need by asking whether they have a history of mental health conditions and watching for signs of disturbance or upset during appointments, such as crying, irritability or arguing with family members. "Family members and caregivers face cancer trauma vicariously," DiScipio says. "If inter- viewed, they can provide a valuable contribution to the treatment benefits of all family members." M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 018 1 5