Mental Health & Cancer: Implications and Strategies for Comprehensive Care

By: Mona McCalley-Whitters, PhD

A cancer diagnosis is a life-changing experience, bringing forth a range of emotions from fear and anxiety to depression. Such mental stressors can directly impact a patient’s quality of life, their adherence to treatment, and even survival rates (National Cancer Institute).

An Overview: Stress & Cancer

Stress describes what people experience when they are under mental, physical, or emotional pressure. The stressors – the factors that cause stress – can arise from people’s daily responsibilities and routines (ex. work, family, health and finances) or living conditions that may be outside of their control (ex. adversity early in life, discrimination, poverty, etc.).

Our body responds to these external stressors by releasing stress hormones (such as epinephrine and norepinephrine) that increase blood pressure, heart rate, and blood sugar levels). This response, often referred to as the fight-or-flight response, helps a person act with greater strength and speed to escape a perceived threat (NCI).

While the fight-or-flight response helps the body manage momentary stress, when this response is caused by long-term, or chronic, stress it can be harmful. Research has shown people who experience chronic stress can have digestive problems, heart disease, high blood pressure, and a weakened immune system (NCI). However, whether stress is linked to cancer development is not clear.

Laboratory studies in animal models and human cancer cells grown in the laboratory suggest that chronic stress may cause cancer to get worse (progress) and spread (metastasize).  You can read more about these studies here:

Cancer Treatment Options Incorporating Mental Health

Emotional and social support can help patients with cancer cope with stress. Such support can reduce levels of depression, anxiety, and disease- and treatment-related symptoms among patients.

Patients experiencing significant stress with a cancer diagnosis may also want to consult their health provider about a referral to an appropriate mental health professional. In fact, some expert organizations recommend that ALL cancer patients be screened with an appropriate tool, such as with a distress scale or questionnaire, soon after diagnosis as well as during and after treatment for the early identification of mental health issues, which can be addressed alongside the physical aspects of cancer.

Below is a list of treatment options commonly incorporated during cancer treatment:

Referral to Mental Health Professional

The interdisciplinary field of psycho-oncology brings mental health services into standard oncology care. By involving mental health professionals in the cancer care team, patients receive support for the emotional aspects of their journey alongside medical treatment.

Treatment of significant distress, depression, and anxiety under the care of a mental health professional might include psychotherapy (talk therapy) and/or antidepressants or other medication. The choice of treatment should be personalized, ideally as a join decision between the patient and the health care provider.

  • Cognitive Behavioral Therapy (CBT): CBT is widely utilized to help cancer patients manage negative thought patterns and develop healthier coping strategies, a therapy shown to improve mental health and enhance the efficacy of medical treatments.
  • Psychopharmacology and Psychosocial Interventions: For some patients, antidepressants or anti-anxiety medications may be necessary to manage mental health symptoms. These medications are often used with psychosocial interventions, such as support groups, to provide comprehensive care.
  • Mindfulness and Stress-Reduction Techniques: Mindfulness meditation and other stress-reduction techniques can also play a significant role in a cancer patient’s treatment plan, aiding in stress management and promoting mental resilience.

Physical Activity

Physical activity of moderate intensity, both during and after cancer treatment, has been shown to reduce anxiety and depressive symptoms in cancer survivors. Evidence even suggests physical activity can prevent depression for childhood cancer survivors. (source)

Addressing the Complex Challenges of Mental Health and Rural Cancer Care

In Iowa, approximately 36% of the population resides in rural areas, where the landscape of healthcare, particularly cancer care, presents unique challenges. Rural residents often contend with barriers that can impede timely access to cancer treatments and supportive care. These barriers include shortages of healthcare providers, the necessity of increased travel to access comprehensive care, limited transportation options, and fewer opportunities to participate in clinical trials.

These issues are not merely inconveniences but can significantly impact patient outcomes. Delays in diagnosis and treatment can lead to cancers being detected at later stages, when they are harder to treat. Furthermore, the psychological strain of managing these barriers can compound the stress experienced by patients and their families, impacting their overall well-being.

To bridge these gaps, an integrated care approach is essential—one that not only addresses the medical needs of cancer patients but also considers the logistical and psychosocial challenges unique to rural communities. Integrated care for rural cancer patients in Iowa may involve the following strategies:

  • Telemedicine: Utilizing telehealth services can enhance access to oncology specialists, psychological support, and follow-up care, mitigating the need for extensive travel.
  • Community Outreach: Ongoing development with proactive steps to address efforts and improve rural cancer care by seeking to hire a Community Outreach Coordinator. This role is pivotal in providing cancer control outreach and partnership development to support the implementation of the Iowa Cancer Plan within rural communities.
  • Mobile Clinics and Outreach Services: Deploying mobile clinics for screening and basic oncology services can help reduce travel burdens for rural patients.
  • Transportation Services: Establishing partnerships with community organizations to provide transportation assistance for medical appointments can alleviate one of the significant barriers to care.
  • Clinical Trial Access: Creating awareness and facilitating enrollment in clinical trials within rural settings can ensure that rural residents have access to cutting-edge treatments and therapies.


The link between mental health and cancer is an intricate one, with psychological well-being playing a crucial role in the management of cancer. As we continue our mission to reduce the burden of cancer in Iowa, incorporating mental health strategies into cancer care is of upmost importance.

About the Author

Mona McCalley-Whitters Ph.D. is a seasoned psychologist, a dedicated community activist, and visionary executive director on a mission to raise mental health awareness, education, and support. She has a Ph.D. in psychology from the University of Iowa with multiple publications, professional awards, and acknowledgements for her healthcare efforts. She is the former executive director of the National Alliance on Mental Illness Linn County, Iowa. With a proven 30-year track record of building resilient communities, she is dedicated to improving health in Iowa.