Learn more about how Advancing Health trainee Vicki Cheng hopes to improve mental health care for cancer patients
Each year, approximately 25,300 Canadians are diagnosed with colorectal cancer, with around 9,200 patients succumbing to it annually.
Cancer is also often associated with changes in mental health because it affects patients far beyond the physical disease itself, but it is only in the last decade that research has acknowledged and begun studying the relationships between a cancer diagnosis and mental health.
Advancing Health trainee Vicki Cheng, under the mentorship of Advancing Health scientist Dr. Mary De Vera, is working on a project that looks at population-based administrative data and clinical trial data to answer questions around patients’ mental health experiences throughout the colorectal cancer care continuum.
We spoke with Cheng to learn more about her project, goals, and experiences as a trainee.
Journey so far
Cheng is currently pursuing her PhD in pharmacoepidemiology and health outcomes in the Faculty of Pharmaceutical Sciences at UBC.
Recalling how her research journey began during pharmacy training, she said, “In a clinical setting, I noticed the direct impact that pharmacists can have on patient outcomes through medication management and patient counselling.”
Through research projects, she noted, “I was exposed to how evidence generation and health research can influence care at a broader population level. That combination made me realize there were multiple ways to improve patient outcomes.”
Having developed a keen interest in exploring how evidence is generated and translated into practice, and how it shapes patient outcomes in real-world settings, inspired her to ponder variation in health outcomes and the importance of using population-based data to better understand patient outcomes.
“I wanted to further explore how different diseases and health systems influence real-world patient outcomes, particularly in the context of chronic disease and cancer care, which ultimately led me to pursue my PhD project,” she shared.
Mental health impacts of a cancer diagnosis
A cancer diagnosis can bring significant emotional distress, uncertainty about the future, and fears related to prognosis and treatment. At the same time, cancer and its treatments can lead to substantial physical side effects, disruptions to daily life, and changes in work, family, and social roles, all of which can contribute to anxiety and depression.
Even after treatment, many patients continue to experience ongoing fear and worry about recurrence and long-term health. Together, these psychological, physical, and social challenges all contribute to why mental health and quality of life have become increasingly important areas of cancer research and care.
Cheng’s project aims to examine the association between mental disorders (i.e., anxiety, depression) and long-term health impacts, including mortality, after a colorectal cancer diagnosis, and the use of mental health services among people diagnosed with colorectal cancer.
In April, a paper co-authored by Cheng and Dr. De Vera showcased some of the findings of the project: approximately one in four individuals with colorectal cancer were diagnosed with anxiety (23.4 per cent) and depression (23.2 per cent) in the first year after diagnosis. But the team was surprised to learn that colorectal cancer patients in the study accessed only a minimal amount of mental health care for anxiety and depression during this period.
Potential causes of mental health care underutilization
While several reasons lead to the underutilization of mental health care, Cheng noted that, “In clinical encounters with cancer patients, the focus is highly centered on diagnosis and treatment,” said Cheng. “This can result in psychological symptoms associated with depression and anxiety falling through the cracks due to de-prioritization or lack of visibility.”
Additionally, anxiety and depression may be under-recognized or not routinely screened for, particularly when high emotions and distress are viewed as an expected response to a cancer diagnosis. Barriers to access, such as limited availability of psychosocial services and long wait times, compound the issue.
“From a patient’s perspective, social factors like stigma, lack of awareness, or a belief that emotional distress is ‘part of cancer’ can dissuade them from seeking help,” Cheng said. “Collectively, these factors contribute to a gap between the burden of mental health symptoms and the use of appropriate mental health care in this population.”
Mental health and its association with patient mortality rates
Recent research has found associations between cancer and subsequent mental disorder diagnoses, deaths from any cause, and cancer-specific deaths.
Adding to that body of research, Cheng’s project explores the occurrence and risk factors of depression and anxiety after a colorectal cancer diagnosis, and the impact of mental health diagnosis on long-term health outcomes such as mortality. Her research found significant associations between colorectal cancer and subsequent depression diagnoses, all-cause mortality, and cancer-specific mortality.
“This work aims to better understand the incidence and risk factors for depression and anxiety following a colorectal cancer diagnosis, as well as their potential impact on long-term outcomes such as mortality,” explained Cheng.
“By clarifying these relationships, the goal is to identify patients at higher risk and inform earlier, more integrated approaches to mental health and cancer care.”
Application to real-world patient outcomes
To enhance the applicability of her research in the lives of patients, Cheng’s project includes using existing clinical trial data from colorectal cancer patients to evaluate patient-reported outcome measures in this patient population. She will do so by analysing their quality-of-life scores and functioning level or ability to navigate daily lives and tasks as they proceed through the trials, as well as comparing younger and older people by the same metrics.
“We found that young colorectal cancer patients represented a small proportion of trial populations and entered trials with consistently poorer baseline patient-reported outcomes than older patients, highlighting the importance of understanding age-related differences in overall well-being and quality of life,” said Cheng, who is working to publish her results.
Paving the way for holistic care
As mental health awareness in cancer research continues to expand, Cheng’s goal is to contribute to raising awareness about how mental health issues impact this patient population. She wants to encourage health care practitioners to have conversations around mental health in the early stages of a patient’s cancer journey — taking on a preventive approach to care.
“I hope that my research will facilitate the identification of high-risk patient groups and integration of mental health assessment into the care continuum, which can ultimately help improve long-term health outcomes for cancer patients,” she added.
