Cancer Care Is Incomplete Without Mental Health Care
As a surgical oncologist, I have the immense privilege of guiding patients through one of the most traumatic events of their lives—a cancer diagnosis. As I review laboratory results, imaging studies, and pathology reports, and as I outline treatment options—surgery, chemotherapy, radiation—and the sequence most likely to offer the best outcome, I’m acutely aware of the bomb that has just detonated inside their psyche. It is almost as if I can hear the reverberations of the explosion. I can see it in their faces: the confusion, the shock, the wounded stillness as they try to make sense of a mind-numbing flood of information and an avalanche of unanswered questions. What is happening to them is not subtle. In that moment, they are experiencing a traumatic event.
I am no stranger to trauma. My childhood ended abruptly when my parents were brutally murdered near our farm in Costa Rica when I was seven years old. Days after the funeral—before I could begin to comprehend what had happened—an American uncle I barely knew arranged for me to travel with him to Texas. Shortly after arriving in the United States, I was sent to live in a children’s home. The adjustment was arduous. I spoke little English and carried immense grief and anger. Yet even in that dark season, I held tightly to something my parents had given me: a reverence for learning. As my English improved, so did my academic performance. While many children in the orphanage sought escape through destructive vices, education became mine.
My initial passion for surgery grew from a simple desire: to prevent others from experiencing the kind of sudden, irreversible loss I had known. It was natural that I was first drawn to trauma surgery. Over time, that interest evolved into surgical oncology—where the trauma is less immediate and less visible, but no less devastating. The wound is not only in the body. It is in the mind.
Modern cancer care is rightly focused on eradicating disease and optimizing survival and quality of life. Yet the psychosocial distress of cancer is often overlooked, underemphasized, or treated as secondary. This is not benign. Failure to address distress may compromise the very outcomes clinicians work so hard to achieve. Chronic stress and depression are associated with worse survival and can adversely affect nearly every organ system, promoting physiologic states that enable cancer progression. The National Comprehensive Cancer Network recommends that all cancer patients be screened for psychosocial distress. And yet, research consistently demonstrates that most patients are not routinely screened—and therefore are not connected to mental health services when they need them most.
Recognizing distress is more difficult than it sounds. Severe distress among cancer patients approaches 40%, yet multiple studies demonstrate that physicians routinely fail to identify it. In part, this is because many patients themselves do not recognize the degree of their suffering. Suppression is common in trauma. I endured the tangible hardships that followed my parents’ murder, but for years I remained unaware of how profoundly it affected me emotionally. Even as I trained at elite institutions, and even as I gained the language of medicine and mental health, I did not apply it inward. I stayed in denial of the void created by my childhood losses. Subconsciously, I feared that acknowledging the damage would erode the walls I had built to keep pain at bay.
But those walls came at a cost. My ability to connect to others weakened. Fear of attachment infiltrated and disrupted the most meaningful relationships in my life. It was not until I met a brilliant therapist—who would later become my wife—that I began to assemble the pieces. I am profoundly grateful to have found a patient, nurturing partner who helped me recognize the emotional toll of loss and accept vulnerability as the first step toward healing and healthy attachment.
That experience now shapes my work. My goal is to translate what I have learned—personally and professionally—to guide patients through both the physical and psychological trauma of cancer diagnosis and treatment. Not surprisingly, many patients are reluctant to address the emotional dimension of their disease with the same seriousness as the physical aspects of cancer. I see familiar avoidance and rationalization strategies—the same survival mechanisms I once relied on. I hear the same misconceptions about therapy that I once believed. But I have learned that these tactics may reduce pain temporarily while undermining long-term mental health and resilience.
My hope is to connect every cancer patient to a compassionate and skilled therapist who can help them organize, name, and process the intense emotions that accompany cancer and its treatment. I also aim to encourage my colleagues to treat psychosocial distress with the same rigor and commitment as tumor biology and operative planning. Treating only the corporal disease fails to care for the whole patient and neglects a fundamental part of their suffering. Only by addressing both the physical and psychological injury of cancer can we provide truly comprehensive care—and optimize not only survival, but the quality and meaning of the life we are trying to save.