When cancer enters the room, clarity can vanish. We dive straight into that moment—what gets heard, what gets lost, and how mental health care can restore focus when everything tilts. With medical oncologist Dr. Nina Balanchivadze, palliative care psychiatrist Dr. Kyle Lavin, and patient Melissa, we map the real terrain: shock at diagnosis, sleepless nights, caregiver overload, survivor guilt, and the quiet dread behind “staying strong.”
Dr. B explains how she balances tumor biology with human reality, using both formal screening (PHQ-9, GAD-7) and subtle cues to catch distress early. She names the burdens some patients undergo: identity shifts from hair loss, financial strain, and the emotional cost of being “the fighter.”

Dr. Lavin opens the door to a different standard: a collaborative care model that brings a care manager and consulting psychiatrist onto the oncology team. The result is faster access, tailored brief therapies, careful medication choices that avoid cancer drug interactions, and measurable improvements in depression, anxiety, and quality of life.
Melissa’s story shows the stakes. A rare diagnosis, rapid referrals, and leading-edge immunotherapy didn’t spare her from fear or uncertainty. What changed everything was timely, plainspoken support from professionals outside her family who could navigate the system, push for results, and teach practical tools. Together, they make the case for a culture shift: treat mental health as the fourth pillar of oncology, offer it from day one, and remove the stigma so help arrives when it’s needed most.
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