Pharmacist Spotlight: Kelly Gable, PharmD, BCPP, FAAPP

Q: As both a pharmacist and a patient, how has your experience with breast cancer changed the way you think about mental health in the context of cancer care?

A: My entire career has involved mental health care advocacy in a variety of ways, including expanding mental health treatment access in communities and helping pharmacy learners feel more comfortable and confident in their understanding of how to treat mental health conditions. There has been a shortage of mental health care providers, with treatment access limitations, throughout my entire career as a psychiatric pharmacist. I have witnessed this through the eyes of the patient and through my own lived experience. In my personal experience navigating breast cancer care, there was an even more overt lack of mental health care integration. It was disheartening to learn that this is a common experience among breast cancer survivors, which is ultimately what pushed me to speak out.

Q: What were some of the biggest emotional or psychological changes you faced during your diagnosis and treatment, and how did you navigate them?

A: There are at least 5 identifiable touchpoints for behavioral health integration throughout the course of breast cancer care: 1) diagnosis/surgery, 2) chemotherapy/radiation, 3) treatment-induced menopause, 4) anxiety about recurrence, and 5) end of life. For me personally, emotional distress came from so many different facets of the treatment process.

Breast cancer treatment is complicated. I underwent a mastectomy quickly after diagnosis, with limited time to process the physical and emotional loss. After surgery, there was a long wait to obtain critical genomic information that would dictate next steps and whether chemotherapy would be indicated. This waiting was emotionally exhausting. Chemotherapy was physically draining, but I found this time to be when friends and family were the most supportive. Long-term hormone antagonist treatment and medication-induced menopause after chemotherapy were by far the most damaging to my mental health. Because you navigate life in survival mode for most of treatment, it is difficult to pause and reflect on your mental health. I found myself shifting from one trauma to the next, and my mental health suffered deeply and silently.

Q: How can pharmacists better support patients who are coping with the mental and emotional toll of breast cancer and its treatments?

A: I would have welcomed any member of my treatment team to ask me about my mental health. I would have loved for a pharmacist to talk to me about the commonality of depression and medication-induced menopause. I wish our community pharmacy system was set up to help me navigate the 9 different providers that I had at one point during my treatment, with prescriptions coming from several different clinicians. Because of medication stock issues, I was forced to go to several pharmacies to acquire treatment. No pharmacist took the time to talk to me about the numerous and well-known tolerability issues that occur with estrogen antagonist medication and how to navigate them. Hearing from a medication expert, even as a pharmacist myself, would have offered some level of comfort and validation. Every aspect of breast cancer treatment feels very isolating, siloed, and disconnected. I believe that there is great opportunity for pharmacists to be the glue that helps keep a patient's treatment plan together, safe, and consistent.

Q: What strategies, resources, or practices have helped you maintain your own mental well-being throughout your cancer journey?

A: Running has been a part of my well-being and a mindful space for me for many years. Throughout cancer treatment, I ran as much as I could until my body couldn’t physically move any longer. Outside of medication and therapy, this was the most valuable aspect of my emotional survival. Once I finally reached out for mental health care, it became very clear that not all my providers were comfortable or understood what my options were. Because of my background as a psychiatric pharmacist, I knew which antidepressant I wanted and still had challenges accessing it. Eventually, I was able to start a serotonin-norepinephrine reuptake inhibitor and titrate to a therapeutic dose. I finally began to see color again, as the darkness of depression lifted. I had no idea how depressed I was until this moment. With improved energy and mood, I was finally able to find a therapist to help me work through the trauma of treatment and begin the healing process.

Q: What message would you share with other pharmacists about prioritizing mental health?

A: My experience is a powerful reminder of the critical need for accessible, integrated behavioral health care. I have worked within mental health care for 20 years, and I still feel like I waited too long to reach out for help. Even more concerning, my mental health was not a priority within the breast cancer treatment process. My overarching message to pharmacists, as both providers and as patients, is that your mental health is just as important as all other aspects of your physical wellness. The more we can embrace this and openly talk about our mental health, the more we can reduce stigma and break down these barriers that continue to show up in our health care system.

Q: If readers would like to learn more about your work or get in touch, how can they reach you?

A: I am hopeful that my most recent publication “Dear Breast Cancer Oncology: Where Is the Behavioral Health Care?” [doi:10.1177/23743735251383590] will spark a deeper conversation on how we can support and encourage more integrated mental health care services, and pharmacists must be a part of this conversation.