Seeing the Whole Patient: Kelly Gable on the Overlooked Realities of Breast Cancer Care

Breast cancer treatment reaches far beyond the clinic, reshaping finances, emotions, relationships, and daily routines. Few clinicians understand that full picture as clearly as Kelly Gable, PharmD, BCPP, FAAPP—both a practicing pharmacist and a survivor. In this conversation at the Hematology/Oncology Pharmacy Association 2026 Annual Conference, she reflects on the invisible weight patients often carry, from fragmented care teams to untreated mental health needs and the isolating impact of treatment-induced menopause. She also shares how pharmacists can step into a steady, grounding role by asking the right questions, creating space for honesty, and using motivational interviewing to truly hear a patient’s story.

Q: Breast cancer treatment can reshape nearly every part of a patient’s life. From your perspective as both a pharmacist and a survivor, what aspects of the lived experience do you think pharmacists most often miss, and why do those gaps matter?

Kelly Gable, PharmD, BCPP, FAAPP: There's a level of time and financial toxicity that happens with breast cancer care that is often overlooked. It becomes really common to have not just 1 or 2 providers in care, but to have upwards of 10 providers because of the needs and the specialized, siloed aspect of our health care system. So a patient may have an oncologist, they see a breast oncology surgeon, a plastic surgeon, a radiation oncologist, their primary care doctor, and then eventually, if they go through medical menopause—as 80% of breast cancer survivors are hormone-positive in care—they’re going to need a gynecologist that actually specializes in menopause, which is not easy to find, and also a bone-health specialist, and the list goes on.

So I think what gets missed is there are so many pieces to the puzzle that the patient has to put together themselves, and oftentimes the pharmacist can be sometimes that one person that is the constant. And that can be a beautiful thing if it's utilized in the right way.

Q: Mental health challenges during treatment often go unspoken or unrecognized. How can pharmacists create space for these conversations, and what signs or cues should they be attuned to during routine encounters?

Gable: Yeah, the incidence of mental health struggles, diagnoses, or possible disorders in breast cancer is upwards of 60%. It's high. And so, especially in that first year after diagnosis, and then if it's an earlier age of diagnosis, and if there's medically induced menopause, that has a dramatic influence and impact on mental health. That's depression, anxiety, panic, [and] posttraumatic stress disorder from constant trauma throughout care.

So I think my advice would be to approach it with the expectation that there is some level of mental health influence in breast cancer care, and we don't know what that is for that person until we ask. Unfortunately, for a lot of patients, they're not being asked. And so in whatever way, if you can ensure that that patient—somebody—is asking them about their mental health: How are they doing? Is there some unmet need? Because there likely is an unmet need there. You don't have to be a behavioral health specialist to care and to ask the questions and make sure that that person has access to the services that they need for their mental health.

Q: What do pharmacists need to know about treatment-induced menopause among patients undergoing breast cancer treatment?

Gable: Yeah, so it's important to recognize that the definition of menopause is 12 consecutive months without a menstrual cycle, and at that point, a woman reaches what is called menopause. But what happens before that is perimenopause, and that can be anywhere from 2 to 5 years or longer for some women. And that's the part where hormone fluctuation really starts to change. Estrogen, progesterone, and testosterone levels will fluctuate—in particular, estrogen and progesterone—kind of like a yo-yo, and it really starts to impact your mental health and your sleep patterns and all of the vasomotor symptoms and other aspects of menopause that we know about. That's in the perimenopause phase.

In breast cancer care, what happens for a lot of women who are not in menopause yet—and the average age is around 51 to 52 in the United States—is that if you're earlier than that and you are induced into menopause with chemotherapy or gonadotropin-releasing hormone agonists or tamoxifen, or aromatase inhibitors are a part of care, that's going to be a more abrupt and intense menopausal experience. That's the part that pharmacists need to understand, because you will be an opportunity for patients to come to you, to ask questions, to help them navigate. It can feel very isolating and alone to navigate these symptoms, knowing that it was earlier than what your body was ready for, and that there are other aspects of cancer care that are also happening at the same time.

So I think, as a pharmacist, just step up to the plate and talk to patients about this and help them navigate it. It's one of the primary reasons people stop treatment early—because no one is addressing the quality-of-life influences of early menopause in their treatment.

Q: Motivational interviewing can feel intimidating for clinicians who aren’t used to it. What are a few practical, approachable techniques pharmacists can use to better understand a patient’s goals, hesitations, or emotional bandwidth?

Gable: I'm a huge advocate for motivational interviewing. I do trainings, and I would say this: Motivational interviewing is like learning a dance. It's like learning to play a musical instrument. It takes practice. So I would say the start would be, if I'm a pharmacist who's interested, do a little reading about it. There's a fourth edition by Bill Miller and [Stephen] Rollnick that came out last year. Pick that book up and give it a read. And then ask yourself: Should I go to an intro training? Intro trainings might be 3 hours, but then, ultimately, if you want to grow your skill, it takes going to multiple, maybe all-day trainings where you practice what you've learned.

And the basics of motivational interviewing are really the spirit and then the skill. And the spirit really involves partnership, acceptance, compassion, and empowerment. Once you grasp that—because that has to be at the core of what you do and how you communicate—then the rest falls into place with the skill, which is open-ended questions, reflections, and affirmations.

And ultimately, why do we do this? Why do we spend the time to become proficient? Because it matters. It matters in patient care. It helps people stay connected in care, and it lets them know that you are here to listen and understand their story. And so often that gets missed.

And you know, one of the things I hear from pharmacists, from health care providers that are just busy, is they don't have time. And what I would say with motivational interviewing is you don't need a lot of time. You need the time that you have with your patient—whether it's 5 minutes, 10 minutes—that's all you need to really embody the spirit and those skills that we learn. And so I would encourage pharmacists to take a deeper dive into it, learn a little bit more about it. And it doesn't just serve the patient well; it serves you well too.