Alicia Mathlin
Alicia Mathlin, 43, benefitted from the CALM program after being abruptly diagnosed with stage four ovarian cancer in June 2022. (Photo: Courtesy Alicia Mathlin)

Alicia Mathlin hadn't had a cold, a headache, or even taken a Tylenol in nearly 10 years when she was diagnosed with Stage 4 ovarian cancer.

As a meditation instructor, yoga teacher and holistic wellness guide in seemingly perfect health, it was a reality she couldn't begin to imagine. By the time she received the diagnosis, the cancer had already metastasized throughout her ovaries, pelvis, stomach, bones and lymphatic system.

She was told she needed to start treatment immediately, if she wanted to live as long as possible.

"I just froze," says Alicia, 43, who was diagnosed in June 2022. "My brain could not process what I was hearing."

It wasn't until she was referred to Princess Margaret Cancer Centre's evidence-based psychotherapy program, Managing Cancer and Living Meaningfully (CALM), that she was able to truly talk through her fears — empowering her to live her life to the fullest extent in the time she has left.

Helping those affected 'recover from the trauma of diagnosis'

CALM has now received funding to become the standard of care for patients such as Alicia, not only at Princess Margaret Cancer Centre, but all across Canada. Thanks to a $2 million donation from the Weston Family Foundation, people with advanced and metastatic cancer, as well as their family caregivers, can now have routine and proactive access to mental health care that is tailored to their personal and medical circumstances.

"The diagnosis of advanced cancer is a personal and family catastrophe in 100 per cent of cases," says Dr. Gary Rodin, Head of the Cancer Experience Program at Princess Margaret Cancer Centre.

"It's like getting hit by a truck. We need to help those who are affected to recover from the trauma of diagnosis, to manage the challenges that lie ahead, and to find joy and meaning in their life."

While there have been major advances in the medical aspects of cancer care, the human touch can easily be lost in busy medical settings, Dr. Rodin says, adding that there is too often inequity in access to mental health resources for these populations and others.

"Many who could benefit from CALM are not yet being provided with this opportunity," says Dr. Rodin, also the Director of the Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC).

"Without routine intervention, there is an inevitable lack of equity in its availability."

Princess Margaret Cancer Centre's Department of Supportive Care has been developing the CALM Program for over 12 years. (Photo: UHN)

CALM is a series of individual and couples-based therapy sessions specifically designed to help people navigate the four unique challenges of living with advanced cancer. That is, symptom management and communication with health care providers, relationships with family and close others, the sense of meaning in life, and sustaining hope in the face of mortality.

Initially developed by Drs. Rodin, Sarah Hales and colleagues in UHN's Department of Supportive Care over a decade ago, a large team has come together to implement the CALM National Program, with clinical specialist Carmine Malfitano as its Manager. CALM is delivered in-person, over the phone or virtually, reaching more patients than ever before.

Princess Margaret Cancer Centre's early palliative care initiatives such as CALM aim to set a global example for care that enables individuals with advanced disease to not only live as long as possible, but as well as possible — something that often requires mental health support.

That's why the Princess Margaret creation is now being disseminated in more than 15 countries in North and South America, Europe, Asia and Australia through GIPPEC. Despite differences in culture, health care and family structures, the challenges, fears and hopes that people with metastatic and advanced cancer face across the world are remarkably similar, says Dr. Rodin, who delivered the first CALM workshop in 2011.

"Our patients and their families understand that we need to treat the whole person," Dr. Rodin says.

"We wouldn't leave physical pain untreated. We shouldn't leave psychological pain untreated."

Alicia knows just how important CALM is. She says she couldn't get through her cancer experience without it.

After numerous rounds of chemotherapy, radiation, a complete hysterectomy and partial omentectomy failed to keep Alicia's cancer away, she was forced to make a difficult decision. She could do chemo every week and prolong her life as long as possible — or she could stop treatment altogether.

"After a while, you begin to feel like a science experiment and not a person," says Alicia, whose cancer has become treatment-resistant.

"I didn't want to make my decision out of fear. I had to ask myself: how much more of this can I take?"

Alicia chose to stop treatment and live her life meaningfully in the time she has left.

Helped her develop more resilience and acceptance

Dr. Rodin has helped her honour her values and fortify her mental health through the process. Alicia has found the courage and resilience to achieve her goals, continuing to teach, finishing her second book and creating new memories.

For Alicia, having a team specialized in both cancer treatment and psychological care got her through this complex and challenging time in her life. ​

"Having cancer is a rollercoaster," Alicia says.

"You're either at the top of the cliff or you're staring up from the bottom. It feels very personal when working with someone who actually understands what that's like."

With CALM soon to be available for patients on a pan-Canadian scale, Alicia is hopeful that the world will take steps towards destigmatizing mental health treatments, and understanding the importance of treating people as whole, holistic beings.

"I can't imagine someone having to come to this alone, and not having access to the mental and emotional help that I did," she says.

"I want to be someone who continued to engage in her life — and CALM therapy made that possible."

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