A bilateral mastectomy. Postponement of a 400-guest wedding. Disruption to a marketing career. The unknown of how treatment would affect fertility.
Breast cancer patient Aileen Keshishian wanted help processing the cascade of losses she experienced after her diagnosis at 33.
But visits to two different therapists left her feeling misunderstood.
“I felt like they were treating me like I was there for something very mundane or regular,” she said. “I was very disappointed. I really walked out feeling worse than when I went in. I gave up on my search for the right psychologist.”
But one day in fall 2018, as Keshishian sat in a recliner at UCLA Health Cancer Care in Burbank while an IV of chemotherapy drugs dripped into her arm, the right psychologist found her.
Valentina Ogaryan, PhD, a clinical psychologist at the Simms/Mann-UCLA Center for Integrative Oncology, stopped by the infusion suite to say hello to Keshishian. She offered to meet with her and explained that the services were available at no cost to her.
“I think I looked at the schedule for that day and noticed a young adult in her early 30s, already identifying that she may need additional support,” Dr. Ogaryan said. “I also noticed she was (also) Armenian. There were multiple factors that prompted me to introduce myself.”
Keshishian declined Dr. Ogaryan’s invitation, still feeling leery after her earlier counseling experience. But as she went in for treatment once every two weeks, Dr. Ogaryan continued to seek her out in a sweet, friendly way.
“She approached me two or three times before I agreed to meet with her,” said Keshishian, now 36. “She was pretty persistent and I’m so glad she was. I really liked her right from our first session.
"She understood me. She understood where I was coming from.”
Cultural competency, where health care providers strive to deliver services that meet the linguistic, social, regional and cultural needs of patients, is one of the pillars of the Simms/Mann-UCLA Center for Integrative Oncology.
Like Keshishian, Dr. Ogaryan is an Armenian-American who also moved to the U.S. as a toddler. Each speak Armenian, although they generally converse in English. Keshishian said she could freely discuss some of the cultural challenges she navigated in the course of her illness, including silence surrounding cancer.
Serious illness isn’t widely discussed in the Armenian community, Keshishian said, but she wanted to be transparent about why her wedding was being postponed.
“In the Armenian community, things like cancer or anything really bad happening — you kind of don’t talk about it,” she said. “It’s not highlighted. You keep it a secret. That’s not always the best thing.”
Treating more than a disease
The Simms/Mann-UCLA Center for Integrative Oncology was established in 1994 to provide whole-person care to cancer patients, including counseling, nutrition, integrative medicine and spiritual support.
“I love working in a field that allows me to connect deeply and meaningfully with patients while they’re navigating a medical crisis that certainly impacts a lot more than their physical function,” Dr. Ogaryan said.
“A lot of this diagnosis holds uncertainty and unpredictably,” she said. “It was really important for Aileen to feel as though she had a team going on this path with her.”
Dr. Ogaryan and 14 other clinicians provide individual counseling at no cost at 19 UCLA cancer clinics that stretch from Laguna Beach to San Luis Obispo. The therapists are embedded in the medical team, consulting and collaborating with oncologists who also refer patients to them, said Kauser Ahmed, PhD, Director of the Center.
“The way our psychosocial support is provided, it is part of the medical care you’re receiving,” Dr. Ahmed said. “There’s no stigma about it. It’s an accepted and understood part of the care that everybody is entitled to — to help them have their best sense of wellbeing through one of the most challenging times of their lives.”
"The things she would say would just make me feel better. I would walk out feeling a lot lighter."Aileen Keshishian, patient
Dr. Ahmed said the counseling services are largely funded by philanthropy, such as from the Simms Mann Family Foundation, and with a significant match from UCLA Health. In addition to understanding the needs of the Armenian community in Southern California, the Center also has care embedded in the Asian community in Alhambra and serves the culturally distinct needs of the more rural and agricultural communities in San Luis Obispo and Santa Clarita.
Not only do the therapists specialize in counseling cancer patients, they understand their medical treatment and can attend medical appointments to provide support.
“Say that an oncologist is about to deliver difficult news; they can ask one of our clinicians to join him or her in that conversation,” Dr. Ahmed said. “In every way, they function as part of the medical care team. Patients can be seen right in the same clinic where they receive their care.”
Dr. Ahmed said counseling services are offered from time of diagnosis through survivorship and through all the phases of their treatment when they may be experiencing additional stress or needing specific support. Patients can opt in and out as needed, with therapists staying informed on their status.
“They have access to all the medical records; they chart in the same medical record system,” she said. “They consult, connect and collaborate with other providers like palliative care, psychiatry or nutrition.”
Finding hope after losses
Keshishian, who lives in Glendale, was diagnosed with stage 2 cancer in August 2018 after her gynecologist discovered a lump in her right breast during a routine appointment. She had already planned her wedding for October for which several family members would be flying in from overseas.
“It was kind of traumatizing, to be honest,” she said. “I had all these plans. I was supposed to get married. We were supposed to start a family. I had just gotten a new job.
“All that had to be put on hold. I had to deal with this really terrible news that I just didn’t know what to do with.”
While Keshishian tried seeing the other counselors, she wanted an environment where she could share freely and develop tools for coping. She found that in her sessions with Dr. Ogaryan, which started out weekly.
“She really let me vent,” she said. “She was really empathetic in her reaction. I could tell that she felt for me. The things she would say would just make me feel better. I would walk out feeling a lot lighter.”
Dr. Ogaryan also gave her practical guidance, including how to navigate issues with her insurance.
“She would really console me,” Keshishian said. “She would give me facts and remind me of things. ‘Remind yourself of all the good things coming up. Don’t run through the bad, what-if list.’"
Just as Keshishian initially turned down Dr. Ogaryan’s offer to meet, other patients may hesitate for a variety of reasons until they learn more about what the Simms/Mann therapists provide.
“In some communities of people or cultures, including the Armenian culture, there continues to be a stigma,” Dr. Ogaryan said. “At other times, patients might feel so overwhelmed with their medical appointments and they’re not really sure what this appointment will look like, if it will require them to come into a medical facility more often. There’s a lot of unknowns at times that can create some guardedness or uncertainty.”
Keshishian said Dr. Ogaryan understood immediately how others reacted to, or in some cases ignored her diagnosis. She understood traditions and cultural elements without her having to explain.
“There was a lot of mutual understanding of some of the more nuanced challenges that are present in the Armenian community,” Dr. Ogaryan said.
Dr. Ogaryan wrote her dissertation on Armenian-American parental attitudes toward children’s mental health services. She traveled to Armenia in 2019 to present a lecture on the work done at the Simms/Mann center.
Keshishian said Dr. Ogaryan’s expertise in cancer was also helpful. She knew the course of her treatment and its potential side effects, such as when she underwent radiation after chemotherapy.
“I didn’t have to give her background or explain everything in detail,” she said. “She understood the process. She understood what it would entail.”
Dr. Ogaryan said she was struck by Keshishian’s motivation and engagement as she went through treatment appointments and counseling sessions.
“When I first met Aileen, there was a lot of problem solving in front of her on a lot of logistical matters,” Dr. Ogaryan said. “She really stretched herself in terms of communicating with her family, her community.”
Keshishian is cancer-free and takes medication to prevent a recurrence. She and her fiancé ended up getting married at City Hall.
“We planned the wedding three times in total; twice it was canceled because of COVID,” Keshishian said. “We never did the big wedding.”
They celebrated their third anniversary in early October. They hope to start a family soon.
These days, Keshishian checks in with Dr. Ogaryan every few months over Zoom because of the pandemic.
“Dr. Ogaryan's Armenian background, as well as her expertise in working with cancer patients, made her the perfect match for me,” she said. “I am so thankful to her and to the Simms/Mann program for being an integral part of my healing process.”
Learn more about Simms/Mann-UCLA Center for Integrative Oncology.
For more information about serving on the center’s community advisory board please contact dmlozano @mednet.ucla.edu.
Courtney Perkes is the author of this article.