British Psychological Society Student Ambassador Jack Wood speaks to Consultant Clinical Psychologist and Clinical Hypnotherapist Shradha Lakhani about what it means to work with people living with cancer and palliative illness.
25 February 2026
What initially drew you to work in psycho-oncology and palliative care?
It's really odd – in many ways, the job found me rather than me finding it. I didn't set out with a clear plan to work in cancer and palliative care. After my undergraduate degree at Aston and my DClinPsy at Birmingham, I worked in a range of services, including adult mental health. Then I had a brief stint in children's services, which I quickly realised wasn't the right fit for me.
I then saw an opening to work in oncology and palliative care, this was almost at the exact same time as my mother-in-law was diagnosed as being palliative, so it just felt right, almost like the job found me. More than 26 years later, it remains my 'bread and butter' role. Over time, I've developed a way of working that centres on being present with people, tolerating discomfort, and feeling privileged to walk alongside them rather than trying to fix anything.
In your experience, what are the most common psychological challenges faced by people living with cancer?
Uncertainty – particularly around fear of recurrence – comes up time and time again. Even when people are given an 'all clear' or are in remission, the anxiety rarely disappears completely. Instead, it shifts into a different question, usually: 'but what if it does come back?'
There's something very human about feeling like this. The brain doesn't easily hold living and dying together. We celebrate birthdays and plan for the future, yet each day technically brings us closer to death. Cancer simply makes that tension explicit. My role isn't to remove fear, but to help people decide where to place their focus – on what they can control and find meaningful, rather than what they can't.
You've described cancer treatment as 'hijacking' people's lives – can you say more about what you mean by that?
A diagnosis doesn't just affect physical health; it restructures our everyday life. Suddenly, people's calendars are dominated by appointments, scans, blood tests, and side effects. Life becomes organised around hospital visits. Identities shift from being an employee or a parent or spouse etc to being a patient. And it's the patient role that dominates the diagnosis.
Interestingly, although many people resent hospital visits at the start of treatment, by the end they can feel quite anxious about being discharged. The hospital becomes a safety net for them – a place where someone is constantly checking in on them. This is why the end of treatment can very difficult psychologically, often bringing heightened anxiety and fears of abandonment.
How does distress in oncology differ from other mental health presentations?
Many oncology patients have little or no prior history of mental health difficulties. They may have coped well with life until cancer suddenly arrives in their lives. That makes the anxiety or low mood that follows feel particularly shocking and destabilising.
Treatment itself can also also play a part in mental health. Chemotherapy, immunotherapies and radiotherapy can induce what I call 'chemical depression' – profound fatigue, emotional flattening, and withdrawal. Patients can mistakenly interpret this as personal failure rather than a physiological response. So, psychological distress in cancer is often a normal reaction to extreme circumstances rather than a pre-existing vulnerability.
What are common misconceptions about psychological care in palliative settings?
Many people assume that psychologists in palliative care will force difficult end-of-life conversations. That's not how I work.
My role is to walk alongside people at their own pace. Some may want to talk about legacy, memory-making, or planning; others may just need space to breathe. Sometimes that space is silent. Therapy isn't about pushing people - it's about being with them and holding whatever they bring.
You are also trained in clinical hypnotherapy – how do you use this in your work?
Clinical hypnotherapy is very different from stage hypnosis. I don't see it as a standalone treatment, but as an adjunct to therapy. It involves guiding someone into a deeply relaxed state where they can access inner resources, process emotions, and shift their relationship with distress.
In oncology, it can be particularly helpful for anxiety, sleep difficulties, confidence post treatments and pain management. Importantly, the person remains fully in control throughout – it's collaborative and grounded in psychological principles and used as a tool alongside other therapies.
How do you work with health anxiety, particularly in medical settings like MRI scans?
Health anxiety is fundamentally our fear of uncertainty. Rather than trying to eliminate anxiety, I help people build distress tolerance - the ability to sit with uncomfortable feelings without immediately trying to escape them.
I often use imagery. If anxiety feels like a huge, suffocating cloak, it can overwhelm us. But if we can imagine reducing it to something you can hold in the palm of your hand – a stone or pebble for example – it becomes more manageable. Anxiety is a survival mechanism; it's meant to be there. The goal is to relearn how to live alongside it, not be ruled by it.
What impact does working in oncology and palliative care have on healthcare professionals?
The emotional toll on oncology and palliative staff can be significant. Regular, structured supervision should be standard – this is aligned with Level 4 NICE (2004) guidance and remains best practice.
I also talk about 'hooks' – moments when a patient or their circumstance resonates personally with a clinician, reminding them of a family member for example. Recognising these triggers is essential to avoid burnout.
I encourage small rituals of closure when a patient dies – writing a reflective note in clinical documents, taking a quiet moment, or even a symbolic gesture like moving a stone. These rituals help clinicians acknowledge and process grief rather than suppress it.
What should students or early-career psychologists prioritise if they want to work in psycho-oncology?
I would say it's less about technical skills and more about your personal qualities. Qualities such as being able to tolerate distress, being comfortable with silence, strong listening and empathetic skills as well as a willingness to 'be with' people rather than trying to fix them.
I also think the relationship is central to therapy – arguably accounting for a significant proportion of outcomes. You don't need to be distant and rigidly boundaried to be professional; you need to be human.
Teamwork is equally vital. Psychologists must avoid working from 'ivory towers' and instead collaborate closely with nurses, doctors, and allied health professionals.
If you had to sum up the work of psycho-oncology, what would you say?
It's learning to live alongside uncertainty. Cancer forces people to confront what none of us can truly control. Psycho-oncology doesn't promise certainty – but it offers companionship, understanding, and the ability to live meaningfully despite fear. It's about learning to flow with what cannot be controlled and taking it a day at a time.Dr Shradha Lakhani is a Consultant Clinical Psychologist and Clinical Hypnotherapist with extensive experience in oncology and palliative care. She now works in independent practice at Compassionate Minds, alongside locum roles in private healthcare.
Jack Wood is a BSc (Hons) Psychology student at Birmingham Newman University, Co-Editor of the BPS West Midlands Branch newsletter, and a BPS Student Ambassador Liaison Link. He volunteers with Deafblind UK and has interests in clinical and health psychology.
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