Cancer is a physical illness. Though it can have a serious impact on the body, it can also affect the mind. According to the American Cancer Society (ACS), one in four cancer patients suffers from major or clinical depression after diagnosis or during treatment and recovery.
A cancer diagnosis and treatment can bring significant lifestyle changes, make some jobs or hobbies impossible, and lead to fatigue and ongoing uncertainty. These challenges can cause mental health problems, like depression or anxiety. The Mental Health Alliance points out that depression symptoms like fatigue and poor appetite are common in cancer patients. Cancer care providers may miss these symptoms, leaving depression untreated.
This issue is significant because mental health issues can impact cancer treatment results. A study in the Journal of the American Medicine Association (JAMA) found that mental health and substance abuse treatment improved outcomes and odds of early detection in U.S. military veterans with non-small-cell lung cancer.
Here is a closer look at the relationship between cancer and mental health.
Common mental health challenges for individuals with cancer
The American Cancer Society says that three of the most common mental health conditions for people with cancer are depression, anxiety, and distress. Here are the signs and symptoms of these three conditions.
Depression
It’s normal to feel sad and frightened after a cancer diagnosis. However, persistent sadness, hopelessness, or helplessness could be signs of clinical depression. Loss of appetite, sleeplessness, inability to perform everyday tasks, fatigue, and difficulty making decisions are other possible symptoms. The National Institute of Mental Health says clinical depression diagnoses are made when multiple symptoms persist for more than two weeks. In severe cases, depression can cause suicidal thoughts, plans for self-harm, or suicide attempts.
Patients who have suffered from clinical depression at some point before a cancer diagnosis are more likely to develop depression after receiving the news or when they experience serious treatment side effects.
Anxiety
Anxiety is a common mental illness. However, the National Institute of Mental Health says anxiety is more than the normal stress one feels when confronted with a life-threatening illness. Symptoms like restlessness, being on edge, an inability to concentrate or complete tasks, and uncontrollable worry can interfere with daily life. Some people with anxiety disorders cease normal daily activities to avoid the anxiety that comes with them.
Anxiety can cause stress to the body and may involve physical symptoms like high blood pressure, nausea, and muscle tension.
Distress
Distress is another common response to difficult life developments like a cancer diagnosis. As with sadness or stress, it becomes a clinical issue when it interferes with everyday activities, work tasks, and family duties. The American Cancer Society points out that distress can lead to panic attacks, extreme sadness, or the inability or unwillingness to go through necessary cancer treatments.
Distress can also cause angry outbursts, loss of appetite for an extended period, or insomnia.
The unique challenges of cancer-related mental health issues
A cancer diagnosis gives rise to stress and uncertainty and requires that the patient cope with significant challenges, including physical side effects and fear. These issues could lead to mental health issues, especially if the person is dealing with other life issues.
Here is a look at the unique needs of cancer patients.
- The stress of a cancer diagnosis: The news of a cancer diagnosis is stressful due to the uncertain outcome, the anticipation of physical pain or challenging treatments, and concerns about employment and finances. Though these responses are normal, they can set the stage for mental health issues like clinical depression or anxiety if not addressed early.
- Treatment side effects: The side effects of cancer treatments can include weakness, fatigue, changes to skin and hair, nausea, and sores. These problems can make everyday activities challenging or painful and could cause patients to avoid social contact. The issues could cause depression and isolation.
- Fear of recurrence: Cancer patients could experience mental health challenges after remission. For example, they could worry that the cancer will return. This fear may lead to anxiety or depression with patients unable to enjoy life even though they are currently free of disease.
- Compounding other mental health issues: The stresses of cancer can complicate other life challenges. You might be able to negotiate coming of age, starting a family, launching a career, or preparing financially for retirement. However, a cancer diagnosis can make these life transitions more difficult, leading to anxiety or hopelessness.
Depression affects 7.1% of the general population, but it afflicts up to 25% of cancer patients because of the challenges associated with the disease. This prevalence makes depression screening essential for cancer patients.
Coping strategies for mental health challenges in individuals with cancer
Evidence-based therapies are effective at treating mental health issues. Researchers test evidence-based therapies (EBTs) in clinical trials to assess their effectiveness. Psychologists, psychiatrists, and mental health counselors then use these therapies following the proven steps. This approach increases the chance of success.
The two primary options for treating depression, anxiety, and distress are psychotherapy and medication. Mind-body practices like meditation can supplement these clinical treatments, as well.
Psychotherapy and counseling
Several varieties of psychotherapy and counseling work for mental health treatment in patients with cancer. Here is a look at three of the most common approaches.
- Cognitive behavioral therapy (CBT) teaches patients positive responses to stress or depressive episodes and seeks to change thought patterns that lead to depression or anxiety.
- Acceptance and commitment therapy (ACT) focuses on acceptance of thoughts and emotions and turning the focus away from these feelings to values and actions.
- Dialectical behavior therapy (DBT) relies on a combination of cognitive behavioral therapy, mindfulness exercises, distress tolerance training, and emotional regulation to deal with difficult mental health issues.
Psychologists usually meet with patients and decide on the best treatment method based on their needs and current mental health. Some counselors specialize in one type of therapy and may refer patients to other therapists if the patient needs services outside their area of expertise.
Medication
In some cases, doctors may decide to combine psychotherapy with medication. Psychiatrists are the only mental health specialists who can prescribe medication.
Medications usually fall into three categories.
- Antidepressants seek to regulate mood-related chemicals in the body. These biological compounds include dopamine and serotonin.
- Anti-anxiety medications like benzodiazepines depress the nervous system to limit overreactions to stress. Some psychiatrists combine these medicines with antidepressants.
- Mood stabilizers like lithium often treat bipolar depression, but sometimes they can augment other antidepressant medications for those with severe depression.
Psychiatrists may have to coordinate with physicians to ensure that any pills prescribed for mental health purposes do not interact with the cancer medication.
Mind-body practices
Yoga, meditation, and other mind-body practices can help regulate emotions and deal with stress. One study published in Frontiers in Psychology found that those who practice yoga were more likely to experience psychological well-being.
Meanwhile, the National Institute of Health analyzed 29 different studies in 2019 that proved that meditation helped cancer patients deal with the stress and uncertainty related to their disease.
Self-care strategies and lifestyle changes to help cope with mental health challenges
Certain lifestyle changes can help with mental health challenges. However, cancer patients typically need to consult their physicians to ensure any planned changes do not interfere with their treatment.
- Exercise and physical activity can elevate mood by increasing blood flow and spurring the production of mood-enhancing chemicals like serotonin and endorphins.
- A healthy diet ensures proper functioning of the nervous system. Poor eating habits are not only bad for general health, but they may affect the production of mood-enhancing hormones and hurt the performance of neurotransmitters that regulate the body’s emotional and physical responses.
- Mindfulness practices like meditation can help train the mind to avoid over-responding to stressors. A muted response to problems can lower the production of stress hormones like cortisol, which can negatively impact mood.
- Sleep is essential for mental and physical health. It is necessary to reinvigorate the immune system, which gets stressed by cancer treatments. Fatigue can make it difficult to cope with the daily challenges of cancer treatment, leading to feelings of being overwhelmed or hopeless.
These practices can enhance psychotherapy or other treatments or help patients avoid the mental health challenges often associated with cancer.
Community support for promoting mental health and well-being in individuals with cancer
People going through cancer treatment may experience feelings of isolation. They may either feel alone while going through treatment or have trouble finding people who can relate to their experiences.
Community support is an important aspect of mental health for cancer patients because it combats feelings of isolation.
- Support groups can help cancer patients and survivors connect with others who share their experiences. In addition to sharing methods for dealing with mental health aspects of cancer,
- Peer counseling connects cancer patients with others who have been through or are going through a similar situation. A review of studies published in Psychooncology found that peer support is an important aspect of cancer care.
- Online communities can provide ongoing interaction with cancer patients and survivors. Internet-based connections are available even if patients are isolated during treatment.
Communication with peers can also help decide whether to seek additional mental health care.
Importance of communication with healthcare providers
Mental health issues can be difficult to diagnose in patients with other healthcare concerns. Cancer care teams often focus on treatment outcomes and managing physical side effects.
Patients need to communicate with their healthcare provider when they have mental health worries. Since depression and anxiety can impact cancer treatment outcomes, patients need to make healthcare staff aware of depression or anxiety symptoms.
Addressing the needs of cancer survivors
Cancer survivors face a unique set of mental health challenges. They may hope that depression or anxiety symptoms disappear when their cancer goes into remission, only to be confronted with a different set of concerns.
- Cancer patients may find the transition to becoming cancer survivors challenging. They may expect life to return to normal only to be confronted with changes such as frequent checkups, new lifestyle requirements, and ongoing side effects from treatment. They may feel depressed that life is not the same as it was before their initial diagnosis.
- Patients who go through difficult or painful treatment may fear a recurrence. This chronic anxiousness can make it impossible to enjoy life and find joy in pre-cancer activities.
- People with certain forms of cancer may have permanently changed appearance due to the removal of part of the body. Some treatments, such as an orchiectomy after testicular cancer, can affect sexual performance, affecting relationships with romantic partners.
Cancer survivors have the resources to address the challenges they may experience after remission.
Survivorship clinics can help patients deal with the physical needs of post-cancer care, such as monitoring health and checking for recurrence of the disease. These caregivers can also help with the other challenges of survivorship, such as dealing with physical changes, addressing anxieties and fears, and other issues that arise from cancer treatment.
In some cases, rehabilitation or specific treatments can help patients regain strength, physical abilities, or sexual functions that they lost during treatment. Regaining these traits can help survivors regain the enjoyment they had before their cancer.
The importance of mental health care in cancer patients
Depression is two to four times more common in cancer patients than in the general population. Depression and anxiety often go undiagnosed because providers are focused on physical cancer treatments and may mistake mental health disease symptoms for side effects of cancer drugs.
Because mental health can improve treatment outcomes and provide patients and survivors with a higher quality of life, psychotherapy and related care are essential elements of cancer treatment.
Cancer screening can lead to an early diagnosis, which can increase survival chances and help patients address mental health concerns early in the process. Genetic testing can define potential cancer risks even before a tumor forms, and many cancer tests are routine for high-risk patients and anyone in a high-risk age group.
A positive cancer test and diagnosis means you will have to undergo treatment. While physical treatments are essential for a positive outcome, mental health care is also vital for cancer patients.