Can cancer affect your mental health?

Caring for your mental wellbeing is as important as looking after your physical health.

  1. Looking after your mental health as a cancer patient
  2. Is depression a side effect of cancer?
  3. Cancer-related anxiety
  4. How to support your mental health after a cancer diagnosis
  5. Who can help you get through any mental health issues when facing cancer?

Looking after your mental health as a cancer patient

From the point of diagnosis, a lot of emphasis and focus is placed upon your physical health, yet there clearly is a need of equal importance to tend to the effect this journey has upon your mental health.1,2

Due to the way your brain processes mental pain, the impact you can experience from emotional distress can be just as crippling as physical pain and equally disabling.3

Living through this new life with cancer can feel like passing through a series of fearful events, as you move through the well-worn steps that many have unwillingly trodden before, all living in the hope of escaping relatively unharmed.

It is therefore little wonder that your mental health and that of your caregiver’s will be deeply impacted and a reported 75% of those newly diagnosed will suffer from psychological distress.4

In cancer, situations can change; drug resistance, recurrence, support networks, mental health and financial pressures can all be fluid over the course of your experience.

How you cope with every stage may differ and your ability to navigate each challenge will depend upon factors such as; the support you feel, what hope you have and ultimately how well your cancer is responding to treatment.

Your life situation and the context in which you are coping with this illness will also play an important role in how well you are able to survive mentally.

For some, the adjustment to the new situation you find yourself in can be more complicated because existing mental health problems are amplified.

It is therefore clear that the strength of anyone’s resolve will be challenged and the status of everyone’s mental wellbeing will fluctuate in response to the many ups and downs experienced along the way.

Through it all, it is common to not only experience one single type of emotional reaction and require not only one strategy to cope well.

Most will be overwhelmed emotionally and suffer desperate feelings of loss of control, fear, sadness, detachment and shock.

Some however, will experience a ‘severe maladjustment’5when such normal emotional responses to a threat become dysfunctional.6

The intense onslaught of these heightened emotions can trigger psychological disorders including; major depression and anxiety disorders.7

If your mental health is suffering a complete devastation, the strength of these dark episodes may even lead some individuals to have suicidal thoughts.

Is depression a side effect of cancer?

Normally the rate of major depression found in the general population which is around 4%–17%.8

However, the number of cancer patients suffering from such a severe form of psychological distress over the course of the experience is 35.1% according to a large study published in the Psycho-Oncology Journal.9

In fact, the amount of people who experience any of the depression spectrum syndromes throughout their experience with cancer can even be as high as 60%.10

To be clear, this is not depression under normal circumstances, this depression is caused by your current circumstance, having to deal with cancer and the threat to your life and the impact upon your lifestyle that it poses.

Mental health impact of cancer

It is called ‘reactive depression’ and is a type of depression which is directly associated with loss, and in your case, depression is fuelled by the loss of your life as you know it.

Notably, most people who suffer from reactive or cancer-related depression have not had any previous need for psychiatric mental health support or from psychotherapy11 such as counselling.

Depression is a normal and understandable reaction to this illness and should be accepted as an appropriate response by those surrounding the patient.12

However, not all patients will suffer from clinical depression and extreme sadness is a common time-limited reaction to the challenges and changes cancer inflicts.13

The difference is that clinical depression can be defined as the continued experience of distressing feelings such as;

  • being overwhelmed
  • unable to cope
  • helplessness and hopelessness
  • withdrawal
  • lethargy
  • a lack of interest and joy
  • inner turmoil.14

A person’s vulnerability to suffering severe depression will depend upon the type, stage and prognosis of the cancer they have.15

Depression can be caused either as a consequence of the challenges faced or even by the perception a patient has of the seriousness of the situation.16

Patients facing an advanced stage of the disease or those who have a difficult to treat cancer, such as pancreatic or lung cancer, are most likely to be impacted by depression.

Other risk factors for the development of clinical depression with cancer include;

  • being young
  • not having a reliable supportive network
  • poverty
  • previous multiple losses
  • previous mental health issues
  • a past negative experience of cancer to someone close to you
  • a history of substance abuse
  • a decline in physical abilities.18

In response to cancer, anxiety and depression often are experienced at the same time,21 which make each challenge you face become even more difficult to manage.

With cancer, it is easy to become locked into being permanently suspended in a state of anxious preoccupation where all aspects of the impact from cancer are incessantly thought through, with little relief almost to the point of obsession.

Quite quickly you find yourself gripped in a compulsion to assess all aspects of this threat and all subsequent dangers this critical illness poses to your life and that of your family.

Although it is common for survivors to experience tension from the uncertainty and fear, research has shown that only 10% of patients22 will suffer from what medical professionals would class as a ‘clinical anxiety disorder’.23

This dramatic descent into the mental pain of anxiety will often occur upon diagnosis and these struggles can stay with you throughout.

Cancer-related anxiety

In fact, the patient or caregiver can experience anxiety at any point in the cancer journey from;

  • routine screening
  • the very first suspicion of cancer
  • through the diagnostic process
  • waiting for scan results
  • during and after treatment
  • even well into the survivorship phase.19

Interestingly, anxiety can also occur as a reaction to any prognosis, whether there is the possibility of achieving a cure or whether the treatment is palliative in nature.20

The worries embedded in your anxiety are born out of the emotional reactions you have to the profound changes in your life.

These changes can seem unending as everything begins to revolve around your cancer and all you can see on the horizon are treatments, medical appointments and waiting for test results.

Fear can take hold as you frantically search in desperation for answers, reassurance and a way out or even better, a way back to the way life was before.

With no one able to give you a definitive answer as to what will happen, with no one able to take the uncertainty away or press the pause button on the nightmare, anxiety disorders can take root.

When anxiety takes a grip of you it can be paralysing both physically and mentally.

A generalised anxiety disorder can feel like you are; extremely tense, sleep deprived, overwhelmed by a rush of negative thoughts, highly irritable and not able to concentrate or focus on a task.

It can also be the sense of having; chest pains, a dry mouth, sweaty palms and dizzy head from not being able to breathe deep enough.

You may also experience changes in your appetite, a loss of self-confidence, a sense of becoming so internalised that you feel absent in the outward experience of your life and you may experience a complete loss of sexual interest.

The overriding sensation is of being entirely consumed by anxiety and being wound up to the point that clear, rational thinking is out of reach and true, bodily relaxation seems like a foreign concept.

You find yourself rigidly stricken, alienated and isolated within your body and locked into your mind by panicked thoughts, all whilst looking on at world happening around you.

How to support your mental health after a cancer diagnosis

Any person with cancer is vulnerable to developing a mental health issue and being in a dark place where professional help is advised.

Mental health and cancer

It is important to note that being in ‘good mental health’ means that your mental wellbeing is sufficiently robust enough to be able to cope with all of life’s challenges, including cancer.

Crucially, being free from a mental health disorder should not be the only goal of looking after your mental wellbeing.24

If you are having to cope with crippling depression and/or anxiety, the additional burden can pose an extreme challenge to your whole life and the quality of that life.25

Cancer patients suffering from mental health issues are more likely to withdraw from those around them.

They also have trouble coping with the burden of treatment, have longer stays in hospital and ultimately, prolonged recovery26 and ultimately are at the mercy of poorer outcomes.27

It was also found by researchers from the Dana-Farber Cancer Institute in Boston that patients suffering from an anxiety disorder alongside advanced cancer were less likely to trust their oncologists and less able to understand the medical information.28

Therefore, it should be on every patient’s radar to seek to look after their whole self when faced with this illness and get support emotionally and also help on a practical level.

You may feel frozen in time and entirely absorbed by your current mental state, but the reality around you is that the practical aspects of your daily life keep happening; the laundry piles up, the dishes are not done, paperwork is left unopened, there is nothing to eat in the house.

Washing piles up

Many of these chores can be simply beyond you when your mental health is suffering, and this is when you need to lean on your family and friends for support.

They are the ones who will help you on a daily basis to gradually get out of the gloom.

Task them with helping you with the household chores and also ‘activity scheduling’ to make it a priority to do something nice every day even if you don’t feel like it.

Having plans made in the diary will help you get from day to day and will keep you moving forward in a positive direction until you are feeling stronger and you can have an unstructured day when it doesn’t feel like you falling back into that dark place.

On a personal level, to escape the turmoil in your head you need to find the reliever which you personally will respond to.

You need to find the activity which soothes your soul and stifles your all-consuming thoughts in order to experience those brief but precious and restorative moments of not thinking anything.

Exercising, having a massage, doing meditation or yoga, going for a walk with friends, reading, eating well and getting enough sleep are some of positive things you can do for yourself and you must prioritise yourself.

Try to actively avoid the so-called ‘maladaptive coping strategies’ such as relying upon alcohol, sleeping pills, chocolate or caffeine as crutches to support you in the depths of your stress.

Although they may seem to help you in the short-term, they won’t help you in the long-run and addictions can just make the situation snowball into something far worse and will be even harder to escape from.

The paradox you find yourself in is that you may be so deep in the thick of the depression and anxiety vortex that escaping this through asking for help is beyond your current ability.

You must recognise that the impact your mental health suffers is a normal reaction to cancer and there is a whole cancer world out there of people who understand where you are coming from.

Just reach out, to someone, even once, but be clear to them you are suffering beyond your own control.

Appreciate that it takes energy to ask for help, an awareness that you are suffering and a belief that you will be supported, so give yourself credit for reaching out.

Say to a friend or family member, even your doctor that you simply feel unable to arrange an appointment with someone, never mind getting yourself organised enough to get to it in order to get the help you need.

Ask for help.

Who can help you get through any mental health issues when facing cancer?

Your medical team are there to support you through the entire journey, the emotional and not just the physical side effects of your treatment.

Talk to your oncologist and ask for help, alternatively you should have a point of contact, for example a specialist nurse whom you can lift the phone to for advice and support.

They will be able to point you or the person you asked to help you, in the direction of a local cancer charity, support groups and counsellors who can all help you and your family get the right support you need at this time.

A combination of both medication and counselling is recognised as being the most beneficial strategy as medication has been found to help you stick to a counselling course, resulting in cumulative benefits for the patient.

Like anything, the first step towards accessing help is the hardest, but once make you needs known to others you will see that there is a huge amount of kindness and love out there for people in your situation.

If you think the information on this new website would be helpful to others, please like and share the word.

Recommend to others facing cancer, on support forums, social media, in person or by email. Thank you.

References

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  2. Zhang, MD, J-K. et al. (2016) ‘Type D Personality in Gastric Cancer Survivors: Association With Poor Quality of Life, Overall Survival, and Mental Health’, Journal of Pain and Symptom Management, Volume 52(Issue 1), pp. Pages 81–91 [Online]. Available at: https://www.jpsmjournal.com/article/S0885-3924(16)30050-1/fulltext (Accessed: 29th April 2019).
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