The diagnosis of cancer creates a flood of negative emotions for patients on the receiving end. Cancer patients are especially prone to depression because of cancer’s symptoms and treatments.1 Depressive symptoms stemming from a cancer diagnosis are treatable when discovered. With the right mental health support, a patient’s depressive symptoms can be managed.
The Connection Between Cancer & Depression
Depression and cancer are linked by their symptoms. There can be overlap between the side effects of cancer and its treatments with the symptoms of depression, making it hard to distinguish between them. A cancer diagnosis causes patients to reflect on their mortality. An additional aspect to this diagnosis is how the associated treatment and therapies including chemotherapy, hormonal replacement, and surgeries, alters the body. These treatments can cause pain, changed body image, nausea, loss of hair, clouded thinking, and can create extreme fatigue.
Sharon Cohan, LCSW and Information Specialist for The Leukemia & Lymphoma Society, states, “One of the biggest myths is that everyone diagnosed with cancer will be diagnosed with depression. Only 15-25% of cancer patients get diagnosed with depression. Everyone will have a period of adjustment with some depression and anxiety which usually improves with time and education.”
People who have had depression before are more likely to have depression after their cancer diagnosis.2 Depression is not exclusive to cancer patients. Family members and caregivers also experience depressive symptoms in conjunction with their loved ones.
Researchers looking at the relationship between cancer and depression addressed the challenges associated with making a clear diagnosis of depression in cancer patients. They found that “mood change is often difficult to evaluate when a patient is confronted by repeated threats to life, is receiving cancer treatments, is fatigued or experiencing pain.”3
Signs of Depression in Those With Cancer
According to Sharon Cohan, LCSW, “Family members should be concerned if their loved one’s behavior changes, such as isolating more, decline in personal care, or lack of enjoyment in previous fun activities that lasts for more than two weeks. Caregivers need to be aware of verbal statements such as: ‘I do not want to be a burden,’ ‘I do not want to live like this,’ or, ‘It might be better if I die.’ These statements may indicate suicidal ideation and need prompt professional assessment.”
Risk Factors for Depression in Cancer Patients
The most significant risk factor for depression in cancer patients is a pre-existing history of depression. The cancer site, stage, prognosis, and treatment associated with the cancer diagnosis influence the patient’s reaction to it. Those diagnosed at a later stage of cancer generally are at higher risk.
In a study focusing on this topic researchers listed a series of risk factors for depression:4,5,6
- Unemployment
- High healthcare costs and limited access to healthcare create higher depression risk.
- Personality factors such as neuroticism, coping skills.
- Disputes with family members or their inability to cope with the cancer diagnosis of a loved one.
- Poor prognosis associated with cancer diagnosis creates higher risk of depression.
- Patients in active treatments (chemotherapy, immunotherapy, radiotherapy, hormone therapy)
- Women tend to be at higher risk for depression than men.
- Anxiety traits, poor coping strategies, poor perceived social support, and early levels of psychological stress after diagnosis influenced depressive symptoms.
Treatment of Depression in Cancer Patients
The symptoms from some cancer diagnosis and some of the necessary treatments can be debilitating. That in combination with the uncertainty of future recovery and lifestyle changes can make it more challenging for people to seek or stay in treatment for depression. The Cancer Network states, “the prevalence of depression in cancer patients varies from 3% to 38%.”7
Patients finding themselves feeling increasingly hopeless, sad, isolated, with changes in sleep and mood, should seek mental health treatment if it lasts for more than two weeks. When your mental health is compromised, it impacts recovery from medical health problems.
There are treatment options available that can offer relief from depression, including:
Individual Therapy
Individual therapy with a mental health professional can be invaluable in terms of identifying feelings and fears related to the cancer. It provides a safe space to discuss these issues. Therapists can offer guidance on coping techniques and ways to reframe negative thoughts in constructive ways. Cognitive Behavioral Therapy (CBT) is often used.
Sharon Cohan, LCSW, observes, “Therapy can be helpful for someone experiencing a cancer diagnosis and depression, as it provides a safe, non-judgmental environment to talk to an objective person about your situation and express your worries, fears and emotions. A therapist can provide active listening, acknowledge what a patient is going through, and help patients find meaning in their cancer experience. Through therapy you can learn stress management techniques and positive coping strategies like relaxation, meditation, journaling, exercise, and so on. These can help with long term quality of life.”
Therapists may recommend close family members participate as well to get additional information on how they are managing and offer them coping and communication skills. Therapy also can facilitate communication between patients and family members.
Group Therapy
Group therapy is an important treatment tool for people battling cancer. Talking with peers who have similar experiences can help patients feel less alone and isolated. The sharing of experiences and advice with peers on ways to cope and overcome cancer can be empowering for all who participate.
According to Sharon Cohan, LCSW, “Hearing first hand from other cancer patients on how they are managing their journey can help normalize and prepare patients for the ups and downs of cancer treatment. Connecting with other cancer survivors provides additional support and can reduce feelings of isolation that cancer often brings.”
Medication
Medication can be used to elevate mood. It needs to be carefully monitored for side effects and how it interacts with other medications and chemo and hormonal therapy treatments. Pharmacist Ebtesam Ahmed, an expert in working with cancer patients, says SSRI antidepressant medications are recommended because “the favorable efficacy and side effect profiles associated with SSRI’s make these agents the most attractive for some patients with cancer who are diagnosed with depression.”8
Medication examples include citalopram and escitalopram. They can be prescribed by a Psychiatrist or another medical doctor familiar with cancer treatment and medication interaction.
Mindfulness Techniques
Cancer can make people feel they have lost control over their bodies. Mindfulness techniques like yoga, mediation, deep breathing, and relaxation training can help patients regain a sense of body control again in non-invasive ways. These techniques can enhance quality of life in meaningful ways. They can be used relatively easily at home when patients believe they can be helpful.
Cancer and the related treatment regime can create changes in your lifestyle. Changes in appetite can also occur. Extreme fatigue is another potential side effect. People sometimes report changes in their memory, thinking, or attention. This phenomenon is sometimes referred to as “chemo brain.”
These alterations in body and brain function can trigger depressive symptoms. That is why the treatment modalities above are so important. Other integrative therapies like massage, and acupuncture, and nutritional counseling, are also used as adjunct therapies designed to help heal the body and mind. They help give patients more of a sense of control when they need it the most.
How to Get Help for Depression in Cancer Patients
Patients that experience depression post cancer diagnosis can seek out experts in palliative care. Palliative care is incorrectly exclusively associated with end of life care. It is a medical specialty area that focuses on improving the quality of life for patients diagnosed with serious chronic or life threatening illnesses like cancer.
Palliative care encompasses many treatment areas including pain management, improving, communication, emotional and spiritual support, and dietary counseling. It also includes practical support like grocery shopping or transportation. It can be critically important for patients, family members, and caregivers. When all these needs are addressed patents and family members can feel more supported, less alone, and more hopeful.
Your primary care doctor, surgeon, oncologist, or oncology nurse specialist, can give you referral information. This type of counseling can be done by many types of mental health specialists including psychiatrists, social workers, pastoral counselors, psychologists, and counselors. Most kinds of insurance including Medicare and Medicaid offer partial to full coverage for palliative care depending on your insurance plan.
Additional places to go to get information on counseling for depression for cancer patients and family members include:
- Use an online directory to find a therapist that specializes in chronic illness in your location
- Palliative Care Provider Directory: Just put in your zip code to find palliative care services in your area
- Cancer.Net offers a multitude of resource information regarding online communities offering counseling support, resources, and education for cancer patients, caregivers, and family members
7 Ways to Cope With Cancer & Depression
Depression can make coping with cancer more difficult.9 Depression can sabotage treatment by undermining your will to live and compromising the courage, fortitude, and determination that you need to face cancer and to endure the necessary medical treatments.10
There are many courses of action available to cancer patients that can help them cope with depression and cancer:
1. Keep Track of How You Feel
Be aware of how your cancer is impacting you physically and emotionally. Seek psychological help as soon as you recognize that symptoms of depression are present. Find a person and place where you feel comfortable openly discussing your feelings regarding your illness and its impact on your life and the lives of your loved ones.
2. Be Open & Build Trust With Your Team
Sharon Cohan, LCSW, states, “Open communication is key to beginning to deal with a tough diagnosis, treatments, and difficult conversations. It is important to build trust with your treatment team and your family/caregiver support system. Educating yourself on your disease, and what to expect with treatments and how side effects will be managed, can help ease anticipatory anxiety related to treatment.”
3. Educate Yourself
Educate yourself about available resources and programs that can help you strengthen your mind, your body, and your spirit. Allow yourself to be open to opportunities and treatment modalities that can enhance your emotional wellness. Discuss these alternatives with your doctor to ensure they will not be harmful to your recovery or treatment.
4. Find Parts of Your Treatment You Can Control
Identify things you can do to help feel more in control over your physical and emotional well being. Try to stay engaged in your treatment as much as you can. Ask your healthcare providers questions and gather information that will help you to understand your diagnosis and its implications.
5. Stay Close With Family & Friends
Try not to isolate yourself from people you are close with as much as possible. The love and support of people that you care about can help foster your determination and healing. These ongoing connections and contacts can help patients feel less alone. It can also help alleviate stress and make a medical condition and the associated treatments feel less overwhelming because of their support.
6. Find Ways to Make Meaning
Find healthy coping mechanisms to provide meaning during this difficult time. Sharon Cohan, LCSW, suggests, “Some coping mechanisms to deal with a difficult diagnosis include focusing on and participating in things that give your life purpose and meaning. Often, that may be the little day-to-day activities. Make a list of your dreams, your hopes, and people who are important to you. Focus on the things in your life that you are grateful for.”
6. Don’t Beat Yourself Up
Don’t blame yourself for your cancer and depression. This sometimes happens with cancer patients as they try to make sense out of being given a serious or life threatening medical diagnosis.
Set realistic goals for yourself regarding your physical and emotional responses and reactions to your diagnosis. Check with your healthcare team to make sure these goals are realistic. Create milestones like finishing chemotherapy or radiation. Acknowledge and celebrate the moments when you are able to achieve these milestones. Don’t berate yourself if you are unable to achieve them due to circumstances that are out of your control.
7 Ways Caregivers Can Help With Cancer & Depression
Family members and caregivers of cancer patients are important members of the caregiving team. They are a critical component to helping in the recovery and the healing of cancer patients.
Here are some suggestions from Sharon Cohan, LCSW: “Family members and caregivers can help their loved ones by gently inviting patients to talk about their fears and concerns, avoiding telling them to cheer up, and making decisions together about how to support one another. Caregivers also need to make time for their own self-care by spending time with friends or doing things they enjoy.”
Here are some ways loved ones and caregivers can help those dealing with cancer and depression:
1. Be There for Them
Be present and ready to listen without expressing any judgement as your loved one discusses feelings and fears associated with a cancer diagnosis
2. Take Care of Yourself
Recognize that a loved one’s cancer diagnosis also impacts you as their caregiver. Get the support you need from friends, mental health, and medical professionals. This will help you cope with the grief, fears, anger, anxiety, and other emotions that cancer can bring to your life and the life of your loved one.
3. Have Fun with Them
Engage in activities that you and your loved one can do together that can create joyful moments between you. Examples include playing music, watching movies, enjoying time in your yard or visiting with close friends and family.
4. Ask How You Can Help
Ask your loved one what you can do to help him/her and what you can do together to help each other cope with the cancer and the changes that arise.
5. Educate Yourself
Educate yourself as much as you can about the type of cancer your loved one has so you understand what to expect in terms of prognosis and treatment options. Try to get information from the healthcare team. This will help you to prepare yourself emotionally. It will also aid you in supporting your loved one along their treatment path.
6. Don’t Violate Their Trust
Talk to your loved one about what information they want shared about their condition in terms of family and friends. You want to have a good understanding about what they want said so you do not violate any unspoken wishes they might have. If this is not done there could be conflict and misunderstandings that could result in hurt or angry feelings.
7. Don’t Be Afraid to Ask for More Help
If you discover your loved one needs help you cannot give, don’t be afraid to ask for additional help for specific tasks. Don’t view it as a personal failure if you are not able to meet the physical and emotional demands a cancer diagnosis may bring.
Assure your loved one that you want to do what you can to keep them safe and as independent and healthy as possible. This may mean bringing in someone with expertise or skills that you don’t have.
Final Thoughts on Dealing With Cancer & Depression
What you are feeling as a cancer patient is unique to you but remember that you are not alone. Patients that are diagnosed with cancer displaying symptoms of depression need to receive counseling after being diagnosed, during their treatment, and after treatment is over.11 Depression may develop at any of these stages.
Reaching out to a mental health professional or taking advantage of any of the many allied health programs and services can help you feel more hopeful in terms of dealing with your illness and in other areas of your life. It is a great first step towards helping you to feel better.
