The diagnosis, and treatment and limitations which accompany cancer, can cause mental health issues in many patients.  The management of mental health is therefore a vital part of any treatment process.

How does cancer impact mental health?

• Some patients may lose their independence
• Patients may have lower energy levels
• The ‘grieving process’ following diagnosis or while in palliative care
• PTSD is possible in cancer survivors and patients due to the traumatic experiences associated with the disease
• Cancer treatments may cause depression and anxiety
• A side effect of chemotherapy is ‘chemo brain’ where the patient may suffer from fatigue, depression mental fog and other forms of cognitive impairment
• Radiation therapy may lead to fatigue, nausea and depression

A large study conducted in Germany and published in 2014 looked at mental or emotional distress in people diagnosed with cancer. The highest prevalence was found among breast cancer patients (42%), followed by malignant melanoma (39%). The lower rates were prostate cancer (22%), stomach cancer (21%) and pancreatic cancer (20%).

Common Conditions

It’s normal to feel anxiety, fear or panic during the adjustment stage after being diagnosed with cancer, as well as when waiting for results, being treated or fearing a recurrence of the cancer.

For some people, these feelings can evolve into ongoing mental health issues, such as having severe panic attacks. If you are not coping well, there is help available, and it’s important to discuss how you are feeling with a medical practitioner.

Depression

• Ongoing sad, hopeless or ‘empty’ mood
• Loss of interest or pleasure in most activities most of the time
• Major weight loss
• Extreme tiredness of lack of energy
• Sleeping too much or not enough
• Feeling guilty, worthless or helpless
• Trouble focusing on thoughts, remembering or making decisions
• Frequent thoughts of death or suicide

Anxiety

• Fear of the future
• Uneasiness
• Negativity
• Feeling very upset
• Feelings of being unable to cope
• Trembling or shaking
• Irritability or angry outbursts

Forms of anxiety may include:

• Generalised anxiety disorder
• Panic disorder
• Agoraphobia
• Social anxiety disorder
• Specific phobia
• Obsessive-compulsive disorder
• Post-traumatic stress disorder

Adjustment Disorder

• This is generally a short term stress response to a traumatic event, such as a cancer diagnosis, but is usually out of proportion to the event. The symptoms do not represent general bereavement symptoms.
• Symptoms include low mood, sadness, worry, anxiety, insomnia, poor concentration or loss of self-esteem.
• This is the most prevalent psychiatric condition among people diagnosed with cancer, impacting around 20% to 30%

Treatment of mental health in cancer patients

Mental health conditions are often underdiagnosed in cancer patients, so both doctors and patients need to be proactive in the area.

Psychotherapy may prove useful, particularly if the psychotherapist has been trained to work with cancer patients. Cognitive Behavioural Therapy (CBT) and Dialectical Behavioural Therapy (DBT) have both been shown to be of use. Treatment strategies in DBT might include breathing exercises, discussion therapy, behavioural modification, medication and coping skills development.

Anti-depressants and anti-anxiety medications may be of assistance in the control of symptoms, however their interaction with other medication should be monitored.

Treatment of mental health in caregivers and family members

Family members of people diagnosed with cancer are also at increased risk of anxiety and depression. Primary caregivers in particular may need support to maintain mental health and cope with stress. 

Depression may occur due to a variety of reasons, including changes to socio-economic status and the inability to work while caring for the patient. They may also go through the same grieving process as the patient, particularly if the cancer is terminal. 

In terminal cases, family members will need support both prior to the loss and afterwards. This reduces the chances of clinical depression, PTSD and anxiety disorders.

A psychotherapist can help caregivers to process their emotions and feelings resulting from the diagnosis. Online support groups are also available.

The Grieving Process

Grieving tends to include the following stages:

1. Denial and isolation
2. Anger
3. Bargaining
4. Depression
5. Acceptance

The process may not occur exactly in that order however, and people may revert back to earlier stages during the process. People also grieve in different ways – while some prefer to keep their feelings to themselves, others may prefer to discuss their grief, for example. 

‘Preparatory grief’ occurs prior to a loss occurring, and while it may be helpful to family members, it may be detrimental to the patient. Research has found that people with anxiety disorder or mood disorders may have a more difficult time during the grieving process.

By seeking mental health assistance, patients may be able to better deal with the difficulties they face, and focus on healing.  For caregivers, they are more likely to be able to fulfil their own needs, and the needs of the person they are caring for.

Resources

http://www.mesotheliomagroup.com/resources/mental-health

http://www.asco.org/press-center/one-three-people-cancer-has-anxiety-or-other-mental-health-challenges

http://www.cancerresearchuk.org/about-cancer/coping-with-cancer/coping-emotionally/cancer-and-your-emotions/fear-anxiety-and-panic/about-fear-anxiety-and-panic

http://www.cancer.org/treatment/treatmentsandsideeffects/emotionalsideeffects/anxietyfearanddepression/anxiety-fear-and-depression-depression

http://emedicine.medscape.com/article/2192631-overview

http://www.minddisorders.com/A-Br/Adjustment-disorder.html

http://www.uptodate.com/contents/diagnosis-of-psychiatric-disorders-in-patients-with-cancer