There is an expectation that when you walk out of hospital on the last day of treatment you are ready to pick up the pieces where you left off and get on with your life. But it’s not so simple. In fact the reality can be quite different. You’ve left behind the security of the hospital care and you may also feel pressure from family and friends to return to normal as quickly as possible. It can be a very worrying time. Recovering from cancer treatment isn't just about your body — our minds are also involved and need compassion and care.
Dana Jennings, whose writings in the New York Times about his treatment for prostate cancer, captured the variety of feelings which cancer survivors face after treatment ends, wrote that while he was “buoyed by a kind of illness-induced adrenaline” during treatment, once treatment ended, he found himself “ambushed by depression.”
Incidence of Depression in Cancer Survivors
For some survivors depression kicks in shortly after diagnosis or at some stage during treatment; for others it may, in Jennings’ words, ambush them weeks, months or even years after treatment ends. Research shows that cancer survivors are more likely than their healthy peers to suffer psychological distress such as anxiety and depression, even a decade after treatment ends.
Researchers in Denmark conducted a nationwide, population-based study of cancer patients in Denmark[i]. The results of their analysis indicated that the risk for admission into the hospital for depression was highest during the first year after the cancer diagnosis. This was true for both men and women and for all types of cancer. However, they found that men and women with hormone-related cancers, women with smoking-related cancers, and men with virus- and immune-related cancers all had a significantly increased risk of depression-related hospitalization that persisted for 10 or more years after their cancer diagnosis.
Depression is clearly a cancer survivorship issue which needs to be addressed. The researchers suggest that “early recognition and effective treatment of depression, both in the cancer setting and beyond, would have the potential to prevent admission for depression and thus reduce patient suffering and enhance the quality of life of cancer survivors.”
The Challenge of Identifying Depression in Cancer Patients
Some research has indicated that depression has been underdiagnosed and undertreated in cancer patients. This may result from several factors, including patients’ reluctance to report depression, physician uncertainty about how best to manage it, and the belief that depression is a normal part of having cancer.
Several of the characteristics of major depression listed below– like fatigue, cognitive impairment, poor sleep, change of appetite or weight loss—are hard to distinguish from the common side effects of cancer treatment. This makes it hard to tease apart the psychological burden of cancer, the effects of treatment, and the biochemical effects of the disease.
Are You At Risk?
It’s not always possible to predict who will develop depression, but some people appear to be at greater risk than others. Factors such as a history of depression, a history of alcohol or substance abuse, and a lack of social support can increase the risk of depression in both the general population and among cancer patients. Even if a person is not in a high-risk category, a diagnosis of cancer is associated with a higher rate of depression, no matter the stage or outcome of the disease.
The first step is to identify if you are experiencing symptoms of depression. If you are experiencing any of the below symptoms it is advisable to speak with your GP, Oncologist or Cancer Rehabilitation Team.
Symptoms of Depression
- On-going sad or “empty” mood for most of the day
- Strong feelings of self-loathing, worthlessness or guilt.
- Finding it hard to concentrate or make decisions
- Feeling restless and agitated, irritable or impatient
- Trouble sleeping with early waking, sleeping too much, or not being able to sleep
- Extreme tiredness and lethargy
- Feeling emotionally empty or numb
- Not eating properly; losing or putting on weight
- Loss of interest or pleasure in almost all activities most of the time
- Crying a lot
- Losing interest in your sex life
- Preoccupied with negative thoughts
- Distancing yourself from others
- Feeling pessimistic about the future
- Anger, irritability, and impatience
- Recurrent thoughts of death and suicide
You Are Not Alone
One of the most common things you feel when you are depressed is that you are completely alone, isolated by your feelings, that no one could possibly understand how you feel because you barely understand it yourself. Staying silent about it feeds the depression and adds to the isolation and loneliness. Tell your doctor about your feelings. If needed, you can be referred to someone who can help you through talk therapy, medication or both. Early diagnosis and prompt treatment are keys to successfully overcoming depression.
Depression – The Way Forward
The first step on the path to recovery is to accept your depression as a normal reaction to what you have been through – don’t try to fight it, bury it or feel ashamed that it is there. There is nothing shameful about seeking help rather it shows you are willing to take the first steps to get back in control of your life. Many people have been where you are and have come out the other side. By obtaining the correct medical intervention and learning new coping skills, you can not only live with depression, but live well.
The psychological effects of cancer are only now beginning to be studied and understood. In time, healthcare teams will not only treat the body to kill the cancer, but will treat the mind which suffers the consequences of the disease long after the body has healed.
At Strive Clinic, our integrated care model emphasises the fundamental relationship between physical health and mental health. We have a comprehensive team of mental health professionals experienced in working with people living with or beyond a cancer diagnosis. Contact us to make an appointment.
[i] Dalton SO, Laursen TM, Ross L, et al. Risk for hospitalization with depression after a cancer diagnosis: A nationwide, population-based study of cancer patients in Denmark from 1973 to 2003.Journal of Clinical Oncology. 2009; 27:1440-1445