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CANCER’S EFFECT ON MENTAL HEALTH

Any serious illness can impact mental health. For patients, caregivers, and their loved ones, going through cancer can be a devastating experience. Receiving a potentially fatal diagnosis, going through treatment protocols, and learning to live with limitations can cause depression in many patients, as can side effects from the treatment itself. Managing mental health needs is a crucial part of the treatment process, and may even impact prognosis.

How Cancer Impacts Mental Health

Some patients may lose the ability to be independent. Others find that energy levels plummet and activities that were once a source of enjoyment are no longer possible. Care must be given to allow the cancer patient to experience their disease in whatever manner is best for them.

Patients frequently experience a process similar to grieving after diagnosis and during palliative or end-of-life care2. There is evidence3 to support the existence of PTSD within both cancer survivors and cancer patients. This is a direct result of traumatic experiences associated with the disease, and because the potential for a fatal prognosis is high.

A study looked into the prevalence of mental health conditions diagnosed in cancer patients of working age; the study identified that nearly 30 percent of the patients in the study were diagnosed with a condition prior to the end of the study. As the national statistics for diagnosed mental health conditions is approximately 26 percent, this points to a noteworthy increase in patients.

Cancer treatments can also cause depression and anxiety. A side effect of chemotherapy known as chemo brain can cause fatigue, depression, mental fog, and other forms of cognitive impairment. An article by the American Cancer Society shows the link between depression and chemo brain, and identifies that both should be considered. Radiation can also lead to fatigue, nausea, and depression.

Treating Mental Health Conditions in the Cancer Patient

Treating mental health conditions in the cancer patient requires several special considerations5. Depending on the prognosis the patient has received, it may not be possible to simply encourage a positive attitude, and it may not be possible to remind the patient that it will eventually get better. This does not mean that treating cancer patients with mental health conditions is not valuable or necessary. Because mental health conditions are believed to be underdiagnosed in cancer patients, it is wise to take a proactive approach to detecting these conditions.

Common Conditions

The most commonly diagnosed comorbid mental health conditions for cancer patients are conditions that fall on the affective or adjustment scale6. This includes both anxiety and depression, as well as several different stress adjustment and coping conditions. PsychCentral has an article available that details adjustment disorders, and how they reduce the ability to handle traumatic situations.

Psychotherapy with an experienced therapist or psychotherapist can be helpful, even to patients who have not yet been diagnosed with a condition. A licensed therapist or psychologist who is trained to work with cancer patients will be able to provide guidance and a listening ear to the patient, right from the start.

Treatment Options

Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT) have both been used to treat mental health issues successfully. Each patient will require an assessment to determine which approach, if either, will work best for them. Basic self-directed mindfulness exercises are a large portion of Dialectical Behavioral Therapy. The website DBTSelfHelp details several such exercises for the public. Treatment strategies may include breathing exercises, discussion therapy, behavioral modification, medication for depression or anxiety, or even coping skills development.

Meditation may be an appropriate choice for some patients. Antidepressants and anti-anxiety medications can help to handle symptoms when they become overwhelming, although care must be taken to monitor the patient for interactions. Generally, medications are chosen if depression or anxiety is protracted and does not dissipate after two to four weeks. For depression, Zoloft, Paxil, Wellbutrin, and Prozac are commonly used. Benzodiazepines may be used to treat short-term anxiety or sleep issues, but they are addictive. Benzodiazepine drugs have also shown some ability to reduce the side effects found within chemotherapy.

Mental Health Conditions in Caregivers and Family Members

The family members of those going through cancer are also at an increased risk for depression and anxiety. Particularly in the case of those who are acting in a caregiver role, proactive support to preserve mental health and cope with stress should be enacted. Family members frequently go through the same grieving process as the cancer patient, especially if the cancer patient is terminal. In a 2013 study8, researchers identified that family members of cancer patients were at an increased risk of depression for a variety of different reasons, including changes to socioeconomic status due to the inability to work.

It is important that caregivers and family members seek support as soon as a diagnosis of cancer is given. Psychotherapists can be a great resource to someone who is dealing with a very abnormal situation like cancer, and can help the caregiver to process their emotions and feelings around the diagnosis. Online support groups like WhatNext by the American Cancer Society, PsychCentral by Dr. John Grohol, and the Caregiver Action Network can all be an excellent way for the family member to gain support. The CareGiving community is also an excellent resource for family members and caregivers, as is Cancer Support Community’s “Living Room.

Preparing for and Dealing With Loss

When prognosis is poor, or cancer is identified to be terminal, family members will require immediate and continued support. Many online communities exist to help these caring individuals deal with the loss of their loved one. PsychCentralhas a grief and loss forum available. Online Grief Support Forums also provide peer support to these individuals. It is not necessary or advisable for the loved one to wait until the loss has occurred in order to reach out for support. If possible, psychotherapy can be initiated prior to the loss, so that the chances of clinical depression, PTSD, and anxiety disorders is reduced.

Grief

Grief is a very normal process, both in the cancer patient and in those around them. Grief tends to happen at a very personal rate for each person that experiences it. According to this article by Julie Axelford at PsychCentral, there are five main stages of grief:

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

In both the cancer patient and their loved ones or caregivers, this process may not be fluid from start to finish. A condition known as preparatory grief is common, according to a 2012 study9. Preparatory grief refers to going through the stages of grief before a loss event occurs. Family members and patients with comorbid anxiety disorders or mood disorders were more likely to have a difficult time grieving.

It is also worth noting that the cancer patient and caregivers or family members grieve in different ways; while preparatory grief can be helpful to the family member, it can be detrimental to the patient as outlined in this article. Additionally, some patients may prefer to keep their feelings to themselves, rather than engage in constant discussion.

Mental health treatment should be an integrative part of caring for both the patient and those around them. With modern medicine, psychotherapy, and peer support groups, neither the patient nor their loved ones need to suffer in silence. By seeking treatment for mental health conditions, patients will be able to better focus on the healing process. Caregivers will be better able to fulfill their own personal needs and the needs of those they care for.

Sources:

1. Spiegel D. Minding the body: Psychotherapy and cancer survival. Br J Health Psychol. 2013 Aug 26.
2. Sirois F. Psychiatric aspects of chronic palliative care: waiting for death. Palliat Support Care. 2012 Sep;10:205-11.
3. Palesh O, Koopman C. Deconstructing the complexity of PTSD in cancer. Nat Rev Clin Oncol. 2013 Aug;10:.
4. Singer S, Szalai C, Briest S, Brown A, Dietz A, Einenkel J, Jonas S, Konnopka A, Papsdorf K, Langanke D, Löbner M, Schiefke F, Stolzenburg JU, Weimann A, Wirtz H, König HH, Riedel-Heller S. Co-morbid mental health conditions in cancer patients at working age – prevalence, risk profiles, and care uptake. Psychooncology. 2013 Mar 14.
5. de Vries M, Stiefel F. Psycho-oncological interventions and psychotherapy in the oncology setting. Recent Results Cancer Res. 2014;197:121-35.
6. Akechi T, Okuyama T, Sugawara Y, et al.: Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors. J Clin Oncol 22 (10): 1957-65, 2004.
7. Triozzi PL, Goldstein D, Laszlo J. Contributions of benzodiazepines to cancer therapy. Cancer Invest. 1988;6:103-11.
8. Lim SM, Kim HC, Lee S. Psychosocial impact of cancer patients on their family members. Cancer Res Treat. 2013 Sep;45:226-33.
9. Mystakidou K, Parpa E, Tsilika E, Panagiotou I, Galanos A, Sakkas P, Gouliamos A. Posttraumatic stress disorder and preparatory grief in advanced cancer. J BUON. 2012 Jan-Mar;17:155-9.