When you receive a diagnosis of cancer it can be easy to shift the focus to your physical health and put everything else on the back burner.
But mental health is a crucial part of your overall health and can have a significant impact on your quality of life during cancer treatment and your overall treatment outcomes.
This was the message delivered by psychiatrist Emily Sorg, MD, and health psychologist Amy Clara, PsyD, of the Center for Psychiatric Oncology and Behavioral Services within the Mass General Brigham Cancer Institute during a recent Blum Center presentation on Navigating Cancer and Mental Health.
Mental Health Challenges are Common During Cancer Treatment
Emily Sorg, MD
If you’re a cancer patient (or the caregiver of a cancer patient) and you are struggling with mental health issues, you’re not alone.
One in three people with cancer will experience significant emotional distress or a serious mental health issue from diagnosis to treatment and beyond, Sorg said.
She emphasized that about a quarter of patients will experience clinical depression, upwards of half may experience clinical anxiety, and even more will report fatigue or cognitive concerns. People with cancer are twice as likely to die by suicide. About 40-70% of caregivers also report significant distress, Sorg said.
If untreated, these mental health issues affect not just quality of life, but also functioning, perception of pain, ability to show up for appointments/treatments, and medical outcomes.
When Is It Time to Seek Support?
Amy Clara, PsyD
While some amount of distress, depression and anxiety is common over the course of your cancer journey, there are certain symptoms, behaviors and patterns that can be the sign of a more significant mental health disorder.
Clara encouraged patients to seek help when they reach their “threshold” moment, i.e., when the symptoms interrupt their functioning, relationships, or quality of life—if not sooner.
“We know that this is going to be one of the most stressful times in people’s lives, but that doesn’t mean you need to white knuckle your way through these experiences,” she said.
Potential symptoms can include depression, manic moods, excessive anxiety, panic attacks (occurring either for the first time or with more frequency), behavior changes, personality changes (indecisiveness, loss of self-confidence) and fatigue/insomnia, among others.
What Does Mental Health Support for Cancer Look Like?
Your care team will probably first talk to you about trying to optimize certain lifestyle behaviors, things like physical activity, good nutrition and getting sleep—these are often compromised because of cancer and its treatments. They will also make sure that none of your symptoms are due to potentially reversible medical issues.
The first line of mental health care for patients is typically supportive therapy that can be done with an oncology social worker, followed by more intensive treatments such as medication management or cognitive-behavioral therapies offered by psychiatrists and psychologists.
Connecting patients to cancer support groups can also be very helpful. Sorg added that many people find being in community with others who can relate to them and their experience as validating and grounding.
Providers can also connect patients to specific evidence-based therapies, things like cognitive behavioral therapy for anxiety, exposure response prevention for fear of needles, or meaning-centered psychotherapy that can help with loss and grief.
Treatment with psychiatric medication can also be helpful for changes in mood, anxiety, thinking patterns, sleep, and other behaviors.
Why Some Cancer Patients are Reluctant to Seek Mental Health Treatment
One common reason that cancer patients are reluctant to seek mental health treatment is they feel that their emotional experience is an unavoidable part of the process (“Of course I’m depressed, I have cancer.”) and thus either shouldn’t be treated or won’t respond to treatment, said Sorg.
Understandably, patients are also often concerned about adding another medication on top of what they are already taking for their cancer treatment or about the potential for negative interactions between drugs.
Others may come to their treatment skeptical of psychiatry or pharmaceuticals. They may worry about the possibility of negative side effects, e.g., weight gain, personality changes.
Sorg emphasized the importances of sharing those concerns with your mental health team so you can have an honest conversation about the pros and cons of treatment.
“I don’t say this to be on [any kind of] soapbox about medications, but really just to communicate that we are happy to engage in any conversation that you might want to have around your concerns,” she said. “We’ll figure out how [medication] may or may not work for you.”
Building a House of Support
Clara said that there are three areas of support that patients can seek out to assist with their cancer journey.
The first is tangible support, which can include rides to appointments, help with making homes more accessible during cancer care, or assistance with other daily tasks during treatment.
The second area is emotional support. This can include professional mental health treatment but also more informal types of support, such as connecting with a support group or simply checking in with a cancer patient to see how their day went.
The third area is informational support. For some patients, information is power, but there is a ton of information out there for cancer patients and it can quickly get overwhelming, Dr. Clara said.
Patients can draw on their oncology team, foundations, online resources, books, media and other patients for help in understanding what to expect from their treatment experience.
Finding Meaning in a Difficult Journey
One bright spot amid the challenges of cancer is that many patients experience positive psychological changes after going through an experience that truly tests all their physical, emotional, spiritual, and psychological limits.
These changes can include an increase in cognitive flexibility, openness, acceptance and a shift in self-perception.
“We don’t want to impose that you have to grow from this experience, but people often do,” Clara said.
“We hear this again and again: 'I would never wish this on myself, but in a way I am glad that it happened because it gave me the opportunity to reexamine how I was living my life, the things I valued, the things I was making time for,'” Sorg said. “And it can really be a transformative experience.”
988 Suicide and Crisis Lifeline
The 988 Lifeline offers mental health support. The services are free and available 24/7, 365 days a year. 988 lifeline specialists provide support to people who are experiencing emotional distress or suicidal thoughts — or are worried about a loved one who is. You do not need to be suicidal to contact 988.
- Call or text 988 to get connected now, or chat online via 988lifeline.org
- Veterans: press 1 | Spanish line: press 2 | ASL: call 988 videophone via ASL Now
- Translation is available in more than 240 languages
Not sure if 988 is for you? Find out when to use 988 and what to expect when you call.
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