Living with cancer

Mental Health

Depression, anxiety, anger, stress and uncertainty are the most common mental health problems in people with cancer. Specialists and treatments can alleviate symptoms and improve quality of life. Learn more.
10 min read
per: Grupo Oncoclínicas
Mental Health
Depression, anxiety, stress, anger and uncertainty are the most common mental health problems in people with cancer.

How the mental health of cancer patients can be affected

When a person is diagnosed with a serious illness such as cancer, it is natural to feel sad, distressed, anxious and have other feelings that make them uncomfortable. The loss of the assumed world, the doubts and uncertainties about the future bring a whirlwind of new challenges and sensations to patients and also to their families.

Gradually, this feeling of estrangement is organized and one learns to live with cancer treatment and its challenges. It is common to feel ambivalence – sometimes being happy with the result of an exam, sometimes worried about the treatment, for example. For most patients, emotion regulation happens naturally and without the need for a more targeted intervention.

We have no control over our feelings – therefore, it is not possible to choose how the reaction will be to the diagnosis or to the different stages of treatment. But it is possible to identify the emotional tools for coping with the situations that will follow.

It is important to remember that illness and its consequences are a process of building a new routine, with impacts on different spheres of life. There is no single way to experience cancer and its oncological treatment, nor a correct way. Each patient and each family will organize themselves to face the treatment in the best possible way.

However, we need to be aware of emotional conditions that can affect mental health and can affect cancer patients from the moment of diagnosis or at any stage of cancer treatment – before starting, during sessions and even after they have ended, but clinical returns are still needed.

Depression, anxiety, stress, anger and uncertainty are the most common mental health problems in people with cancer. Next, understand each of them.

Depression x cancer

Depression is a disabling disease that affects between 15% and 25% of cancer patients. It impacts men and women equally and also has negative effects on family members, close friends and caregivers, who have to deal with two difficult situations in order to provide the necessary support.

If depression in itself is already a problem that requires attention and specialized care, associated with cancer it can be even more complex, as it can make it difficult for the patient to deal with the disease and treatment (in issues that may seem simple, such as choosing an integrative care modality), can extend hospitalization periods, reduce quality of life, and increase the risk of suicide.

In any case, it is important to highlight that the feeling of sadness is very common in patients and family members, and feeling sad and distressed is normal during this period – these feelings tend to pass after a few hours or days. Sadness is normal, when you feel it, you look for ways to improve the feeling.

In depression there is a feeling of being paralyzed. The patient “dysfunctionalizes”, which means that depression often prevents him from having pleasure in activities that were once important, generating a permanent state of anguish, fear and negative thoughts for a long period.

Therefore, identifying and treating depression are an important part of cancer treatment. Symptoms can range from mild to severe, with the most common being:

• Deep sadness and discouragement;
• Hopelessness;
• Constant irritability;
• Feeling of emptiness;
• Feeling of unimportance;
• Loss of interest in activities that used to satisfy the person;
• Sudden crying crisis;
• Withdrawing from friends and family;
• Concentration problems;
• Difficulty in making decisions;
• Memory problems;
• Negative and self-destructive thoughts;
• Reluctance to talk about one’s feelings;
• Fatigue;
• Loss of appetite;
• Insomnia (difficulty sleeping and/or getting a good night’s sleep) or hypersomnia (feeling sleepy all the time and not wanting to get out of bed); and
• Loss of libido.

In addition to the shock of the news of having cancer and the difficulties that can arise during the fight against the disease (side effects of medications or loss of muscle and physical vigor that impacts the ability to work and exercise, for example), inherent factors treatment itself can lead to depression. Such as:

• Interruption of the production and secretion of serotonin and dopamine;
• Side effects of chemotherapy drugs;
• Untreated pain or pain from surgery, chemotherapy or radiotherapy; and
• Sleep problems caused by treatment medications.

Anxiety x cancer

When talking about anxiety disorder, it is not that normal expectation or nervousness while waiting for something to happen, but a disabling mental disorder that affects about 25% of cancer patients and affects men and women equally.

This disorder tends to be more prevalent before treatments are started and in people with lung, brain, and gynecologic cancers.

The main symptoms of cancer-related anxiety are:

• Expressing great fear of the treatment and its adverse effects;
• Excessive concerns about loss of independence;
• Continuously express the fear of dying;
• Feeling of being apart from the people around;
• Palpitations or heart accelerations for no apparent reason;
• Changes in blood pressure;
• Chest pain for no apparent reason;
• Accelerated breathing;
• Insomnia;
• Difficulty concentrating;
• Feeling of suffocation;
• Sweat and trembling;
• Dizziness;
• Nausea, diarrhea;
• Change in appetite (completely losing hunger or eating all the time) and
• Abdominal pain.

Anxiety can make cancer treatment difficult, especially when it comes to making health-related choices. This is due to the fear of harming health and treatment, the feeling that it is mandatory to have certainties or guarantees that one is on the right path, and this insecurity is in itself anxiogenic. Therefore, it is important to identify it and report the symptoms to one of the doctors as soon as you notice them.

Stress x cancer

It is estimated that one in three cancer patients experience stressful moments during treatment. And we are not talking about that common nervousness with everyday tasks, but about a psychological disorder, caused by the body’s response to extreme situations in a person’s life, which affects hormone levels and has negative effects on the body.

In the case of cancer patients, stress can harm the evolution of therapies used in the search for a cure (since hormonal dysregulation weakens the immune system) and considerably reduces the patient’s quality of life.

Several factors trigger stress in cancer patients, such as:

• The pressure to continue working despite the possible adverse effects of treatments;
• Not knowing how to deal with the family (who are often as stressed as the patient); and
• Financial problems caused by reduced workload or job loss.

Whatever the reason, it is worth noting that there is no evidence that stress, by itself, is capable of causing cancer.

Rabies x cancer

Although there are no statistics on the number of cancer patients who express anger at the time of diagnosis or during treatment for the disease, this is a common emotion in offices and clinics. The reasons for the manifestation of anger can be several, such as:

• The arrival of a more serious problem than the person expected in his life;
• The way cancer and its treatment change the routine; and
• The way family and friends start to deal with the patient (too much condescension can make him feel infantilized or relegated to a role of “useless”).

In many families, the expression of anger is repressed from childhood, which can lead cancer patients to hide this feeling. It is important to make it clear that feeling angry is normal and that not expressing dissatisfaction will not make it go away, in addition to making everything much more difficult in the treatment.

Suppressed anger can lead to:

• Depression;
• Anxiety disorder;
• Difficulty communicating (even adverse treatment reactions);
• Self-destructive behaviors; and
• Alcohol and/or drug abuse.

Which doctors should advise on mental health during cancer treatment

If symptoms of depression, anxiety, stress and anger last two weeks or longer, it is important to seek the help of psychiatrists and psychologists who specialize in cancer patients, as they know how to combine therapies and, if necessary, medications without harming cancer treatment.

The oncologist usually has colleagues to indicate, as well as good specialized clinics have a psychology service with professionals dedicated to this care.

How to take care of mental health during cancer treatment

Psycho-oncology can be the first approach to the manifestations of insecurity, fear and nervousness in the face of cancer diagnosis and treatment.

In it, medical care is complemented by the work of a psychologist specializing in psycho-oncology, in order to assist in coping and in creating essential self-care strategies to maintain mental health during cancer treatment – and even after it ends, in the period in which the returns and the examinations to control the return of the disease (recurrence) are necessary.

If and when the diagnosis is confirmed, learn how to manage cancer-related depression, anxiety, stress, and anger.

Depression

The need for medication for depression or not will be determined by a specialized professional (psychiatrist) after at least one consultation to identify the problem and knowledge of cancer treatment (so there is no risk of negative interaction with cancer medication).

Drug treatment is not the only alternative for mental health care. Psychiatric treatment associated with psychotherapeutic treatment has shown good results in improving the quality of life of patients.

It is recommended to maintain a therapy routine with a psychologist, psychotherapist or psycho-oncologist – they provide the tools for the patient to be able to deal with their emotions and develop a mechanism to deal with them. Couples, family, or group therapy (which includes close friends and caregivers) may also be recommended.

Improvement is gradual and varies from case to case. For some patients, the feeling of improvement may be rapid, for others it may take longer. It is important to maintain regular follow-up with the care team to assess the patient’s progress and reassess the clinical management. More important than immediacy is medical follow-up: if an advance in the patient’s mental health is not noticed, a new approach to depression can be devised.

Anxiety

The need for medication for anxiety disorder will be determined by a specialized professional (psychiatrist) after at least one consultation to identify the problem and knowledge of the cancer treatment (so there is no risk of negative interaction).

In addition to the use of drugs, therapy conducted by a psychologist, psychotherapist or psycho-oncologists can help with the patient’s condition. It can be done individually, as a couple, as a family or in a group (which includes close friends and caregivers), if the professional and the patient feel the need.

Currently, it is already proven that relaxation techniques have many benefits for cancer patients. For anxiety, relaxation techniques done with the help of an instructor (preferably) or by the patient alone are also effective, such as:

• Breathing techniques;
• Mindfulness;
• Meditation;
• Stretching; and
• Yoga.

Improvement is gradual and varies from case to case. For some patients, feeling better may come quickly, while others may take longer to notice the effects. It is essential to maintain regular follow-up with the care team to assess the patient’s progress and reassess the clinical management, if necessary.

More important than immediacy is medical follow-up: if an advance in the patient’s mental health is not noticed, a new approach to anxiety disorder can be devised.

Stress

Stress control can be done with medical supervision or individually by the patient. In the latter case, it is important to note that it is easier to deal with the problem after going through a consultation with a specialized doctor, as in it one learns to master the tools to deal with emotions.

Among the day-to-day needs to reduce stress are:

Control the day’s appointments – using a planner, phone book or an online calendar allows each activity to be given the necessary time and appointments to be rearranged so that they do not overlap;
Respect your limits – if there is no energy, time or interest in a commitment, it is completely acceptable to decline it;
Ask for help – no one needs to be responsible for everything, much less during treatment for an illness. Asking family, friends and co-workers for help helps to reduce worries and, consequently, the risk of stress;
Focus on what you can control – the reaction to something that is out of control can be the trigger for a stress crisis; and
Seeking financial help – if the problem is financial, asking for help from people close to you or a finance counselor can relieve – a lot – of stress.

Among the techniques included in everyday life to control stress, it is interesting to think about:

Exercise regularly – a 30-minute walk a day is enough to keep your body healthy and stress under control;
Getting out of the house – looking at something other than the walls of the house or apartment gives a fresh air to ideas and can help reduce the risk of stress;
Eat well – maintaining a balanced and healthy diet provides the body with energy, helps to minimize the side effects of treatment and reduce stress;
Sleep well – getting at least seven hours of rest a night is essential. If possible, it is also interesting to take a few naps throughout the day;
Participate in a support group – support groups for cancer patients are usually mediated by specialized professionals and are a good environment to vent, feel welcomed when listening to the stories and experiences of other patients, which may be similar to yours, and put your problems in perspective;
Include a relaxing activity in your routine – half an hour of gardening, reading, listening to music, cooking, painting a day. No matter the activity, the important thing is to have this time to focus on something other than illness or everyday problems; and
Journaling – putting your emotions on paper or on a computer screen can be a good technique for people who are unable or unwilling to express what they are feeling out loud.
Relaxation techniques such as mindfulness, meditation, stretching and yoga can also help to manage the cancer patient’s stress.

Rage

There are healthy ways to get the anger out, which result in a positive change in life and in the way of facing the disease and treatment. With the advice of a therapist, the cancer patient can find the origins of their anger and the triggers that cause it to be triggered, avoid destructive behaviors and habits, and learn techniques for dealing with it (such as journaling or practicing a physical activity).

The professional is also able to assess whether there is a risk of anger progressing to depression or anxiety disorder and act preventively to prevent this from happening.

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Living with cancer

This content is part of a series of articles about living with cancer
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