How the mental health of cancer patients can be affected
When a person receives a diagnosis of a serious illness such as cancer, it is natural to feel sad, anxious, and distressed, among other feelings that can be uncomfortable. The loss of the assumed world, doubts, and uncertainties about the future bring a whirlwind of new challenges and sensations to patients and their families.
Gradually, this feeling of strangeness becomes organized, and one learns to live with oncological treatment and its challenges. It is common to feel ambivalence – sometimes feeling happy with the result of an exam, other times worried about the treatment, for example. For most patients, emotional regulation occurs naturally and without the need for more targeted intervention.
We do not have control over our feelings – therefore, it is not possible to choose how the reaction to the diagnosis or the different stages of treatment will be. 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 live with 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 attentive to the 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 the sessions, and even after they have ended, but clinical follow-ups are still necessary.
Depression, anxiety, stress, anger, and uncertainties are the most common mental health problems in cancer patients. Next, understand each one of them.
Depression vs Cancer
Depression is a debilitating illness 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 must deal with two difficult situations to provide the necessary support.
If depression is already a problem that requires attention and specialized care by itself, when associated with cancer, it can be even more complex. It can hinder the way the patient deals with the disease and treatment (in issues that may seem simple, such as choosing an integrative care modality), extend hospitalization periods, reduce quality of life, and increase the risk of suicide.
However, it is important to note that feeling sad is very common in patients and families, and feeling sad and distressed is normal during this period – these feelings tend to pass after a few hours or days. Sadness is normal, and when feeling it, means are sought to improve the feeling.
In depression, there is a feeling of being paralyzed. The patient becomes “dysfunctional,” which means that depression often prevents them from finding 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 important parts of cancer treatment.
Symptoms can range from mild to severe, with the most common ones being:
- Deep sadness and hopelessness;
- Lack of hope;
- Constant irritability;
- Feeling of emptiness;
- Feeling of unimportance;
- Loss of interest in activities that used to bring satisfaction;
- Sudden crying spells;
- Withdrawing from friends and family;
- Concentration problems;
- Difficulty making decisions;
- Memory problems;
- Negative and self-destructive thoughts;
- Reluctance to talk about one’s own feelings;
- Fatigue;
- Loss of appetite;
- Insomnia (difficulty sleeping and/or having 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 being diagnosed with cancer and the difficulties that may arise during the fight against the disease (side effects of medications or loss of muscle mass and physical vigor that impacts the ability to work and exercise, for example), factors inherent to the treatment itself can lead to depression. Such as:
- Disruption of the production and secretion of serotonin and dopamine;
- Side effects of chemotherapy medications;
- Untreated pain or pain from surgeries, chemotherapy, or radiotherapy; and
- Sleep problems caused by treatment medications.
Anxiety vs Cancer
When talking about anxiety disorders, it is not about the normal expectation or nervousness while waiting for something to happen, but about a debilitating mental disorder that affects about 25% of cancer patients and affects men and women equally.
This disorder tends to be more prevalent before the start of treatments and in people with lung cancer, brain cancer, and gynecological cancers.
The main symptoms of anxiety related to cancer are:
- Manifesting a lot of fear of treatment and its adverse effects;
- Excessive worries about losing independence;
- Continuously expressing fear of dying;
- Feeling apart from people around;
- Palpitations or rapid heartbeats for no apparent reason;
- Changes in blood pressure;
- Chest pains for no apparent reason;
- Rapid breathing;
- Insomnia;
- Difficulty concentrating;
- Feeling of suffocation;
- Sweating and trembling;
- Dizziness;
- Nausea, diarrhea;
- Change in appetite (losing appetite completely or eating all the time); and
- Abdominal pains.
Anxiety can make cancer treatment difficult, especially when it comes to making health-related choices. This happens because of 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 itself anxiety-inducing. Therefore, it is important to identify it and report the symptoms to a doctor as soon as you notice them.
Stress vs Cancer
It is estimated that one in three cancer patients experience stressful moments during treatment. And we are not talking about the common nervousness with daily tasks, but rather about a psychological disorder caused by the body’s response to extreme situations in a person’s life, which affects hormonal levels and has negative effects on the body.
In the case of cancer patients, stress can hinder the progress of therapies employed in the search for a cure (as hormonal dysregulation weakens the immune system) and significantly reduces the quality of life of the patient.
Several factors trigger stress in cancer patients, such as:
- The pressure to continue working even with the possible adverse effects of treatments;
- Not knowing how to deal with the family (which is often as stressed as the patient); and
- Financial problems caused by a decrease in 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.
Anger vs Cancer
Although there are no statistics on the number of cancer patients who express anger at the time of diagnosis or throughout the treatment of the disease, this is a common emotion in offices and clinics. The reasons for the expression of anger can be various, such as:
- The arrival of a more serious problem than the person expected for their 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 them feel infantilized or relegated to a “useless” role).
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 disappear, and it can make everything much more difficult in treatment.
Repressed anger can lead to:
- Depression;
- Anxiety disorder;
- Difficulty in communication (even adverse reactions to treatment);
- Self-destructive behaviors; and
- Alcohol and/or drug abuse.
Which doctors should guide on mental health during cancer treatment
If symptoms of depression, anxiety, stress, and anger last for two weeks or more, it is important to seek help from psychiatrists and psychologists specialized in cancer patients, as they know how to combine therapies and, if necessary, medications without harming cancer treatment.
The oncologist usually has colleagues to refer to, as well as good specialized clinics that offer psychology services with professionals dedicated to this care.
How to take care of mental health during cancer treatment
Psycho-oncology can be the first approach to 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 specialized in psycho-oncology, in order to assist in coping and creating self-care strategies essential to maintain mental health during cancer treatment – and even after its end, in the period when returns and control exams for the return of the disease (recurrence) are necessary.
If and when the diagnosis is confirmed, learn how to take care of depression, anxiety, stress, and anger related to cancer.
Depression and Cancer
The need for medication for depression will be determined by a specialized professional (psychiatrist) after at least one consultation to identify the problem and understand the cancer treatment (to avoid the risk of negative interaction with oncological medication).
Medication is not the only alternative for mental health care. Psychiatric treatment combined 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 deal with their emotions and develop a mechanism to cope with them. Couples therapy, family therapy, or group therapy (including 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 quick, while for others it may take longer. It is important to maintain regular follow-up with the healthcare team to assess the patient’s progress and reevaluate the clinical approach. More important than immediacy is medical follow-up: if there is no improvement in the patient’s mental health, a new approach to depression may be outlined.
Anxiety and Cancer
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 understand the cancer treatment (to avoid the risk of negative interaction).
In addition to the use of drugs, therapy conducted by a psychologist, psychotherapist, or psycho-oncologists can help the patient’s condition. It can be done individually, as a couple, as a family, or in a group (including close friends and caregivers), if the professional and the patient feel this 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, the feeling of improvement can be quick, while others may take longer to notice the effects. It is essential to maintain regular follow-up with the healthcare team to assess the patient’s progress and reevaluate the clinical approach if necessary.
More important than immediacy is medical follow-up: if there is no improvement in the patient’s mental health, a new approach to anxiety disorder may be outlined.
Stress and Cancer
Stress management can be done with medical supervision or individually by the patient. In the latter case, it is important to note that there is a greater ease in dealing with the problem after having a consultation with a specialized doctor, as it is where one learns to master the tools to deal with emotions.
Among the daily needs to reduce stress are:
- Managing daily commitments – using a planner, phone calendar, or online calendar allows each activity to be given the necessary time and commitments to be rearranged so as not to overlap;
- Respecting your limits – if there is no energy, time, or interest in a commitment, it is completely acceptable to refuse it;
- Asking for help – no one needs to be responsible for everything, especially during treatment for an illness. Asking for help from family, friends, and
colleagues helps reduce worries and, consequently, the risk of stress;
- Focusing on what is possible to control – the reaction to something out of control can trigger a stress crisis; and
- Seeking financial help – if the problem is financial, asking for help from close people or a financial counselor can greatly alleviate stress.
Among the techniques included in daily life to control stress, it is interesting to consider:
- Exercising regularly – a 30-minute walk per day is enough to keep the body healthy and stress under control;
- Getting out of the house – looking at something different from the walls of the house or apartment gives a breath of fresh air to the mind and can help reduce the risk of stress;
- Eating well – maintaining a balanced and healthy diet provides energy to the body, helps minimize the side effects of treatment, and reduces stress, which is why nutrition for cancer patients during treatment is so important.
- Sleeping well – resting for at least seven hours per night is essential. If possible, it is also interesting to take a few naps throughout the day;
- Participating in a support group – support groups for oncology patients are usually mediated by specialized professionals and are a good environment to vent, feel welcomed by listening to the stories and experiences of other patients, which may be similar to yours, and put your problems into perspective;
- Including a relaxing activity in the routine – half an hour of gardening, reading, listening to music, cooking, painting per day. No matter the activity, the important thing is to have this time to focus on something other than the disease or the problems of daily life; and
- Writing a diary – putting your emotions on paper or on the computer screen can be a good technique for people who cannot or do not want to express out loud what they are feeling.
- Relaxation techniques such as mindfulness, meditation, stretching, and yoga can also help control the stress of oncology patients.
Anger and Cancer
There are healthy ways to express anger that result in a positive change in life and in the way one faces the disease and treatment. With the guidance of a therapist, cancer patients can find the origins of their anger and the triggers that cause it, avoid destructive behaviors and habits, and learn techniques to deal with it (such as writing a diary or practicing physical activity). Learn more in our physical exercise session during treatment.
The professional is also able to assess whether there is a risk of anger progressing to a state of depression or anxiety disorder and act preventively to prevent this from happening.
