Recently, cancer experts made news when they announced that half of all patients seriously ill with cancer suffer from anxiety, depression or other mental health problems and could use help in getting treatment.
It seems natural to feel upset when faced with a life-changing diagnosis. City of Hope psychologists, though, say there are differences between normal worries and fears and the sometimes debilitating grip of anxiety and depression.
Andrea T. Thornton, Ph.D., co-director and assistant professor in the Department of Psychology at City of Hope, helps patients and their families deal with mental health challenges through her involvement with the Sheri & Les Biller Patient and Family Resource Center. She recently talked about these issues with eHope.
EHope: How would someone know the difference between just feeling sad about having a serious disease, like cancer, and actually being depressed?
Thornton: Changes in mood are common across the cancer experience, and it’s important to recognize that cancer-related distress can range from mild and expectable to severe and disabling. Yes, feeling sad can be a common response to the diagnosis of cancer. Clinical depression, on the other hand, is less common, with the current estimates hovering at about 25 to 30 percent of cancer patients.
The sadness that accompanies clinical depression...
lasts longer (more than two weeks, more days than not)
is stronger than regular “sadness,” and
interferes with day-to-day activities.
Long-lasting sadness or “emptiness,” loss of interest in previously enjoyable activities, strong feelings of guilt, worthlessness, helplessness or hopelessness, or suicidal thoughts may indicate clinical depression.
eHope: What's the difference between feeling scared about cancer and having anxiety?
Thornton: Again, it’s certainly common to experience some level of fear or anxiety across the cancer continuum. Cancer is a scary thing and most patients feel some level of worry about how they and their family will be affected by the cancer.
Sometimes, low-level anxiety can motivate patients or families to stick to their treatments or to seek out information and support that improves their adjustment to illness.
However, a high level of anxiety can be problematic when it interferes with a person’s functioning or their ability to engage in day-to-day activities, or it impedes their ability to adhere to treatment, follow-up or screening recommendations. Also, anxiety can heighten physical symptoms such as pain, and it may be associated with sleep disturbances, or anticipatory nausea or vomiting. In these situations, the person may have an anxiety disorder and may require additional psychological or psychiatric intervention.
eHope: Can you suggest any ways people can help loved ones close to them through a hard time with cancer or other illnesses?
Thornton: It can be very difficult to watch someone you care for deal with significant depression or anxiety.
Encourage your loved one to seek treatment, and to continue treatment for their symptoms, since effects are not always immediate after starting treatment. Also, if there is no improvement after a few weeks, consider other treatments or options that may be available.
Help reduce barriers to making mental health appointments, such as arranging for transportation or assisting in appointment scheduling. Provide reinforcement and reassurance to your loved ones that they’re on the right track to getting better, especially if you see them making progress that they can’t see themselves because their depression or anxiety keeps them from thinking objectively.
It also can be helpful to promote physical activity or mild exercise such as walking, with the patient’s physician’s approval, and to ensure that your loved one is getting adequate nutrition and rest. Also, it’s important to recognize that cancer is a family illness, and that caretakers and family members also experience emotional distress. In that case, these suggestions may be useful for them as well.
eHope: What signs of distress should I look for if my mom, dad or other family member has been diagnosed with a serious illness?
Thornton: Emotional distress can manifest in different ways, and there is no one standard, or “normal” response to cancer. Distress may look different for different people.
Feeling down, worried, overwhelmed or stressed most of the time is a signal that assistance in managing emotional distress may be required. Also, it is important to be alert to changes in mood, behavior, or functioning in your loved one. For example, your normally jovial, outgoing family member may become quiet and introverted. These kinds of changes in typical ways of behaving or regular functioning may be a sign that your loved one needs assistance.
Other signs of emotional distress may include these:
changes in eating habits
loss of interest in formerly pleasing activities
sleep disturbances (more or less than usual)
concentration problems, and
Also, most of what I’ve mentioned so far focuses on distress in adults with cancer — but children and teenagers may also become depressed due to a cancer diagnosis in themselves or someone they are close to. Children may be more likely to become quiet or withdrawn, irritable or demonstrate “acting out” behavior.
EHope: Whom should I approach for help if I think I have depression or anxiety or I suspect a family member or friend might? Shouldn't their cancer doctor be able to figure it out?
Thornton: There are a lot of good resources out there, but sometimes it can be hard to know where to start. Also, there are some good data coming out that suggest that members of the medical team sometimes have difficulty identifying and addressing emotional distress in patients, and there may be multiple barriers to this. However, if you are concerned about emotional distress in yourself, a family member or a friend, let your physician and members of your health-care team know — this is a good place to start.
Most hospitals have a social worker available who can do a screening or assessment to identify the issues and needs, may provide support themselves and can link you to resources for additional support such as support groups, counseling, psychotherapy or medication management.
You may request referral to a psychologist if you are interested in working on your distress through therapy and finding new solutions to what is troubling you. You may also request referral to a psychiatrist if you are interested in taking medicines that can reduce symptoms of emotional distress. Some people feel comfortable working within their faith base, too; chaplains or spiritual care providers may be able to help.
eHope: Do you think that feeling less anxious or depressed can help me or my family member or friend help fight cancer better?
Thornton: Thank you for asking about this; this is actually a complicated question and a source of some controversy depending on what you mean when you say “fight” cancer.
Treating anxiety and depression is an important component of comprehensive cancer care. Our emotional and physical wellbeing are closely intertwined, and patients who are clinically depressed or significantly anxious may have greater trouble coping with their cancer diagnosis, treatment, or survivorship. Depression and anxiety may worsen physical pain, fatigue, and nausea, impair decision-making, and just generally make it tough to navigate the many challenges that someone with cancer faces.
However, the way that this message is delivered is crucial. I see many patients who believe or have heard that psychological distress or high levels of stress may have caused their cancer or may lead to cancer progression. Obviously, this is a very negative message and one that can lead to high levels of distress and anxiety that are only counterproductive. There are no good data that low mood or high stress levels influence the biology of cancer, unless these issues interfere with adherence to cancer treatment.
eHope: Do you know of any resources to help people learn more about anxiety and depression?
Thornton: There are some good resources and pamphlets about emotional effects of cancer available through reputable organizations such as the Lance Armstrong Foundation, American Cancer Society, National Cancer Institute and People Living with Cancer.