Cancer’s impact
Due to medical advances over the last few decades, around half the people diagnosed with cancer are expected to survive for 10 years or more. The decline in quality of life caused by both the diagnosis and treatments e.g. surgery, radiotherapy and chemotherapy side effects (nausea, vomiting, hair loss, sleep problems, pain, flu like symptoms etc.) are therefore more likely to influence a cancer patient’s long-term mental health.
Signs and symptoms of mental illness
Mental illness can manifest in many different forms. Anxiety and depression are the most common cancer related mental illnesses. Signs of anxiety include nervousness, trembling, nausea, sweating, heart palpitations and shortness of breath. The initial response to a cancer diagnosis can be shocking, hard to process and evoke many negative emotions such as anger, worry and denial. Health anxiety is therefore also common, whereby the symptoms of anxiety are orientated around worry of becoming unwell or relapsing after remission. Depression is characterised by low mood, inability to experience pleasure (the clinical term being anhedonia) and low motivation. Both anxiety and depression can cause irritable mood and disrupted biological functions (sleep, appetite and sexual function).
Who is most at risk?
The chances of being diagnosed with a mental illness such as depression or anxiety are around 5 times higher than a non-cancer patient, depending on the type of cancer. Around 30-40% display symptoms of anxiety or depression that require the attention of a mental health professional. An estimated 11-20% of breast cancer patients will display symptoms that warrant a clinical diagnosis of depression, and 16-18% for anxiety compared to non-cancer patients. Some types of cancer, such as pancreatic, can reach as high as a 70% chance of depression and 30% chance of comorbid anxiety and depression. The increased awareness of mental health problems in cancer by GPs, oncologists and clinical nurse specialists is encouraging but greater access to mental health specialists is required.
What causes the psychological decline?
- Long term adjustment
- The intense schedule of assessments and treatments endured by a cancer patient may not allow time for the psychological adjustment required to adapt to their diagnosis and lifestyle changes. A cancer patient may not have time to process the magnitude of the event until when treatment suddenly stops. This can sometimes result in a subconscious sense of abandonment that increases levels of health anxiety (constant worry about health or subsequent cancer diagnosis). Furthermore, the novel and increasing realisation of potential mortality and the ongoing burden of symptoms can lead to loneliness in over half of cancer patients, which can contribute to psychological distress and depressive symptoms.
- Gender
- The early detection and treatment of breast cancer now has an overall survival rate of 80% over 10 years. Breasts, however, are associated with sexuality and the female body. Their surgical removal can induce a large shift in identity as a woman, which can be challenging to adapt to and have a big impact on self-esteem, confidence and self-perceived sexuality. Physiological changes after some cancer treatments also include premature menopause. Similarly, males who undergo surgery for prostate cancer (one of the most commonly diagnosed cancers in males) may experience retrograde ejaculation, whereby semen enters the bladder instead of the penis, which can cause male infertility. Hormone therapy can also diminish sex drive. These side effects will have a large impact on sexuality and will be a deeply stressful life event if the patient is planning on having children, which can cause strain on relationships and psychological well-being.
- Biological
- Sometimes mental symptoms can be the first biological sign of cancer. Tumour growth in pancreatic cancer, for example can increase the release of cytokines (hormone-like proteins that often cause ‘flu-like symptoms’ e.g. fatigue and anhedonia), which has been proportionally linked to higher levels of depression. Cancer of the glands e.g. thyroid and pancreas secrete hormones causing similar symptoms such as anxiety and depression. An overactive thyroid gland can produce sensations of anxiety such as nervousness, heart palpitations and trembling, whereas an underactive thyroid gland can cause depressive symptoms such as low mood, reduced pleasure activities and tearfulness. Additionally, approximately 10% of patients who undergo radiotherapy for head and neck cancer develop hypothyroidism-induced depression.
What should you do?
If you think you, your friend or family member with (or without) a cancer diagnosis are showing signs of mental illness, you should consult your GP, a mental health professional or cancer specialist immediately. Even if the cancer has remitted or a tumour has been removed, psychological symptoms may persist for months or even years and should continue to be treated if necessary.
Cognitive behavioural therapy is a common psychotherapy for understanding how thoughts, feelings and behaviours interact with each other. It can help understand refusal and avoidance behaviours with regards to cancer treatment/medication or how anxious and depressive symptoms are maintained. Alternatively, various anti-anxiety and antidepressant medications can be prescribed by your GP or psychiatrist – sertraline and citalopram are thought to have the lowest risk of toxic interactions with other cancer medications.
Cognacity is a large group of mental health professionals (psychiatrists, psychologists and psychotherapists) offering almost all forms of psychotherapy within 24 hours of booking an appointment. One of the Cognacity directors Dr Gary Bell is a consultant psychiatrist who has over 20 years of experience in the private sector. He also has specialist expertise and an excellent reputation in the field of oncology and the psychiatric impact of cancer. To book an appointment call 02032193080 or email us on enquiries@cognacity.co.uk.
