June is National Cancer Survivor month. According to the American Association for Cancer Research (AACR) more than 16.9 million people in the United States are cancer survivors who are living with, through, and beyond their cancer diagnosis. After a cancer diagnosis and going through treatment, the person’s life has changed forever.
Due to life changes, cancer survivors often face unique mental health challenges. The cancer diagnosis has an impact on the way the person views life. In addition, stress and trauma from treatment can linger, and worry over the cancer returning can be a constant battle. According to the National Cancer Institute, the most common emotional and mental health problems that cancer survivors face are depression and anxiety.
With cancer being the second leading chronic condition in the United States, it’s important for behavioral health professionals to understand the potential impacts of cancer on mental health. Cancer survivors are twice as likely to have disabling psychological problems compared with adults without cancer. In addition, they are 6 times more likely to have a psychological disability when compared to adults without cancer or another chronic condition.
Changes in Cognition: The CDC describes a possible challenge for cancer survivors is changes in cognitive thinking. A person who went through chemotherapy, may experience challenges with cognition, memory or attention. This may make it difficult for a person to learn new facts or skills, have problem concentrating, or have trouble remembering things. These challenges can occur during or after treatment.
Increased Stress Levels: According to the National Cancer Institute, often times a survivors’ distress level goes up after treatment, and often unexpectedly. The fear that the cancer will come back can haunt survivors. This is the most common emotional difficulty a cancer survivor often faces. In addition to fear of recurrence, other stressors include concerns about finances, changes in body image and sexuality (especially when parts of the body have been removed), as well as, challenges of managing long term health needs.
During the pandemic, cancer survivors have reported new stressors. Some treatments weaken the immune system and may increase a person’s risk of severe illness from COVID-19. In addition, hospital protocols to deal with the pandemic have delayed and affected treatment options available. According to NCI, the specific types of distress may not fall into the class description of anxiety or depression, but they do disrupt a person’s quality of life.
Anxiety: A person’s anxiety may increase around the time of doctor’s appointments, or when a scan is scheduled. A certain amount of anxiety is normal; however, some survivors may find the anxiety to be debilitating.
Depression: Long lasting feelings of sadness and anger may interfere with the person’s life. These feelings may persist and develop into depression.
Mental health is particularly important to monitor within the first three years after treatment (Naughton, M. J., & Weaver, K. E., 2014). One common challenge that cancer survivors face is shifting the focus from treatment (i.e., fighting cancer) to waiting to see if the cancer comes back, recovery, and wellness.
Other common challenges include changes in life roles, cancer recurrence, long-term treatment effects (which can be both physical and psychological), and perceived loss of support from providers, family, and friends.
Not everyone will experience increased distress, anxiety, and depression. Some survivors may experience post-traumatic growth. The person may develop new coping strategies to deal with the ups and downs of life. It may help them to deepen their relationships with family and friends. It may increase their resilience and help them to see that they can get through difficult situations. They may also find themselves re-evaluation life priorities and have more of an appreciation of life.
Risk factors for mental health problems include younger age, less education, additional chronic conditions, lower income, living in a rural community (access to care), and not being partnered or married. Racial and ethnic differences remain unclear. For example, some studies have not found a difference in mental health among difference ethnicities, while other studies have found African Americans report better emotional well-being than whites, and a few have reported lower mental health among Hispanics, Asian Americans, or African Americans.
Factors that have been associated with better adjustment after cancer diagnosis include older age, being married or partnered, greater optimism, greater self-efficacy, better social support, less rigorous chemotherapy, less pain, and less impact of illness on daily life.
The American Society of Clinical Oncology (ASCO) published adapted guidelines for the screening, assessment, and treatment of anxiety and depressive symptoms in adults with cancer. These guidelines are an important resource for recommendations regarding the timing of symptom screening, screening tools, and follow-up care.
In general, it is recommended that validated instruments to screen for depression and anxiety are used across the continuum of cancer care. Timely identification and treatment of mental health concerns can greatly improve both the mental and physical health of cancer survivors. According to Naughton, M. J., & Weaver, K. E. (2014), the screening instruments recommended include: the 9-item Personal Health Questionnaire, the Hospital Anxiety and Depression Scale, the Geriatric Depression Scale, the Beck Depression Inventory, the Center for Epidemiological Studies–Depression Scale, the Spielberger State-Trait Anxiety Inventory, and the Beck Anxiety Inventory, the National Institutes of Health’s Patient Reported Outcomes Measurement and Information System, the 12-Item Short-Form Health Survey, the Functional Assessment of Cancer Therapy scale—General, or a single-item assessment (asking patients to indicate their overall quality of life on a scale from 0 to 10).
Approaches that have been successful for managing the stress and anxiety of cancer survivors include:
There is currently a lack of studies on how best to support the psychological and emotional health needs of cancer survivors. Most studies completed to date, focus on breast cancer survivors. Additional research is needed to understand the complexity and how to tailor approaches to meet the needs.
An important way behavioral health providers can support cancer survivors is by increasing coping skills. Living with a cancer diagnosis and through treatment requires many life adjustments. There are numerous points in a cancer survivor’s journey where coping skills are needed. These include:
Behavioral health providers can support the quality of life of cancer survivors through screening, assessment, treatment, and support throughout the person’s cancer journey. Survivorship is complex, as physical health and mental health are impacting one another throughout this journey. Additional research is needed as more and more people are becoming cancer survivors.
References
American Association for Cancer Research (AACR). (2022). National cancer survivor month.). Retrieved June 22, 2022, from https://www.aacr.org/patients-caregivers/awareness-months/national-cancer-survivor-month/
Buchanan Lunsford, N. (2018). What cancer survivors should know about their mental health. Centers for Disease Control and Prevention. Retrieved June 22, 2022, from https://blogs.cdc.gov/cancer/2018/05/17/cancer-survivors-mental-health/
National Cancer Institute. (2021). Adjustment to cancer: Anxiety and distress (PDQ®)–patient version. Retrieved June 23, 2022, from https://www.cancer.gov/about-cancer/coping/feelings/anxiety-distress-pdq
Naughton, M. J., & Weaver, K. E. (2014). Physical and mental health among cancer survivors: Considerations for long-term care and quality of life. North Carolina medical journal. Retrieved June 22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4503227/
NCI Staff. (2020). Managing anxiety and distress in cancer survivors. National Cancer Institute. Retrieved June 22, 2022, from https://www.cancer.gov/news-events/cancer-currents-blog/2020/cancer-survivors-managing-anxiety-distress
