Up to 25% of cancer patients will also suffer from depression. Everyone who gets diagnosed with cancer will experience some amount of stress and sadness, but everyone reacts differently to a diagnosis. For some people, their stress and strain will develop into depression.
With a diagnosis of any life-threatening illness come many fears, anxieties and changes to lifestyle, quality of life, relationships, even body image. “Often when a person is diagnosed with cancer, they immediately think and fear death”, says SADAG’s Cassey Chambers. “Even if they are positive about the prognosis, there are still, realistically, interruptions to daily life and to plans, changes in the way they look and feel about themselves, and concerns about money and the financial implications of such a diagnosis. All this can lead to anxiety and depression.” Sadness and grief are normal reactions to a diagnosis of cancer, and will be experienced at times by all people. But there are many mistaken beliefs about cancer and about how people cope.
Like all misunderstandings about everything, these ‘beliefs’ are false. Yes sadness and fear are common but one needs to tell the difference between normal levels of sadness and anxiety and clinical depression. While most people will experience sadness, anxiety and grief at times throughout their diagnosis, treatment, and survival of cancer, and while most people feel denial or despair when they are diagnosed, these reactions do not always lead to clinical depression.
Cancer is a frightening illness – and the fear of cancer exists for many people who don’t have cancer. Gaye’s father was recently diagnosed with lung cancer. While, in itself, a traumatic diagnosis, it triggered memories of her mother’s battle with breast cancer, her sister-in-law’s death due to colon cancer and her own back-of-the-mind ‘knowledge’ that “she’d be next”. “There’s still this hush about the word cancer – no-one knows how to react or what to say, so no-one says anything”, says Gaye, who kept all her emotions and fears bottled up until she had a “melt down”. “Not talking about it seemed like the easy way to deal with the pain and the nightmare – but I became so depressed and burnt-out that I wasn’t helping anyone.” According to Gaye, her father is still in denial.
The sadness, anxiety and grief can be adaptive and healthy, and symptoms and fears usually lessen as the person accepts their diagnosis. “Becoming depressed shortly after diagnosis may be a normal, healthy, maybe even necessary experience that can help the grieving and adjustment process”, says psychiatrist Dr Dora Wynchank. “But if depression lingers, it may become toxic and have negative consequences and implications for survival.”
Depression is an illness and, like any other illness, it needs to be recognised and treated. Some people may have more trouble adjusting to the diagnosis of cancer than others and clinical depression affects about 25% of cancer patients. Depression should not be assumed to be a ‘normal’ part of dealing with cancer. “Depression affects a patient’s mental and physical wellness”, says Chambers. “It can get in the way of a person’s recovery and without treatment, can mean that the person stays ill.” Many people who are depressed while on treatment, don’t take their medication or stick to their therapy because they feel hopeless. Stigma, shame, expectations, and lack of support can all make people try to suppress their emotions. Many people who try to ‘put on a brave face’ and who ‘look fine’ aren’t. “My mom was diagnosed with breast cancer 6 months ago and everyone says how strong she is, how she just carries on and nothing gets her down”, says Yvonne. “But I hear her in the middle of the night sobbing and gasping for breath. It breaks my heart because I don’t know how to be there for her and she has been so strong for so long that she doesn’t know how to ask for help.” When people admit to their fears and worries, they don’t feel so overwhelmed. SADAG runs a helpline from 8am to 8pm 7 days a week on 0800 20 50 26, which people can call for help.
Research often finds important connections between depression and physical illnesses, but psychological help is often overlooked in treating illnesses like cancer. Yet, decreasing depression may improve not only the quality of life but also the quantity of life for cancer sufferers according to US researcher Dr David Spiegel. For many doctors, the challenge of helping patients through cancer is redefining priorities and seeing hope. “Many of us feel like we’ve been negatively transformed, we’re damaged by the cancer”, says Johan, 54-year-old cancer survivor. “My ‘salvation’ came when I stopped feeling like a victim and saw myself as more than the illness – I transcended the label and the stigma that goes with a diagnosis and now I live with it as best as I can.”
“Support groups, counselling, one-on-one therapy is all important to help people adjust to life changing situations – and cancer is a major one. If loved ones are able to express feelings openly and solve problems effectively, both the patient and family members have less depression”, says CANSA. And just as patients need to be evaluated for depression, so do their caregivers and family members. Caregivers, spouses and children are also affected when a loved one develops depression.
So what do you look out for? A person who cannot accept or adjust to the diagnosis even after a long time, and who loses interest in their usual activities, may be depressed. Even mild symptoms of depression can be upsetting and counselling is advised. “Even a patient who doesn’t have obvious symptoms of depression may benefit from counselling”, says Wynchank.. Someone who can maintain an active involvement in daily life activities, and function ‘normally’ as a spouse, parent, employee, or friend by incorporating treatment into his or her schedule, is generally the person who has adjusted to their diagnosis.
We should treat depression because it makes patients miserable. A diagnosis of cancer is difficult enough without having to pretend you’re not scared and sad. As Johan says “Stop surviving, start living” and talking honestly and openly is the first step.
Symptoms of Depression
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
- Insomnia, early-morning awakening, or oversleeping
- Appetite and/or weight loss or overeating and weight gain
- Decreased energy, fatigue, being “slowed down”
- Thoughts of death or suicide; suicide attempts
- Restlessness, irritability
- Difficulty concentrating, remembering, making decisions
- Persistent physical symptoms that don’t respond to treatment, such as headaches, digestive disorders, and chronic pain
By The South African Depression and Anxiety Group