Not Just the Blues

Some level of sadness is normal after receiving a cancer diagnosis. The fear of dying, negative changes in self-esteem and body image, interruption of life plans, and other physical and emotional issues can easily cause a cancer patient to feel downcast—and downright fearful.

Jimmie Holland, MD, attending psychiatrist at Memorial Sloan-Kettering Cancer Center, says that feeling sad is a part of dealing with a chronic illness such as cancer. Prolonged sadness, however, may be due to depression.

Research has shown that about 20 to 40 percent of cancer patients experience depression. Most of these, Holland says, are minor to moderate cases. About 10 percent suffer from severe depression. These patients are less likely to take their medication, maintain their health, and are more likely to withdraw from support, she says.

Emotional symptoms include a continuously dejected mood, loss of pleasure or interest in activities, increased feelings of guilt or worthlessness, and thoughts of death or suicide. Physical symptoms include weight loss or gain, fatigue, difficulty concentrating, and sleep disorders.

Doctors diagnose depression when five or more of the physical and emotional symptoms are present daily for two weeks or more or when they begin interfering with normal life activities.

Dealing with major lifestyle changes and financial issues, such as those that accompany a cancer diagnosis, can cause emotional distress that can turn into depression.

Depression also can be a side effect of chemotherapy, hormonal therapy, and drugs that manage symptoms such as nausea and pain. Holland says the two biggest culprits in this category are interferon, used to slow growth in certain tumors, and steroids, given to reduce potential allergic reactions to different cancer treatments.

Cancer-related risk factors for developing depression include poorly controlled or increased pain, increased physical impairment, and an advanced stage of cancer. Other risk factors include a history of depression, lack of family support, history of alcoholism or drug abuse, and having other medical issues besides cancer.

The Institute of Medicine recommended in 2007 that all new and recurring cancer patients should be evaluated during their appointments for their level of distress.

The screening process lets patients rate their level of stress on a scale from one to 10. If the patient‘s level is four or higher, a discussion about potential causes should take place. The nurse or oncologist should then refer the patient to the proper psychosocial resource.

“Quality care today can’t be done without this dimension being included,” Holland says.

Patients with mild to moderate depression are largely treated with counseling, she says. This is done through cognitive-behavioral therapy, support groups, and religious and spiritual resources.

Research studies have shown complementary therapies, such as yoga and regular exercise, also benefit patients with mild to moderate depression.

Most patients do not require antidepressant medication unless they suffer from major symptoms or have difficulty sleeping or eating, Holland says.

If your doctor prescribes an antidepressant, he or she needs to know all medications and supplements you are taking to avoid possible drug interactions. For example, St. John’s wort can cause pronounced side effects or diminished activity of other drugs by interfering with their metabolism or activity.

The American Psychosocial Oncology Society provides a helpline at 1-866-APOS-4-HELP (1-866-276-7443) that can help patients find a counselor in their local communities who is familiar with cancer issues.