Depression and Cancer: More than a Side Effect?

This post was written by Curtis Pesmen, survivor and author of My Cancer Year. With the heightened awareness of depression this week, we hope colorectal cancer patients facing depression read this to understand the psycho-social impact of cancer and seek help if needed. On a personal note, our condolences to Curtis and his wife who had a friendship with Robin Williams and his wife. Read Curt’s tribute to him posted in Esquire this week. 

 

For all the advances and new diagnostics in cancer therapy, a stark fact remains: There is no standard CT scan for depression. (At least not yet.) And depression often follows cancer diagnoses.

This is but one reason why it remains difficult to diagnose and treat depression among so many cancer patients and survivors. Beyond initial shock or sadness about a diagnosis, survivors often experience later phases of mood swings or disorder that bring common, complex questions:  They wonder whether feeling despondent, angry, or helpless is normal—normal, that is, for someone who already has been diagnosed with a life-threatening illness. They also wonder how long feelings like these tend to last.

Oncology researchers state that approximately 25 percent of cancer patients develop or have clinical depression.

“It’s been months since I’ve finished treatment… I’ve noticed a sense of depression…loneliness…it’s hard to see the future…is this normal?”—a survivor’s lament, 2014

In 2014 then, even the best oncologists, therapists, and psychiatrists all utilize a set of diagnostic criteria that are updated and carefully reviewed, but by their nature remain imprecise. Doctors rely on DSM-5, The Diagnostic and Statistical Manual of Mental Disorders to make their decisions, guided by patient input.

It’s not nearly so black and white as an X ray or similar image of a tumor, yet left untreated it also can be a life-threatening condition. For survivors and their caregivers, then, it helps to know what to look for in order to separate sporadic, or “episodic” depression moods from a diagnosis of clinical depression.

Episodic Depression vs Clinical Depression

These eight signs are among the most common symptoms:

  • Persistent sadness, empty feelings
  • Loss of interest in daily activities
  • Fatigue
  • Feelings of guilt, worthlessness
  • Loss of concentration
  • Sleep problems
  • Marked weight loss or gain
  • Suicidal thoughts, hopelessness

Whenever symptoms last longer than two weeks, and they don’t seem to be caused by your cancer medications (or by radiation in the case of rectal cancer patients), it is time to be evaluated for depression.

Depending upon your health community, therapists or psychiatrists can offer counsel; so can specialists known as psycho-oncologists .

Clinical depression causes great distress, impairs functioning, and might even make the person with cancer less able to follow their cancer treatment plan,” —American Cancer Society

Better Mental Health Treatment Plans

Fortunately, with so much uncertainty in patients’ and survivors’ lives, the federal Institute of Medicine (IOM) (with its 2005 guidelines: From Cancer Patient to Cancer Survivor: Lost in Transitionhelped extend the reach of survivorship medicine. The report called for doctors both inside and outside the oncology community to take notice of survivor moods as part of regular, ongoing survivors’ care.

Beyond causing fear, distress, and often impaired functioning, depression linked to cancer might cause patients to alter their protocols, or to disrupt their actual cancer treatment plan.

Ellen Stovall, a survivor, an editor of the IOM report, and senior health policy advisor to the National Coalition for Cancer Survivorship, points out two related, key areas of ongoing concern:

  1. comparing ‘usual care’ of survivors, including mental health surveillance, with the IOM cancer survivor guidelines;
  2. looking at patients’ adherence to taking medication (properly), which can be affected by mood disorders and depression

 

“I’ve always thought that post-cancer treatment is a lot like posttraumatic stress [disorder]. All of a sudden, you’re home and things are supposed to be great, but your head is still in the battle. It takes time.” —Nancy Roach, survivor, founder and Board Chair, Fight Colorectal Cancer

 

Sometimes, from a clinician’s point of view, patients can be helped by different interventions at different points in their treatment and disease progression. (It’s not always depression drugs that work best, nor always support groups for those fighting the same type of cancer.)

“How do you feel?” Takes on New Meaning

Wayne Bardwell, Ph.D., a psycho-oncology specialist and associate professor in psychiatry at the University of California-San Diego, believes that “it should be much easier to identify a psychosocial intervention to target a [specific mood] characteristic than a diverse group of patients who just happen to have the same kind of, stage of, and treatment for cancer.”

When therapists truly are tuned in to specific cancer-related moods and emotions, they can provide targeted behavioral therapy in new, helpful ways that weren’t available just a generation ago.

Colorectal Cancer Survivors and Less Positive Outlooks

Not long ago, a study funded by the National Cancer Institute and published in an American Association of Cancer Research (AACR) found that colorectal cancer survivors—when compared with breast cancer, melanoma, and other cancer survivors—tended to have “less positive outlooks” and poorer quality of life reports.

There was no clear finding as to why colorectal cancer survivors seemed to have a tougher time coping mentally, but investigator Kathryn E. Weaver, Ph.D., MPH, assistant professor at Wake Forest Baptist Medical Center in Winston Salem, N.C., told this blog: “What stands out for me are the long-term difficulties with bowel and bladder functioning that many survivors with colorectal cancer may face as a consequence of treatment…. I would expect them to impact physical well-being.”

When Dr. Weaver talks about impacting survivors’ “physical well-being,” she isn’t discounting emotions. In fact she and her colleagues are circling back to mood—and the brain—the most important organ of emotional recovery following cancer treatment.

If only the newest PET and SPECT and scans of the brain could catch up more quickly to the advanced CT scans that now pinpoint micro-tumors in the smallest spaces and at the earliest stages. Then depression could perhaps be whittled down to size more quickly and more effectively, relieving survivors of yet another burden they hardly need.

Resources for Cancer and Depression

If you need help finding resources in dealing with quality-of-life issues, please consider using the resources below:

 

 

Sources:

http://www.iom.edu/Reports/2005/From-Cancer-Patient-to-Cancer-Survivor-Lost-in-Transition.aspx

Press release, AACR News ; Cancer Epidemiol Biomarkers Prev; 21(11); 1–10

(abstract published online Oct. 30)