As a cancer patient, you may see many doctors and clinicians from a variety of medical disciplines during your treatment journey. A medical oncologist often leads the care team and helps determine a course of treatment. You may see surgeons or receive treatment from a radiation oncologist. Nurses, physician assistants, nurse practitioners and others may serve as key members of your care team. Then there is the psychiatrist. While not the first doctor you may think of when facing a cancer diagnosis, a psychiatrist may play an important role in treating stress, depression and other cancer-related side effects that sometimes interfere with treatment and impact quality of life.
"A lot of people who are diagnosed with cancer or dealing with cancer treatment develop emotional distress and anxiety," says Dr. Noah Horowitz, a Psychiatrist at our hospital near Phoenix. "They feel down. They feel scared. They have trouble sleeping. There are a lot of potential symptoms that overlap with what a psychiatrist does in practice treating major conditions. Not that all of those people need a specialist like me, but some might have a more severe reaction or severe symptoms."
Normal responses to life-altering events
Starting a new job, getting fired, having a baby, losing a loved one—these ups and downs of life often bring on a wave of strong emotions. Anxiety, depression and stress are normal responses in many life-altering events—both celebratory and difficult. When facing a cancer diagnosis, those emotions may become overwhelming. "My contention is many patients with a cancer diagnosis can be considered a post-traumatic stress disorder patient (“PTSD”)," says Dr. Lynn Bornfriend, a Psychiatrist at our hospital in Philadelphia. "The primary diagnostic criteria for PTSD are being in a situation you think might kill you or seriously hurt you. People who hear they have cancer may think, 'I might die.' It segues right into that pattern of exaggerated startled response and hypervigilance."
If not addressed, stress and anxiety may have a profound effect on the human body at a cellular level and may have serious effects on the body's ability to fight off disease. In physically or psychologically stressful situations, the body's glands, like pilots preparing for takeoff, start switching on systems that produce hormones that help the body cope. Adrenaline is released to help increase blood circulation, stimulate quicker breathing and prepare the muscles for exertion. Dopamine sends messages to the body's nerve cells. Glucocorticoids are on standby to deal with inflammation or to help trigger an immune response. Cortisol begins to increase the body's blood sugar.
"These are really good responses when you are trying to outrun a tiger," Dr. Bornfriend says. "Your heart rate goes up, your muscles tense, your breathing quickens, and your vision focuses and sharpens. But your body also moves energy away from certain things. When you are under stress, depressed or anxious, your body responds by dumping stress hormones like cortisol and catecholamines, such as adrenaline and dopamine. Chronic stress can dampen your immune response. It may leave you more exposed to a virus and your ability to absorb nutrients."
A 2003 study by researchers at Ohio State University concluded that stress, both short-term and chronic, "can have direct adverse effects on a variety of immunological mechanisms; both animal and human studies have provided convincing evidence that these immune alterations are consequential for health." And a 2010 study published by the National Institutes of Health links stress to cancer growth. "Chronic stress results in the activation of specific signaling pathways in cancer cells and the tumor microenvironment, leading to tumor growth and progression," the study says.
Exacerbating side effects
Stress and depression may also sap a patient of the energy and strength often needed to combat some of cancer treatments' draining side effects, Dr. Bornfriend says. Chemotherapy treatments may cause nausea and decreased appetite that then may lead to hair loss and weight loss. Fatigue may set in. Pain can be physically and emotionally taxing. "Not only do these things not feel good, but your experience with them may get so powerful, it can interfere with what needs to be done to treat your cancer," she says. "If you're so depressed and ask, 'What's the point?,' you may not push yourself to eat. Or you cannot rest at night because you are too anxious. How are you going to get the rest you need to be strong enough for your treatment?"
Enter the psychiatrist, who may work with your care team to recommend medications, such as anti-depressants and anti-anxiety drugs designed to help ease stress and improve mood. A psychiatrist may also recommend supportive care therapies such as massage therapy and acupuncture, to help ease stress or some of the side effects contributing to stress.
Despite the many potential benefits involved, some patients resist seeing a psychiatrist because of outdated and long-held stigmas attached to psychiatric care. "The stigma never really goes away," Dr. Horowitz says. "People, for whatever reason, based on their pride or their values, view it as a sign of weakness." But psychiatric care isn't just about helping people feel better. Psychiatrists may be called on for reasons other than depression or anxiety. They may recommend drugs such as bupropion (Wellbutrin® or Zyband®) or varenicline (Chantix®) to help with smoking cessation. They may be able to help patients with eating or sleep disorders or pain management. They also may help patients suffering from delirium, which is an acute state of disorientation or confusion that sometimes occurs during extended hospital stays. "Some patients who resist seeing a psychiatrist will say, 'What are you saying, I'm crazy?'" Dr. Bornfriend says. "People will argue, 'Of course, I'm depressed. I have cancer.' I get that. I'm not saying you're not entitled. I'm saying there are things we can do that may have a dramatic effect on how you fight this disease."
