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Mental health may pose challenges before and after a cancer diagnosis

Mental health
In addition to physical challenges, your mental health before and/or after your cancer diagnosis, may also need to be addressed.

Many patients are faced with other medical challenges, in addition to their cancer diagnosis. Some conditions, such as obesity, diabetes or heart disease, may be been diagnosed before their cancer and may have contributed to their disease. Other conditions, such as fatigue or infertility, may develop after their diagnosis, sometimes as a result of treatment side effects.

In addition to physical challenges, your mental health, before and/or after your diagnosis, may also need to be addressed. For example:

  • Pre-existing mental health problems may lead to behaviors, such as heavy drinking or smoking, that put people at greater risk for developing cancer, or may make them less likely to seek treatment once cancer symptoms start emerging.
  • Mental health issues may cause a person to miss cancer treatments, potentially worsening their health outcome.
  • Mental health issues may arise in people who are unable to cope with a cancer diagnosis or the rigors of cancer treatment, or with cancer survivors struggling to re-establish normal lives.
  • Cancer symptoms and side effects may induce or amplify mental health issues.

“Any cancer treatment needs to take a multidisciplinary approach and involve people from different disciplines, and mental health has to be a part of it,” says John Kenny, MD, Psychiatrist at Cancer Treatment Centers of America® (CTCA), Phoenix.

Pre-existing mental health disorders

Young adults with emerging mental health problems may develop lifestyle habits that may increase their risk of developing cancer, according to a 2017 study for the U.S. Centers for Disease Control and Prevention. The factors may include poor eating habits, lack of exercise, excessive alcohol use and smoking. These individuals may also have less access to health care and face other obstacles to accessing health services.

study completed this year of more than 50,000 U.S. veterans treated for lung cancer by the U.S. Department of Veterans Affairs found those receiving treatment for their mental health problems were more likely to have cancers diagnosed at an earlier stage and to have better outcomes than veterans whose mental health problems went untreated.

“Significant mental illness may lead to delays in discovering the cancer and diagnosing the cancer,” Dr. Kenny says. “It may also lead to a decrease in the frequency of follow-up and the quality of follow-up—where patients don’t get the care they need to get the cancer under control.”

Dealing with a cancer diagnosis, treatment and survivorship

A cancer diagnosis may conjure up worst-case scenarios, including a patient’s own mortality, which may make critical decision-making difficult. Dr. Kenny remembers a breast cancer patient in need of a mastectomy who “essentially froze for a period of almost two weeks,” unable to decide about the surgery needed to potentially save her life.

“Had the mental health team not gotten involved, she essentially may have just stayed in a mixture of denial and severe, crippling anxiety and not treated the cancer,” he says.

Even after treatment, survivors may feel more vulnerable, may have surgical scars that affect how they view themselves, and may fear a relapse or spread of their cancers. Each of these emotions may affect their quality of life. Despite the emotional toll of a potentially terminal diagnosis, many patients are able to work through their issues without psychiatric intervention, Dr. Kenny says. "They push through it and keep going to treatment, and eventually, they get through the whole process,” he says.

Treatments that cause mental health side effects

Dr. Kenny says some therapies and conditions related to cancer are known to cause mental health issues, such as:

  • Anti-estrogen treatments for breast cancer and anti-testosterone medications for prostate cancer, which may create hormonal imbalances affecting mood and anxiety
  • Steroids, which may affect mood
  • Brain radiation, which may produce mood or cognition issues
  • Brain metastases, which may lead to mood problems or psychosis

“There’s a whole group of factors, that even if a patient didn’t walk in the door in the beginning with any kind of mental health issue, there are points along the way where things can turn that way,” he says.

Advice for caregivers

Dr. Kenny says some mental health signs to watch for in cancer patients or survivors include:

  • Depression
  • Lack of interest in activities
  • Lack of proper sleep
  • Overwhelming anxiety
  • Hallucinations
  • Drug abuse
  • Heavy alcohol consumption

Dr. Kenny recommends that patients or their caregivers reach out for mental health services or to their care team when such signs emerge, “because the long-term effect of any of those is not going to be good,” Dr. Kenny says. “We can work with them to get them through it.”

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