Reflecting on the effects of cancer on mental health this Cancer Survivors Day

Sunday, 4 June 2023, is Cancer Survivors Day, a day that unfortunately some never get to celebrate. But for most patients who do celebrate it, they first have to go through the hurdle of depression and anxiety that comes with the deadly disease.

“Healthcare professionals may miss the diagnosis of depression and anxiety because they have a false belief that these disorders are normal when facing death,” says Dr Michelle King, a specialist psychiatrist and member of the South African Society of Psychiatrists.

“If left untreated or undiagnosed it can impact the patient’s ability to function on a daily basis, including going through treatment.”

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With more than 30% of cancer patients diagnosed with depression, the South African Society of Psychiatrists calls on National Cancer Survivors Day for greater awareness of patients suffering from mental health disorders.

The mental effects

King says being diagnosed with cancer and being a survivor is a scary and emotional experience, and some people may go through a period of grief before being able to accept their diagnosis. Others may become depressed and anxious.

“The sudden nature in which the cancer is diagnosed, and the uncertainty associated, can trigger fear which could lead to depression and maladaptive anxiety,” says the psychiatrist.

“Patients may feel hopeless, despair, a sense of failure and grief as their chance to a long and healthy life is under threat. Getting through the day becomes a struggle since they must deal with treatment, symptoms, and the uncertainty of their longevity.”

Cancer is the second leading cause of death globally, with an estimated one in six deaths (9.6 million). The most recent statistics available indicate that in South Africa 108 168 men and women were diagnosed in 2020 with cancer.

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Pain, fatigue, loss of appetite and insomnia are common symptoms experienced by many patients diagnosed with cancer. Poorly controlled pain could lead to or worsen mental health conditions such as depression and anxiety.

“Those who are survivors might alternate between disheartenment, isolation and fear, to times of hopefulness when returning from a successful follow-up screening. The goal is to find a middle-ground for one’s mental health between treatments, remission or possible relapse,” says King.

Palliative care

Dr King says early referral to palliative care services can have a significant improvement in terms of reducing suffering and prolonging the patient’s life.

“Palliative care is specialised care for people living with a life limiting illness. It focuses on providing support and helping patients, and their families, make informed decisions about their treatment. As well as providing relief from physical symptoms and psychological and emotional distress.:”

“The team provides an extra layer of support, working closely with the patient’s doctor, and is based on the needs of the patient, rather than the prognosis.”

According to the Dr this type of care is appropriate at any age and at any stage in a life limiting illness, and it can be provided along with curative treatment. “The goal is to improve the quality of life of the patient, and their family, by means of a multi-disciplinary team. This team provides emotional support and help the patient and their family come to terms with the reality of cancer.”

Making the diagnosis of depression is challenging as there is an overlap between many of the physical symptoms caused by the medical condition with those experience with a depressive episode.

These symptoms may include:

• Loss of energy;
• Insomnia;
• Fatigue;
• Loss of libido;
• Weight change;
• Appetite change.

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If you are experiencing these symptoms together with any of the following symptoms, please seek support:

• Excessive feelings of hopelessness, guilt, and worthlessness;
• An ongoing depressed or dysphoric mood;
• Wishing for a hastened death;
• Suicidal thoughts or plans;
• Social withdrawal;
• Loss of pleasure in daily activities;
• Irritability and agitation;
• Anxiety;
• Psychotic features (delusions, paranoia) with a depressed mood.

Where to seek help:

PALPRAC, has a list of palliative care providers and services in your area.

In addition to working with a palliative care team, patients and, or, their family members, can reach out to the CANSA help desk who provides counselling, support groups and peer-to-peer interaction.

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