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Dealing with cancer: Are you anxious, depressed or both?

Depression and anxiety are feelings that patients sometimes have when coping with upcoming surgery or a cancer diagnosis.  

Depression and anxiety are common amongst Australian women and can complicate the detection, treatment and follow up of cancer. Seeing medical specialists, going through tests and having cancer treatment is stressful, indeed. However, for patients suffering from anxiety or depression, cancer diagnosis and treatment can be extremely fearful. Patients can be overwhelmed by the loss of control; patients panic, delay decisions or make poor choices for themselves.

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How common is depression and anxiety during cancer?

My team recently published a paper in the journal Gynecologic Oncology and in a study of 719 early stage endometrial cancer patients we found one in eight patients already had medications prescribed for depression and anxiety before diagnosis and surgery.  Prescription was more likely in those of younger age, a history of previous cancer and higher number of comorbidities.

In another study of 893 women with ovarian cancer researchers found more than 40% experienced a form of anxiety or depression during treatment or the first three years of follow-up.

Difference between depression and anxiety

Many people with depression also develop anxiety or vice versa.

Anxiety

Anxiety is a term that covers a range of more specific conditions most commonly generalised anxiety disorder, however it also includes phobias, panic disorders, adjustment disorder, and overly or undue stress reaction. Those with generalised anxiety disorder experience excessive anxiety and worry on most days, not just in specific stressful situations and find it difficult to control these feelings. Worries can relate to several aspects of daily life rather than just one issue.

In contrast to the adjustment to surgery or a potentially life-threatening condition, anxiety can also be a condition that has been present for a long time.  During the normal daily life, anxiety can be managed reasonably well; however, with additional stressors such as cancer, patients lack options to handle these new stressors. In such cases anxiety can suddenly have profound effects on the health of patients needing the input of a gynaecological oncologist.

Depression

Feeling down or sad is common in hard situations and usually is temporary without severely affecting your life. However, clinical depression is different from feeling down or sad and is more than a mood you can snap out of. Symptoms of clinical depression include feeling low or flat, losing interest in activities you used to enjoy, experiencing a change in appetite or weight (although this may also be side effects of treatment), having sleep problems, finding it difficult to get up in the morning or a feeling that overall life isn’t worth living. Effects of depression may be severe. Depression can also be common among cancer survivors, even long after treatment has been completed. The fear of cancer recurrence may make you susceptible to depressive thoughts or emotions. 

What can help?

Our physical and mental health are connected. Poor physical health can affect you mentally, and poor mental health can affect you physically. In my 20 year experience, I find that patients with severe anxiety and depression that is left untreated face a worse prognosis. The sooner people get support, the more likely they are to recover.

It is important for our practice to find ways of helping you to deal with your feelings. Here I discuss some ways that may help improve mental health during cancer.

  • Find other patients to talk to who are going through the same journey. In my office, we can arrange contact between patients, we can also do this for patients who require certain operations that don’t involve cancer. It can greatly help someone when you can share your experiences and ways of coping with someone in a similar situation as you. 
  • Develop relaxation methods. Breathing, mindfulness, or yoga. Try deep breathing and relaxation exercises several times a day. Researchers reviewed seven clinical trials which overall included 888 cancer patients and found that mindfulness-based interventions effectively relieved anxiety and depression among patients. Another review of studies found women with a breast cancer diagnosis who practiced yoga improved their mental health.
  • A balanced and nutritious diet will help you to keep as well as possible.
  • Exercise.  Regular exercise can be a healthy distraction. Exercise produces endorphins (chemicals in the brain that act as natural painkillers) and also improve the ability to sleep, which reduces stress. Physical exercise has attracted increased interest in rehabilitation of cancer patients. Particularly for patients undergoing chemotherapy, exercise can reduce the number and severity of physical and psychosocial treatment-related side effects and improve a patients’ quality of life. I am currently involved in the ECHO trial. The ECHO trial evaluates the effects of an exercise intervention during firstline chemotherapy for ovarian cancer. For those who may be interested in participating in the trial see here
  • See a GP with a special interest in depression or anxiety. I do not prescribe medication for depression or anxiety because it is outside the spectrum of my qualification. I witnessed that for some patients medication has worked wonders. They are so more relaxed and are able to tolerate treatment a lot better and enjoy life again. Think about also asking your GP to refer you to a psychologist who can work with you and your family for ongoing help. I can also refer you to a psychologist.
  • Beyond Blue also has a 24-hour anonymous phone service for those suffering mental distress. The Cancer Council (13 11 20) helpline is a free, confidential telephone information and support service for cancer patients.

Depression and anxiety are not conditions that will simply go away easily, and like all forms of therapy, the effect can vary. Depression and anxiety, if not addressed properly can affect cancer diagnosis and treatment in many ways.

What helps:

Talking openly about anxiety or depression is very helpful. The journey that patients and her medical specialist take, will become very challenging if the patient or the doctor pretend that these issues don’t exist.

My rapport to patients is certainly a lot better if we can discuss mental health issues, similar to how we discuss cardiac conditions, hypertension or allergies.

The above strategies are a good starting point to get on top of depression and anxiety, and after trying some different options you will find what works for you.

If you wish to receive regular information, tips, resources, reassurance and inspiration for up-to-date care, that is safe and sound and in line with latest research please subscribe here to receive my blog, or like Dr Andreas Obermair on Facebook. Should you find this article interesting, please feel free to share it. 

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