A recent New York Times article “Cancer Patients Are at High Risk of Depression and Suicide, Studies Say” (Jessica Wapner, March 28, 2022) noted that “five percent of patients were diagnosed with depression after a cancer diagnosis, and the same was true for anxiety.” From my experience, this is a low estimate. For anyone who has faced cancer, it’s certainly not a surprise to read that depression and anxiety are side-effects. However, for oncologists focusing on treating the disease, psychological adjustment problems may not be in the forefront of their minds.
The article brought back memories of an exchange I had with 4 advanced cancer patients almost 20 years ago during the filming of Voices from the Lived World of Illness, a video produced by the Center for Communication in Medicine. It took a bit of digging but I discovered a transcript of the video.
As I sifted through the lengthy transcript, I found a section where Pat Barr, who was living with advanced breast cancer, admitted, “Eventually, the wear and tear is enormous psychically. I mean, I think walking anxiety unless drugged…”
“Yeah, for drugs,” echoed Adrienne Barnes, a pancreatic cancer patient,
Pat continued, “and fighting the drugs all the way. And I think that it’s an important element of care that people recognize that there’s that dimension to it. That there’s different of us cope with fear differently and different of us cope with hope differently. And, you know, the first time around I didn’t need any medication. Second time around I didn’t need any medication. First year of the third time I didn’t need any medication, and then it kicked in and I just needed it.”
As I sat with them, I heard 4 people offering a candid and heartfelt account of the emotional stress that cancer imposed on their lives. In reading further I found my words in the transcript. I said, “And there’s that, you know, stigma about how you’re supposed to handle your disease and normal reaction to a diagnosis. Fear, anxiety, depression and someone [doctor] says ‘they want me to see that guy [psychologist]. There’s nothing wrong with me. I’m not crazy.’ Imagine yourself hearing…imagine in one split second of your life…a moment ago, you were healthy and one moment later…”
Then, before completing my thought, Adrienne interjected, “Every day you wake up and it’s… and your whole sense of self has changed, you know, whether you want it to or not. You have to think of yourself as different.”
Pat concluded, “From the reading I know it took a long time for oncologists to decide that there was room for psychologists and psychiatrists in taking care of cancer patients.”
The findings of the studies are not a revelation to any patient or loved one who’s experienced the shock of a cancer diagnosis. The article’s author references Dr. Nathalie Moise, professor of medicine at Columbia University’s Vagelos College of Physicians and Surgeons, who concludes, “Normalizing mental health treatment as an integral part of your overall cancer care may also go a long way.”
The article not only reminded me of the video-taping discussion but also about my role as a medical humanist at the cancer center in Bennington where I’d ask patients about how they and their loved ones were coping with illness. In my note I documented what the patient said about their psychological adjustment problems. Then, the oncologist could discuss it with them and make a referral to a psychologist on the team, who, incidentally, thought of depression and anxiety as a “normal” side-effect of a cancer diagnosis. Nowadays, the protocol is for a nurse or social worker to administer a depression checklist, which is intended to trigger a referral to a mental health specialist.
The New York Times article confirms the importance of the emotional side-effects of a cancer diagnosis being identified and properly treated. That’s why the topic “Coping with Unwelcome News” is included in SpeakSooner: A Patient’s Guide to Difficult Conversations, which is aimed at helping patients identify and communicate their questions, concerns and supportive care needs. The Guide empowers patients to open conversations with their cancer care team about emotional distress and ask for help in facilitating referrals for mental health services. As I said at the video-taping, there should be no “stigma” attached to having a normal reaction to a frightening disease.