Neglecting Mental Health in Cancer Treatment

Research shows a significant link between psychological factors and survival.

Posted Feb 23, 2017

For many, receiving a cancer diagnosis can be as devastating to the psyche as the cancer itself is to the body. Given how many of our lives have been affected, it’s hard to imagine that cancer was once so shamed, it was referred to as the ‘c’ word. Thankfully, that’s changing. Awareness and advocacy have played and continue to play essential roles in prevention, early detection, and treatment advances.

What seems to be missing from the conversation, however, is the psychological impact of a cancer diagnosis and its implications in care and prognosis. This is clearly evidenced not only in the hollow literature on the subject, but also by the sparsity of resources available. Most baffling is the lack of attention paid by the medical specialists whose very job it is to help.

”As ongoing physical, psychological, and social needs affect the quality of life for patients and survivors, the existing method for delivering cancer care is becoming unsustainable and is not adequately configured to deliver high-quality cancer care to this growing population in the US.” -University of North Carolina Gillings School of Public Health

According to The National Cancer Institute, up to 25% of cancer survivors experience symptoms of depression and up to 45 % experience anxiety. Many also experience symptoms meeting the criteria of Post-Traumatic Stress Disorder (PTSD). Most concerning is that survivors are twice as likely to commit suicide than the general population.

For many cancer patients, negative psychological effects don't even begin until after treatment ends. This is often when distress sets in and one of the most crucial junctures during which attention must be paid to the emotional well-being of the patient. As important as it is to have support throughout treatment, perhaps more important is an ongoing sustainable support system that the patient can count on throughout recovery.

“Cancer survivors who are depressed are twice as likely to die prematurely as those who are not depressed” -Journal of Cancer Survivorship   

According to Floortje Mols, PhD, assistant professor of medical psychology and neuropsychology at Tilburg University in the Netherlands, “Depression is the most commonly studied psychological variable with respect to cancer mortality.” A study conducted by Mols and his team of researchers found a 19 percent higher mortality rate in depressed patients.

David Spiegel, MD, professor of medicine at Stanford University in Palo Alto, California, advises that “just as many oncologists now view pain as a symptom to be treated, they should also consider depression a symptom to be treated to improve quality of—and possibly extend—life.”  

Over the past several decades, The Institute of Medicine (IOM) has reported significant findings on the role that psychosocial factors play in health. “Many interventions traditionally considered irrelevant actually are quite important for the health status of individuals and populations.”  IOM is one of many organizations recognizing the need to address all aspects of our health, particularly in the treatment of cancer, “one of the nation’s most serious and burdensome illnesses.”

Just last month, the British Journal of Medicine (BJM) published the findings of 16 cohort studies conducted in England and Scotland over a 14 year period, that examined the role of psychological distress as a predictor of mortality in cancer patients. Based on self-reports of over 160,000 men and women, those with higher levels of distress had a 32% greater risk of total cancer mortality, specifically those reporting symptoms of depression and anxiety. These findings, the journal reports, contribute to the growing evidence of the link between psychological factors and cancer survival.

Help Is Out There

William Goeren, LCSW, director of Clinical Services at CancerCare states:

"Being diagnosed with cancer causes distress and changes life in the time it takes to hear 'You have cancer!' and often results in severe and, sometimes, permanent changes to important components of well-being and quality of life such as professional productivity, financial stability, familial and social relationships, life predictability and consistency, and hope and plans for the future."

CancerCare is a leading national non-profit organization- one of only a handful- that provides comprehensive services to patients and caregivers, including counseling, phone, online and in-person support groups, educational workshops and others, all at no cost. 

A Walk Toward Healing

When Nick Arquette was a child, his mother was diagnosed with breast cancer. Much of Nick’s childhood was spent caring for her, which he says required him to ‘grow up’ rather quickly.  “The trauma of losing someone lasts- it doesn’t go away. So, the question becomes how can we turn it into something positive?”

For Nick, one way was by building a strong social support system. Friendships and social connections became his lifeline. “Those connections were the most helpful to healing.” Continuing to turn his pain into something positive, Nick founded Walk With Sally (WWS), a non-profit organization named in memory of his mother.

WWS matches children who have a parent or sibling with cancer with a mentor who is either a cancer survivor or has a parent or sibling with cancer. Other services offered to mentees include meditation, art therapy, and referrals to mental health counseling. Program Manager of WWS, Julie Cegelski, who lost her father to cancer in 2010, says: “Walk With Sally has impacted my life tremendously. My heart is able to heal through the work that we do at Walk With Sally.”

More Work Ahead

The American Cancer Society estimates that there were over 1,600,000 new cancer cases and more than 500,000 cancer-related deaths in the United States alone in 2016. On a global level, cancer accounts for nearly 1 in 7 deaths - that's more than HIV/AIDS, tuberculosis, and malaria combined.

In order to improve overall quality of cancer care, a more holistic approach to treatment is needed, beginning with the assessment of a patient as a whole person. Such an approach would take into account the significant role mental health and other psychosocial factors play in the body’s ability to recover.

Some places to start

  • More research on the intersection between psychological well-being and cancer survivorship
  • Inclusion of mental health care in the training of medical professionals
  • A collaborative, interdisciplinary approach within hospitals and facilities, e.g, Oncology and psychiatry working together
  • Periodic psychiatric evaluations, such as depression screenings for cancer patients beginning at the time of diagnosis
  • Availability and access to free counseling services for patients
  • More funds toward resources for mental health services, particularly for cancer patients and their families
  • Health care coverage that includes access to providers with expertise in the treatment of mental health conditions in those with cancer

When considering our health, we cannot neglect our emotional and psychological well-being. Stigma, lack of awareness and lack of access to resources remain deterrents to patients receiving the best care. If mental health care were acknowledged not only as a normal part of the process but as an integral part of treatment, patients might feel less alone and more empowered to speak up and seek help, and ultimately, live longer, healthier and happier lives.

References

Arquette, N. & Cegelski, J. (2017). [Phone Interview] www.walkwithsally.org