Being diagnosed with cancer and undergoing treatment can impact a patient's mental well-being. A cancer diagnosis is a life-changing event. It can be overwhelming to deal with cancer treatment and side effects, while also handling the normal stresses of everyday life. Paul D. Thielking, MD, Assistant Professor of Psychiatry and Pain Medicine/Palliative Care at the Huntsman Cancer Institute at the University of Utah in Salt Lake City, Utah, says, stress associated with cancer and cancer treatment can manifest in many ways, including symptoms of depression and anxiety.
Recognizing Cancer-Related Mood Changes
Mood changes may occur at any time after being diagnosed with cancer. Some people experience depression or anxiety right after diagnosis. Others may have mood changes during treatment. When you undergo cancer treatment, your body may have reactions to the treatment, both physical and mental. Although mental changes may be harder to notice, they are just as significant as any physical changes. It's important to identify and manage mood changes. Symptoms of mood changes include:
- Feeling down or depressed
- Difficulty concentrating and remembering
- Loss of sexual interest or problems with sexual performance
- Changeable emotions (sudden crying or anger)
- Loss of interest in activities, social events, and socializing
- Changes in sleep (insomnia or excessive sleeping)
- Changes in appetite (overeating or loss of appetite)
- Loss of energy and motivation
- Feelings or hopelessness or worthlessness
- A feeling that life is not worth living; suicidal thoughts.
- Increasing interest in alcohol
- Frequent or excessive worry, unease, or fear
- Upset stomach or other physical symptoms
- Panic attacks
The Mood-Body Connection in Cancer
Andrew H. Miller, MD, Director of Psychiatric Oncology at the Winship Cancer Institute at Emory University School of Medicine in Georgia, says that most cancer treatments, as well as cancer itself, can activate the immune system to release inflammatory cytokines. Inflammatory cytokines are chemical messengers released from immune cells that signal to increase or decrease inflammation. "Research has shown that inflammatory cytokines can enter the brain and affect many of the brain circuits and chemicals that are involved in depression, anxiety, fatigue, and impairment in memory and concentration," Dr. Miller says.
Cancer treatments, including many of the chemotherapy medications, can directly impact the way people feel emotionally and physically, says Dr. Thielking. Common side effects of chemotherapy treatments include fatigue, nausea, loss of appetite, sleep disruption, and many symptoms of depression and anxiety. "Some people receiving chemotherapy may also experience difficulty with concentration or attention," he adds. "More severe side effects may include confusion, disorientation, or hallucinations."
If you are concerned that you have symptoms of anxiety, depression, or other emotional changes related to cancer and cancer treatment, Dr. Thielking recommends that you tell your cancer doctor.
"Your doctor can help distinguish whether your symptoms are related to stress or more directly related to treatment side effects," he says. "Your doctor can then help you develop a plan to feel better." But Thielking notes that your doctor may also go a step further. "Your cancer doctor may also want to refer you to a specialist, like a psychiatrist," to help address your problem, he says.
If you aren't sure if your mood changes are a concern, the NCCN Distress Thermometer can help. The NCCN Distress Thermometer is a tool that you can use to talk to your doctors about your distress. It has a scale on which you circle your level of distress. It also asks about the parts of life in which you are having problems. The Distress Thermometer has been tested in many studies and found to work well. Please complete the Distress Thermometer and share it with your treatment team at your next visit.
Some patients have mood changes that can be managed with self-help methods and support from others. Other patients have more serious mood changes. In these cases, experts in mental health can help. These experts include psychiatrists, psychologists, advanced practice clinicians, and social workers.
Psychosocial care has been found to help improve mood. Three types of psychosocial care recommended for cancer patients include CBT (cognitive behavioral therapy), supportive psychotherapy, and family and couples therapy. Your mental health team can suggest which type is best for you.
"Anti-depression and anti-anxiety medications are commonly used, and most cancer doctors feel comfortable prescribing these types of medications," Dr. Thielking says. "There are also medications that can help with common problems such as insomnia, concentration problems, or fatigue." However, he cautions patients to remember to ask about potential side effects whenever a new medication is started.