Feature

On Cancer: Depression Can Be Dangerous in Patients with Cancer, But Help is Available

By Celia Gittelson, BA  |  Monday, October 7, 2013
Pictured: Mary Jane Massie & Patient Mary Jane Massie (left) counsels women with breast cancer and their families.

Depression may not be the first thing a person thinks about when faced with a cancer diagnosis. Other words and ideas may more immediately come to mind: fear, despair, a sense of urgency. However, during treatment, and even long after it ends, depression can play an important role in how well a patient fares.

“We’ve learned that depressed people generally do less well in the oncology setting,” explains Memorial Sloan Kettering psychiatrist Mary Jane Massie. “This is probably due in part to the fact that because they feel bad — psychologically, physically, or both —they decide it isn’t useful to take their medications. And there can be a domino effect: They stop filling their prescriptions and may even start to miss medical appointments. But there is a lot of help available.”

Dr. Massie, who specializes in the psychological treatment of people with breast cancer and their families, points out that comprehensive cancer centers are now required to offer emotional support services for patients and that Memorial Sloan Kettering has a myriad of them. “We have so many gifted and highly trained professionals specializing in all areas of psychological counseling, that we are able to accommodate the needs of virtually any patient with any type of problem,” she says.

Emotional Support: Actual and Virtual

Individual counseling and group support can be very useful and are usually available at large urban medical centers. Such centers often offer groups for people with specific types of cancer, with cancer at different stages — from those who are newly diagnosed to those with metastatic disease — and even for people of different ages. 

However “out in the heartland, at smaller hospitals, there may be just one support group a week,” says Dr. Massie. “Men with prostate cancer, people with lung cancer, and women with breast cancer may find themselves in the same group.”

But with a burgeoning social media universe, another, more recent option is virtual groups or online support groups. These can be helpful to people who do not have access to a group that focuses on their particular illness, age, or gender, or who, because of the illness itself, find it difficult to travel to a medical center or a psychiatrist’s office.

“Social media such as Facebook can be used to develop emotional and psychosocial support networks,” Dr. Massie says, “and can be extremely effective.”

Medications: How They Can Help

Not all people are willing to join a group. Some patients are unwilling to acknowledge that their moods may be changing or that they could be suffering from depression as a result of dealing with cancer and its treatment. Others may simply not be “joiners.”

In either case, Dr. Massie encourages oncologists to begin a conversation about mood and depression, consider prescribing an antidepressant, and then referring a patient to a psychiatrist for followup. “Patients should also feel free about asking their oncologists for an antidepressant if they sense they may be getting depressed or are feeling anxiety,” says Dr. Massie. “These medications can be enormously helpful.”

“There are many different antidepressants available,” Dr. Massie elaborates. “Everyone is different and what works for one person may not work for another. Some antidepressants are energizing and some are sedating. So if Person A needs a boost in mood, we might consider one of the more energizing drugs. If Person B is having anxiety, trouble sleeping, and depression, we would look to a drug that has a slightly sedating effect.”

Depression after Treatment

Dr. Massie most often sees patients after they have received a cancer diagnosis and during the time they are receiving treatment. However, patients are also referred to her after they have finished treatment, sometimes even as long as a year later. “Certain people are able to hold it together very well during diagnosis and treatment, but then ‘lose it,’ when treatment is over,” she observes.

Surrounded by skilled healthcare professionals and supportive family and friends during treatment, a person can suddenly feel cast adrift once treatment has concluded.

“It can be frightening, even lonely, to be back in the ‘real world,’” Dr. Massie says. “People may be tired of hearing about your cancer. Your co-workers may just want you to get back to your desk and do your job. Even family members may be worn out and no longer eager to talk about it.” As cancer survivors ease their way into the lives they knew before cancer, psychiatry and medication may again play useful roles.

End of Life

Although there are approximately 14 million cancer survivors in the United States today, there are, unfortunately, those who will eventually succumb to their disease. For people who are receiving palliative care and nearing the end of their lives, specially tailored counseling is available.

“This may include talking about dying, how to talk about death with your children, and other issues,” says Dr. Massie. For many patients, a combination of group and individual counseling can be helpful, along with medication.  “Hospice workers are very tuned in to patients’ needs — including their psychological and emotional needs — and can be invaluable in this regard,” says Dr. Massie.

Comments

Thank you for an excellent article on the benefits of psychosocial support for cancer patients, survivors, and their caregivers. I encourage anyone who is affected by cancer and who is struggling with sadness, anxiety, or anger to reach out to your health care providers. Ms. Gittelson offers great ideas for finding sources of emotional support.

what to do if the doctor/ surgeon is opposed to prescribing anti depressants?

Dear Stefanie, we sent your inquiry to Dr. Massie, and she responded: "Sometimes oncologic specialists are not comfortable prescribing antidepressants or anti-anxiety agents because they are unfamiliar with dosing strategies for these drugs/feel not well trained to prescribe these drugs. Many times our internist, gynecologist or family practice doctor IS comfortable prescribing antidepressants and many patients with depressed mood and/or anxiety turn to these doctors for help. All comprehensive cancer centers have mental health professionals who are comfortable prescribing antidepressants and antianxiety medications and in many communities in the US there are mental health professionals who specialize in working with individuals who are being treated for cancer and will be happy to prescribe these drugs when indicated."
Thank you for your comment.

Could you please address depression in cancer patients with adrenal cancer where hormones may be affecting mood? Our depression medications recommended in these types of cancers?

Sarah-Jean, we forwarded this to Dr. Massie, and she said it is a great question, adding that "yes, antidepressants are prescribed when depression results from hormonal Imbalances resulting from cancer and when hormones used to treat cancer cause depression. This applies to both men and women and to people with various types of cancer." Thank you for your comment.

* Are

I had bladder cancer and iv'e been through chemo and had surgery on Jan. 21st to remove the bladder and now have the bag. I haven't even changed the bag yet because i don't want to face it thank god for my wife.Sometimes when alone i just sit and cry i sometimes think i should have done nothing and let nature take it's course because i'll never be who i once was.I don't know what to do i didn't think i would be able to do the treatments and surgery and now i don't think i will make anyway or if i want to living this way.

Bobby, we are sorry to hear about your diagnosis and what you've been through. It is normal to feel worried, sad, angry, anxious, or isolated when affected by a serious illness. Know that you are not alone and there is help available.

Our psychologists and psychiatrists are trained to help people cope with the emotional impact of cancer diagnosis and treatment. To make an appointment, please call our Counseling Center at 646-888-0100.

We also offer a monthly support group designed to give people with bladder cancer an opportunity to work on adjustment to life after treatment and enhance physical and emotional recovery. For more information about this group and to register, go to http://www.mskcc.org/cancer-care/survivorship/upcoming-programs/bladder-challenges-and-solutions?dtstart=1394726400&dtend=1394731800

Out Patient-to-Patient Support Program that offers the opportunity to speak with a cancer survivor who has had a similar diagnosis and treatment experience. For more information about the program go to http://www.mskcc.org/cancer-care/counseling-support/patient-patient-support or call 212-639-5980.

Our online community, called Connections, is a way to exchange support, information, and inspiration with other cancer survivors. Learn more at http://www.mskcc.org/cancer-care/counseling-support/connections-online-community

Hopefully one or more of these resources will be helpful for you. Thank you for reaching out to us.

My dad had throat cancer last year and has recently had this 1 year scan that has come back clear, however he seems to be very down and not doing anything that he would normally do. He has just been sitting on the couch and burst into tears for no apparent reason and has trouble making himself go to work.
He also is also frequently asking my mum not to leave him. I just want to know if this is common after having completed treatment and if there is something I we can do as a family to help him. Any kind of suggestion is welcome, I just really want to help my dad.

Dear Traci, thanks so much for reaching out. We're so sorry to head that your dad is having a difficult time. If your dad is in the New York area, he may wish to consider making an appointment with one of the therapists from our Counseling Center: http://www.mskcc.org/cancer-care/counseling-support/counseling-outpatients. If he is outside New York, he (and your mom) may want to participate in our Virtual Groups program. These online support groups, conducted over the phone and by computer, allow patients and caregivers to connect with people who are going through similar experiences. You can learn more about the program by going to http://www.mskcc.org/cancer-care/counseling-support/virtual-groups or emailing VirtualGroups@mskcc.org. Thanks again for your comment, and let us know if there's anything else we can do.

MY husband is diagonised with lung cancer. vertebroplasty done for three vertebra. He is given 6 cycles of chemo with pemetrexed, avastin and carboplatin. afterwards maintenance therapy with only pemetrexed. however, after two cycles of pemetrexed, disease grew in bones. For pain relief, given radiation. afterwards took two cycles of chemo with docetaxel. but developed severe throat infection, after every cycle. WBC came down. Docetaxel has been discontinued. Now erlotinib tab 150 mg being given. Every night he takes one tablet. but he has severe rash. he is applying oil , moisturiser almost continuously on the skin, he is having burning sensation on the skin. so he is continuously sleeping with covered with a blanket, though it is summer.

My husband was diagnosed with advanced metastatic appendix sigmoid adenocarcioma involving the peritoneum in Feb, 2014. He has undergone 6 cycles of chemo (will continue them for the rest of his life) and has tolerated them fairly well but he is extremely depressed. He repeatedly refuses any professional help but he is in dire need of it. When asked if he is suicidal he says no but in my head I disagree....what he is doing is a slow death.

He refuses to leave the home unless it's for a doctor's appointment and is living on less that 800 calories (most likely 300-500) a day if that much. Basically starving himself to death. All you see are his ribs. He is extremely weak (needs a walker) because of his refusal to eat.

Hygiene is out the window. Agrees to bathe only once a week and we always wind up fighting about it.

I am a pretty optimistic person but I don't see him getting any better and having a quality of life in which we could enjoy life, each other and our new grandbaby.

In his last visit, he had lost 10 lbs (aside from the weight he previously lost) within a 2 week period. He was extremely upset that he lost so much weight and started crying. Couldn't understand how that could happen. Unfortunately, I think when he returns again for the next round next week, he will have lost another 10 lbs.

At what point does the oncologist say" enough" to the patient? "You need to reevaluate what your expectations are?"

I feel all we do is argue because I know what he needs to do to maintain some sort of quality of life and he is just not cooperating. He tells me it's his life and he will make his own decisions.

Any help/advice you can provide will be very appreciated.

Els, we are very sorry to hear about what you and your husband are going through. If you haven't already, we recommend that you speak with your husband's healthcare providers about your concerns. They should be able to give you a referral for someone you and your husband could speak with about these issues.

If you are in the New York area, you may wish to make an appointment with the MSK Counseling Center. You can get more information at http://www.mskcc.org/cancer-care/counseling-support/counseling-outpatients

In addition, you and your husband may find it helpful to participate in support groups. MSK has an online "virtual" support group for caregivers. You can find more information here: http://www.mskcc.org/cancer-care/counseling-support/virtual-programs. And our Connections program (www.mskcc.net) offers the opportunity for cancer patients and caregivers to connect with each other for support through online message boards. You can go to the site to register.

Thank you for your comment.

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