Depression and anxiety are common in cancer patients, but many of them don't receive proper treatment. A new overall care program can help.
Imagine you are waiting anxiously for news that could change your life. The phone finally rings. It’s your doctor, who tells you the biopsy results are back. Malignant. You have cancer.
This scenario, in one form or another, was played out in 2014 for almost 1.7 million Americans, according to the National Center for Health Statistics.
Depression and anxiety in cancer patients
While most people try to beat their cancer, few are treated for the depression that often comes with it. Trying to beat depression is just as important; research shows you can.
Learning you have cancer is a life-altering shock. It can trigger worries about finances and personal relationships, concerns about the side effects of treatment and the long-term consequences of cancer.
So it’s no surprise that the National Institute of Mental Health (NIMH) lists feelings of extreme stress, anger, and sadness as common reactions to a diagnosis of cancer. It’s normal to grieve over the changes and uncertainty that cancer brings to your life, says the American Cancer Society (ACG).
But when an ongoing bleak mood affects a cancer patient’s day-to-day activities, often disrupting their sleep and ruining their appetite, odds are they have clinical depression. In fact, about one in four people with cancer are depressed.
While there’s no evidence that depression causes cancer, serious depression can wreak havoc with the quality of cancer patients’ lives. It can even interfere with their ability to follow cancer treatment plans. What’s more, depression may impact whether some people with cancer even survive.
A 2010 study showed the risk of dying increased by 17 percent in cancer patients with depression compared with those without depression – especially when the depressed patients had leukemia and lymphoma, breast, lung, and brain cancers.
Most cancer patients with depression don't get treatment
Unfortunately, other studies reveal the vast majority of cancer patients (about 73 percent) who have major depression are not receiving treatment for this disorder.
But there’s also good news: Depression, once diagnosed, can usually be treated. A new integrated treatment program may be especially effective at reducing depression and improving the quality of life of people with cancer.
A new treatment program
Called “Depression Care for People with Cancer” (DCPC), the program tackles depression as part of overall cancer care. A team of specially-trained cancer nurses and psychiatrists work with the patient's entire cancer medical team to treat depression with both antidepressants and psychological therapy.
To document how well this approach works, researchers at the University of Oxford in the U.K. studied 500 adults who had both major depression and cancer – and were expected to live for more than a year. Some patients received regular care without any particular emphasis on depression treatment, while others participated in the DCPC program. After six months, both groups were checked for signs of depression.
The results, published in The Lancet, were striking. Over 60 percent of the patients who received DCPC responded to treatment, with at least a 50-percent decrease in the severity of their depression – but only 17 percent of the patients who received usual care were less depressed.
In addition, the integrated approach to treating depression was still working at 12 months. The program also relieved anxiety, pain, and fatigue, and improved the patients’ ability to function and their overall quality of life.
"The huge benefit that DCPC delivers for patients with cancer and depression shows what we can achieve for patients if we take as much care with the treatment of their depression as we do with the treatment of their cancer,” said Michael Sharpe, MD, who headed the Oxford research team.
But what about people who have more serious, and even terminal, cancer? To find out, another group of Oxford researchers tested a DCPC program for lung cancer patients with a poor prognosis. Remarkably, after 32 weeks of treatment for depression, patients functioned better and had less anxiety and an improved quality of life.
"Patients with lung cancer often have a poor prognosis. If they also have major depression, that can blight the time they have left to live,” study leader Jane Walker said. “This trial shows that we can effectively treat depression in patients with poor prognosis cancers like lung cancer and really improve patients' lives."
What you can do
If you have cancer and are depressed, don’t ignore it. Talk to your doctor about whether or not medication may be right for you. Psychotherapy may also help. Believe it or not, exercise has been shown to reduce the symptoms of depression. Finally, sticking to routines can help you feel a sense of accomplishment and control over your life.
If you are a caregiver for someone with cancer, be encouraging. Help your family member or friend understand the importance of addressing their depression – that treatment may help them cope with their diagnosis, have a higher quality of life, and even get better.
March 22, 2018
Christopher Nystuen, MD, MBA