Improvements in cancer detection and treatment has led to higher rates of long-term survival. But this has also increased the number of cancer survivors suffering from depression and anxiety. Here’s what you should know about cancer survivors and depression, stress, and anxiety:
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Cancer Survivors and Depression, Anxiety, and Stress: the Causes
When cancer treatment ends, life doesn’t go back to normal for cancer survivors. Not only do survivors have to deal with the negative physical effects from treatment, but there are many unexpected emotional and mental landmines in which to navigate. Landmines that cause stress and anxiety, and can even lead to depression.
So, what are these landmines?
The 4-Letter “F” Word: FEAR
Fear is ever-present in cancer survivors. Initially, there’s fear that the cancer isn’t all gone. Over time, there’s fear that cancer will come back. Although these fears diminish over time, they never go away.
And these fears are stoked each time they go to their oncologist for a follow-up or feel ill or “off” without explanation. I’m so aware of my body now that any time I feel “off” for more than a day or two I can’t help but wonder whether my cancer has come back.
Although the fear does tend to diminish over time, it can overpower the best of us (especially during the first year or two post-treatment).
Many survivors deal with guilt over the fact that they lived and others didn’t. Although not rational, it’s difficult not to feel guilty about living when you meet so many beautiful souls who die from their cancer.
For some, this guilt might become overwhelming and lead to depression.
[Related Reading: For more about survivors guilt and my battle with it, read Wrestling With Survivor’s Guilt].
Physical Effects of Treatment
Cancer does a number on your body. Most cancer survivors look different post-cancer (at least in the short-term) and also feel different. Here are just a few of the physical effects that continue post-treatment:
- physical fatigue and exhaustion;
- digestive problems;
- memory and attention difficulties; and
These physical issues cause internal pain and emotional distress. They wreck your self-confidence levels and self-esteem. And all of this can lead to severe anxiety and even depression.
Cancer is expensive. Not only do treatments cost a lot of money (that most patients must cover a portion of), but the effects of treatment inhibit patients from working as much as they normally would, which has a negative impact on income.
Financial struggles often lead to emotional distress that can become overwhelming.
Struggling to Find a New “Normal”
One of the worst things about life after treatment is the struggle to feel “normal” again. Many patients have a difficult time figuring out how cancer has changed them and what that means for their life going forward. Some deny that they’ve changed and fight to go back to their pre-cancer life. Unfortunately, this only makes things worse because cancer changes how you perceive yourself and your place in the world.
This struggle can lead to grief and feelings of sadness and regret that can become all-encompassing if not dealt with.
[Recommended Reading: for my struggle with this and how I got through it, read The Impossibility of Going Back].
Life during cancer treatment isn’t normal. You can’t do everything you used to and often have to change or cancel plans. My family had to cancel a big Disney World vacation after I was diagnosed.
And, because of the physical and mental effects of treatment, cancer patients often miss out on important career and life opportunities. When undergoing treatment, most cancer patients are willing to miss out on these opportunities. But after treatment ends, many cancer survivors experience grief over them. Sometimes it’s difficult to get over this grief.
Lack of Support
During treatment, most patients are smothered by support from their doctors, family, and friends. But when treatment ends, that support quickly disappears. Although it’s expected, the drastic change is hard to deal with. Especially given the long-term physical and emotional effects of cancer and it’s treatment.
Cancer Survivors and Depression
A Look at the Numbers
Cancer changes everyone and everything it touches… forever. From your physical appearance, to your relationships (including your marriage), and even to your capabilities. Because of this, many cancer survivors grieve. They grieve what’s been lost, the opportunities they missed out on, and what might have been.
Body image, self-esteem, and self-confidence levels can take a huge hit post-cancer. And new fears are introduced. Moreover, all the emotions that were put off during treatment come roaring back (and you finally have to deal with them). This takes a huge toll on cancer survivors. In fact:
- Cancer survivors in the United States take anxiety and depression medicine at around twice the rate of people without any cancer history.
- It’s estimated that as many as 15-25% of people diagnosed with cancer suffer from depression post-treatment (which is more than double the rate of the general population).
So, what should you look out for?
[Recommended Reading: trying to rebuild self-confidence and move past fears? Read 5 Effective Tools to Stop Living in Fear and Worry].
Cancer Survivors and Depression: Signs and Symptoms
Someone exhibits depression when they’ve lost interest in activities they once enjoyed or are consistently sad for a period of 2 weeks or more. Depression affects a person’s ability to function at home, at work, or in both places.
Depression isn’t the same thing as sadness or grieving. When someone grieves, negative emotions come in waves. However, depression is when negativity takes hold without the interspersed positive feelings. And depression is often marked by feelings of worthlessness and hopelessness.
Some of the common signs and symptoms of depression, in addition to persistent sadness and loss of interest in previously enjoyed activities, include:
- long-term fatigue and tiredness;
- changes in appetite, which might lead to weight loss or gain;
- difficulty in concentrating or making decisions;
- memory issues;
- extreme moodiness or irritability;
- consistently feeling overwhelmed;
- sleeping too much or not being able to sleep;
- feelings of guilt or worthlessness; and
- thoughts of death or suicide.
Please note that some of these symptoms can be caused by treatment, such as feeling fatigued or not being able to concentrate or remember. Note that when depressed, these symptoms tend to be persistent instead of erratic.
Cancer Survivors and Anxiety
What is Anxiety and How Does It Relate to Cancer?
Anxiety isn’t the same thing as depression. It’s when you’re worried and tense because of stressful circumstances or situations. And feelings caused by cancer and the post-cancer journey often cause anxiety.
Everyone feels anxious from time to time. It only becomes worrisome when you have recurring intrusive thoughts or concerns that don’t easily go away and are persistent. That’s when it has escalated into an anxiety disorder (because it’s interfering with your ability to function).
Common Anxiety Disorders Affecting Cancer Survivors
Cancer survivors can suffer from several types of anxiety disorders. Here are some of the common anxiety disorders that might plague cancer survivors:
- Panic attacks. These are commonly triggered by doctor visits and medical tests and are marked by extreme anxiety with an overwhelming urge to escape.
- Post-traumatic stress disorder (PTSD). Although this disorder is most often associated with events such as war or physical/sexual attacks, it can also affect cancer survivors. PTSD is developed after experiencing a life-threatening situation and is marked by overwhelming feelings of anxiety and/or worry. Although it’s normal to feel anxious and worry about the risk of cancer recurrence or an upcoming doctor appointment, if these feelings don’t diminish over time, get worse, or affect daily life, they might be a sign of PTSD.
- Phobias. Common phobias experienced by cancer survivors relate to needles and claustrophobia. Often these phobias exist pre-cancer (but are exacerbated by treatment), but sometimes these can present as new phobias.
- Generalized anxiety disorder. This disorder is marked by unrealistic and pervasive worry that’s difficult to control. Symptoms aren’t sudden in nature (like panic attacks).
What You Can Do About Cancer Survivors and Depression and Anxiety
What Cancer Survivors Can Do: Take Control
Attention cancer survivors: you do not have to just “deal” with the stress, anxiety, fear, and/or depression that comes your way. There are things you can do to be proactive and feel more in control of your life. Here’s how to start taking control.
Dealing With Fear
First and foremost, understand that fear of recurrence is normal. Luckily, it tends to go down as time passes. To help you cope with your fear, try the following:
- Take control of what’s controllable. Inform yourself about your cancer, services that are available to you, and how to reduce your risk of recurrence. And take care of yourself by exercising, eating well, and following your doctor’s advice (both on what to do and what not to do). This will give you a sense of control over your health and might help reduce your fears.
- Talk about your fears and emotions. Fear has a way of taking control when you try to ignore it or pretend that it doesn’t exist. Naming your fear, acknowledging it’s existence, and talking about it has the opposite effect. Talk to someone you trust about your fears. And don’t hold your emotions about what you’ve been through and how you feel in. You need to process them so that you can let go of them. Processing your emotions requires that you talk about them to someone you trust (and even get therapy if needed).
How to Handle Stress and Anxiety Caused by Your Feelings and Emotions
Cancer causes stress. You might feel stress over what you missed out on or have added financial strain because of your cancer. Not only that, but many cancer survivors wonder whether stress helped play a role in getting cancer in the first place.
Although there’s no evidence of a direct link between stress and cancer, stress does have a negative impact on your physical and mental well-being. Use the following tips to help reduce your stress levels:
- Exercise and eat well. Exercise reduces tension, releases stress energy, and helps to relax you. Good nutrition will give you energy and help you feel good about yourself. Both have positive affects not just on your physical well-being, but also on your mental health. Plus, doing this will help you feel more in control of your health.
- Meditate. Meditation decreases stress and anxiety, increases focus, and helps you to relieve tension in the body. A simple breath meditation can work wonders on your stress levels. Get started by sitting comfortably with your eyes closed, breathing slowly and deeply through your nose, and counting your breath in and out. Go to a count of 10 breaths in and 10 out and then start over. Try meditating for 10-12 minutes (set a timer). Any time you catch your mind wandering, return to counting your breath.
- Journal. Writing down your thoughts and emotions in a journal is therapeutic and can help to relieve stress. This act is a form of processing through your emotions so that you can let go of them. It will also make you more aware of your subconscious thoughts so that you’re better equipped to deal with them.
[Recommended Reading: for more simple and easy ways to reduce stress and anxiety, read 20 Easy Ways to Reduce Stress Naturally and Quickly (and Keep It Low)].
Depression and Anxiety Disorders
Although you might not have experienced depression or anxiety before your cancer, it’s still possible to experience them post-cancer. After treatment, you’ll experience a host of emotions and feelings. You’ll likely have times when you’ll be sad, angry, or tense (even anxious). For most survivors, these feelings will lesson over time. But for some they won’t.
Be aware of your feelings and emotions and deal with them so that you can process them through. Also, don’t shut yourself up or hide from the world (it’s one of the worst things you can do). Instead, get outdoors and seek to connect with people. Talk about your feelings and emotions with someone you trust.
Be aware of the signs and symptoms of depression and anxiety and listen to your gut. If it tells you that something is wrong, don’t ignore it. Talk to your doctor and seek professional help if you think you could be suffering from depression or an anxiety disorder. The most important thing to remember is that there’s nothing to be ashamed of.
Friends/Family of Cancer Survivors
What can you do as a friend or family member? Here are some tips for how to help cancer survivors navigate their emotional post-cancer roller coaster:
- Be open to talking and encourage it, but don’t force them to talk;
- Be aware of signs and symptoms of anxiety disorders and depression;
- Encourage that they talk with their doctor if you believe they’re suffering from depression or severe anxiety;
- Get them moving and outside through activities such as walks and bike rides;
- Engage them in activities they enjoy;
- Don’t force positivity, but instead acknowledge that it’s normal to have negative feelings and fears;
- Reassure them that with time and treatment (if needed), things will get better; and
- Don’t try to reason with someone who is depressed or tell them that they should cheer up.
Don’t be afraid to share your concerns with the cancer survivor. As someone who cares for them, it’s acceptable to ask how they’re doing and share with them what you perceive in them.
Raise Your Awareness and Do Something
Cancer is a life-changing experience that doesn’t stop the moment treatment stops. Navigating your cancer journey isn’t just about treatment and it’s physical effects. There’s a huge emotional impact that affects the way you think and feel. And it’s imperative that you take care of your psychological well-being (and not just your physical self).
Take time to acknowledge the grief, fear, and negative emotions that you have. Be aware of the warning signs that you might need help in dealing with these feelings. And take steps to do something about them. There’s nothing to feel ashamed of and help is available.
Until next time…