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Survivorship: Emotional Well Being

The emotional impact of a cancer diagnosis is hard to measure.   It is safe to say that for many people, it is a life-altering event.  It is not surprising, therefore, that cancer survivors and their caregivers may have to deal with a broad range of emotional and psychological issues. Support for Emory Winship Cancer Institute patients is available through several resources. We have licensed social workers and medical experts in the field of psychiatry available to patients at all stages of diagnosis, treatment and recovery. The goal of all members of our care team is to help cancer survivors achieve good quality of life beyond their cancer diagnosis.

Some of the emotional effects of cancer and cancer treatment include:

Support for Emory Winship Cancer Institute patients is readily available.  Anyone with a concern or question should seek the assistance of a qualified medical professional.


Depression

Depression can be a very important mental health issue for cancer patients. Depression is more common in cancer patients than in the general population. Major depression, the most common type of depression, is defined as the loss of interest in nearly all activities for at least two weeks in addition to three or four other symptoms including:

  • depressed mood lasting for most of the day, nearly every day
  • significant weight loss/gain and decrease/increase in appetite
  • sleeping much than usual or much less than usual
  • fatigue or loss of energy nearly every day
  • feelings of worthlessness or inappropriate guilt
  • decreased ability to think or concentrate
  • frequent thoughts of death or suicide

Cancer has the ability to alter a patient's life plans, body image, family/social role, and financial status. It is normal to fear these changes but this usually decreases over several days or weeks as patients adjust to their diagnosis. It is normal to have feelings of grief and sadness but it is important for cancer patients to distinguish between normal degrees of grief and depressive disorders. Patients with a more advanced disease are more likely to be depressed. It is important for patients suffering from any of the symptoms above seek the advice of a health care provider.

Causes of cancer-related depression include:

  • psychological stress
  • physical problems such as alterations due to surgery
  • side effects of medication
  • reaction to chemotherapy
  • thyroid gland dysfunction
  • inadequate diet

In addition to decreasing an individual's ability to function and enjoy life, there are a variety of ways that untreated depression can negatively impact a cancer patient's health. Untreated depression may make it more difficult for a patient to decide on a treatment method or make it more difficult for a patient to follow through with treatment. Studies suggest that untreated depression may slow recovery or affect survival via influences on the immune or neuroendocrine systems.

There are two distinct treatments for depression. They may be used in combination:

Psychotherapy may include counseling, relaxation techniques, cancer education, hypnosis, and/or participation in support groups.
Pharmacotherapy uses medications to address the chemical and biological aspects of the condition.   

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Fatigue

Fatigue is a common symptom for patients diagnosed with almost all types of cancer. Nearly 88% of chemotherapy patients and 76% of radiation therapy patients experience fatigue. Fatigue is commonly described as feeling weak, tired, exhausted, worn out, or slow. Fatigue can be acute, a tired feeling may begin quickly and last for a short period of time, or it can be chronic, a nagging weakness that may persist for longer periods of time.

Every patient experiences fatigue differently. In many cases, rest and sleep alone cannot cure fatigue. It is therefore important that patients speak with their doctors if any of these symptoms are present. It is not yet clear what causes cancer-related fatigue. The current belief is that the fatigue is caused by both the stress of the disease and its treatments. Physical problems such as anemia (too few red blood cells), poor nutrition, insufficient liquid intake, and a weakened immune system have been shown to correlate with fatigue.

Fatigue can have a wide range of effects on a cancer survivor. Because fatigue is not easily treated with medications, it has the potential to be more distressing than pain, nausea, and vomiting. Fatigue can be made worse by pain, emotional distress, eating habits, sleep patterns, decreased activity, and/or other diseases. As a result of fatigue, patients may not have the motivation to go to work, visit with friends, continue with treatment, and/or continue with other normal activities. Cancer-related fatigues is more sever, more mentally stressful, and less likely to be relieved by rest than non-cancer related fatigue; however, there are ways to try to deal with fatigue.

Suggestions for dealing with fatigue:

  • plan your events (appointments, etc.) so that you are active during the times when you expect to have the most energy
  • take short naps throughout the day
  • let friends and family help you
  • continue doing what you enjoy but monitor your energy levels and reduce the amount of time you spend doing these activities accordingly
  • consider joining a support group

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Anger and Fear
Anger is a natural reaction to the loss of normalcy that may accompany a cancer diagnosis. It is likely that friends and family are feeling the same emotions. When strong feelings like anger are held in, problems such as depression, tiredness, hopelessness, and a lack of motivation can develop. It is very important to release these feelings by speaking with friends, family, or a licensed healthcare professional. It is common that a survivor may feel uncertainty in planning the future because they are not sure what will happen in terms of their cancer treatment. If a cancer survivor experiences negative feelings, it is important to remember that everyone has low times and that acknowledging and recognizing feelings of tiredness, anxiety, anger, and depression is actually a positive thing. Expressing feelings openly and honestly can often help to relieve stress and tension. Strong feelings ranging from self-blame, need to blame others, overwhelming stress, and guilt may be frightening but are common.

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Anxiety
Because stress levels naturally increase when a person feels threatened and because cancer can be a very dangerous disease, anxiety is a normal and common reaction to a cancer diagnosis. Symptoms of anxiety include shaking, fast or irregular heartbeat, and extreme levels of worry. Anxiety related to cancer can occur at any time: during screening, diagnosis, treatment and post-treatment. People who have anxiety at the time of diagnosis, severe pain, lack of social support, advancing disease, and previous anxiety disorders are at higher risk of developing anxiety disorders during treatment. Fears associated with anxiety may cause enough mental suffering to prevent patients from performing their normal activities. Anxiety can reduce a patient's quality of life and interfere with their ability/willingness to follow through with their cancer therapy. Higher levels of insomnia, anticipation of pain, and depression may also be a result of anxiety. Patients can reduce anxiety by learning more about their cancer, through psychological interventions, and with the help of drugs. In cases in which anxiety is caused by pain, a hormone producing tumor, or side effects from medication, treating the source can often relieve anxiety. A cancer patient should contact a licensed healthcare professional if they are feeling any form of anxiety.

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