Cancer patients have a significantly higher risk of mental health conditions, like depression, anxiety, and suicidality, compared to the general population, two new studies show. The findings confirm what’s been long observed in cancer patients: that the disease can be both physically and emotionally damaging, particularly for those who were recently diagnosed, received a poor prognosis, or are actively receiving treatment like chemotherapy or radiation.
The researchers of both studies hope the findings will encourage health care providers to be more proactive in identifying risk factors and screening cancer patients for mental health issues in order start treatment sooner and ultimately minimize the impact cancer can have on people’s mental health. There’s also hope that oncologists will help patients understand the psychological risks of cancer treatments to help them make informed decisions about their care.
“We think that a major implication for clinical practice is for clinicians and patients to engage in a collaborative decision-making process starting from the point of cancer diagnosis where patients are presented with information on the potential adverse effects that are associated with some of these treatments so that they can make informed decisions by weighing benefits against harm,” Alvina Lai, PhD, a University College London health informatics professor who was involved with the research, told Health.
Prognosis and Cancer Treatments Contribute to Depression and Suicidality
Past research has found that cancer patients experience higher rates of suicide and suicidal ideation compared to the general population. It’s also known that tumors can have neuropsychiatric effects and that many cancer patients have adverse reactions to cancer treatments. Evidence has consistently shown that living with cancer can have a severe emotional and social impact on people’s lives.
The first new analysis, published in Nature Medicine, involved 28 studies that included over 22 million cancer patients. Researchers aimed to explore how various factors—like how a person’s prognosis, time since diagnosis, and type of cancer—contribute to a person’s risk of developing mental health issues.
The team found that the suicide rate was 85% higher in cancer patients than the general population. People who received a worse cancer prognosis—which is more typical of stomach and pancreatic cancers—experienced higher rates of suicide compared to people with a better cancer prognosis, with cancers like melanoma or prostate cancer. Compared to Europe, Asia, or Australia, cancer patients living in the U.S. had the highest suicide rates (1.5-fold greater suicide mortality compared to Europe), which the researchers suspect may be due, in part, to the high cost of care in the U.S. along with easy access to guns.
Compared to the general population, cancer patients also had a three-fold greater risk of dying by suicide within the first year of being diagnosed. According to Nicole Bates, MD, an attending psychiatrist at the Seattle Cancer Care Alliance and assistant professor of psychiatry and behavioral sciences at the University of Washington, the most intense changes and treatment regimens typically occur within the first year of diagnosis and greatly impact people’s work, identity, finances, and social and family life.
The researchers hope their findings will help cancer patients, especially those with known risk factors, be more closely monitored for suicidality. “An increased awareness and earlier screening for mental health issues should lead to earlier involvement of specialized care, may thereby improve the quality of life of affected patients, and hopefully prevent suicides,” Dr. Corinna Seliger-Behme, a neurologist at Heidelberg University and one of the researchers involved in the study, told Health.
The second report, also published in Nature Medicine, evaluated the health records of over 460,000 people in Britain diagnosed with 26 different types of cancer between 1998 and 2020. After diagnosis, approximately 5% of the patients developed depression and another 5% developed anxiety. About 1% attempted self harm, and the attempts were more common in people with brain tumors, testicular cancer, prostate cancer, Hodgkin’s lymphoma, and melanoma. About a quarter of the patients struggled with substance abuse.
The biggest risk factor for a mental health disorder was cancer treatment, like surgery, radiation, or chemotherapy, which are known to cause severe physical and emotional stress. People who received all three treatments had the highest rates of depression and anxiety, and chemotherapy was linked to significantly higher rates of psychiatric disorders compared to those who only received radiotherapy.
People diagnosed with testicular cancer, which typically has a good prognosis, had the highest rates of psychiatric disorders, impacting 98 out of every 100 patients. Cervical cancer, Hodgkin lymphoma, and cancers of the spinal cord and nervous system were linked to higher rates of psychiatric disorders as well.
Younger patients ages 18 to 34 were more 4.3 times more likely to be diagnosed with a mental health condition before a self-harm episode than patients aged 51 to 65 years. The researchers believe this shows that depression may be missed in many older patients. “We think that older patients are less likely to seek help due to the perceived stigma of mental illness among the older generations,” Lai, one of the researchers, said, adding that some older patients may not recognize that they have mental health issues or know who to go to for support.
How Cancer Treatments Impact Mental Health
Chemotherapy can cause fatigue and various changes to the body — like pain and insomnia — which can take a toll on a person’s wellbeing. Chemotherapy can also cause cognitive changes, and many people receiving the treatment develop brain fog, colloquially known as “chemo brain,” Lai said. While chemotherapy is effective at killing cancer cells, it also hurts healthy cells. “There are significant side effects: nausea, diarrhea, hair loss, painful neuropathies, skin changes, other pain, fatigue,” Dr. Bates said. Other supportive medications, like steroids, can lead to insomnia, anxiety, panic attacks, agitation and mania, she added.
Surgery, too, is an intense undertaking that can cause physical trauma to the body. Patients have to spend a lot of time in a hospital and prepare for operative risks and complications. According to Dr. Bates, surgery can lead to issues with wound healing, scarring, and major changes in how their body looks and feels, like a mastectomy or amputation, which can have long-term implications on how someone lives their daily life.
Radiotherapy too—better known as radiation—has also been found to trigger heightened anxiety and psychological stress in some patients. Throughout radiation therapy, patients can experience claustrophobia, panic attacks, skin changes and fatigue, according to Dr. Bates.
Each of these treatments, alone, cause a lot of distress. “Patients who do all three are running this marathon, and they don’t often have a lot of time to recover between treatments, so by the end there’s a lot of cumulative burden,” Bates said.
Mental Health Resources for Cancer Patients
There are several effective treatments available to help people with their mental health as they go through their cancer journey. Dr. Bates highly recommends people reach out for support, because they’re likely to see improvements in their mental health and physical health along with their ability to tolerate cancer treatments.
Many oncology centers and local cancer centers have on-site resources, including social workers, spiritual care, psychologists, psychiatrists, and support groups. Accessing resources that include person-to-person interactions is part of an effective treatment plan, Bates said, especially since so many people have been isolated during the pandemic. Ask about the type of programs they have in place to support mental health in cancer patients. For those who are worried about taking the first step, Bates recommends reaching out to someone that you trust, whether that be a health care provider or a support person such as a pastor or community leader.
CancerCare offers professional counseling services and Cancer Support Community has a helpline that connects patients and caregivers to local resources like support groups, transportation services, and other programs related to finances, housing and treatment decision making.
Cancer Survivors Network provides various forums for patients to connect with one another and Cancer Hope Network matches cancer patients with a survivor or caregiver for peer-to-peer support. Mindfulness, too, is known to improve mood, anxiety, coping skills, resiliency, Dr. Bates said.
It’s helpful to work with friends and family members to create a space where it’s okay to talk about cancer and mental health, Bates said. If you’re worried about a loved one with cancer who might be struggling, start by reaching out to their care team—whether that be an oncologist and primary care provider—and kick start the mental health conversation. “I find that just normalizing that we are humans with emotions—those will come up with cancer and sometimes we need extra support—is a nice frame for inviting people to mental health treatment,” Bates said.