Mental health goes hand-in-hand with physical health, and maintaining optimism, hope and psychological resilience during cancer treatment and after can improve your quality of life and your physical health outcomes.
Both cancer patients and their caregivers face considerable emotional stress and strain, which is why David Wakefield, PhD, a licensed psychologist and mind-body therapist at Cancer Treatment Centers of America® (CTCA), Tulsa, explains, “It is a good idea to be intentional about your mental and emotional health every day just like you follow hygiene patterns in taking care of your physical body.”
Top Mental Health Challenges for Cancer Patients and Caregivers
Upon receiving a cancer diagnosis, feelings of grief and loss are common. “Grieving the loss of health, the loss of normal, the loss of body image and the loss of future hopes and dreams,” Wakefield says, are among the emotions you may experience. Other possible types of loss include:
- Loss of income due to the loss of a job because you are too sick or fatigued to work
- Loss of insurance
- Loss of friendships (people who you thought were friends may disappear when you need them)
- Loss of a marriage (one spouse may feel it’s too much to handle)
- Loss of hope
- Loss of confidence in God or a higher power; loss of faith
Anxiety is also common among cancer patients and may affect those with cancer at rates three to 10 times higher than the general population. Fear of the unknown is a common driver, with patients first questioning whether they have cancer, then wondering if the treatment plan will work and if they will get rid of the cancer. Other drivers of anxiety, according to Dr. Wakefield, include wondering:
- What will the scan results show?
- Will the cancer recur?
- How long do I have to live?
- How will this impact my family?
- Why me?
Depression is also common, with some studies suggesting it may affect up to 77 percent of patients with lung cancer, 71 percent of those with cervical cancer and 76 percent of those with esophageal cancer, with an overall prevalence rate of nearly 67 percent in cancer patients among certain populations. Depression may manifest as feelings of helplessness and hopelessness, or you may feel like you have no energy to do anything other than sit on your couch.
Depressed patients may even contemplate suicide, questioning whether they will be too great a burden to their family. According to Wakefield, “The risk of suicide in someone with a cancer diagnosis is approximately double the risk of suicide in the general population. The first year after diagnosis carries a higher risk for suicide. Risk factors for suicide include serious illness or physical impairment, chronic pain and social isolation.”
Caregivers may also experience feelings of depression and anxiety, along with fatigue, burnout and stress over what may become a conflicted relationship with the patient. In fact, one study found that caregivers were more distressed and had higher anxiety scores than did cancer patients. “Caregiving is often very stressful,” Wakefield says. “It’s usually a marathon—not a sprint—and many caregivers feel helpless, exhausted, overwhelmed, and/or underappreciated.”
What to Watch Out For
Tending to your mental and emotional health daily is something that is recommended for every cancer patient and caregiver. Left unchecked, the stress, anxiety and depression may interfere with getting a good night’s sleep or eating right, both of which can lead to further fatigue and health problems, while lessening your overall quality of life.
There are some indicators to watch out for that may signal a person needs help on an emotional or mental level. According to Wakefield, in cancer patients and caregivers this may include:
- Changes in behavior
- Difficulty coping
- Mood disturbances
- Hypersomnia (excessive sleepiness)
- Changes in appetite
- Personality changes
- Changes in weight
- Decreased energy
- Difficulty thinking, concentrating or making decisions
- Impaired attention
- Conflict in relationships
- Impairment in social or occupational functioning
- Loss of interest in pleasurable activities
- Feelings of worthlessness or excessive guilty
- Decreased motivation
- Irritability or edginess
- Inability to relax
- Loss of libido or impaired sexual functioning
You may want to seek professional help if you’re experiencing a number of the symptoms listed above, or you feel like you’re going to “lose it” if you don’t get some help soon. Wakefield says, if “the stressors of life become greater than your current resources or coping skills to deal with what is happening,” it’s time to get help.
Mental Support for Caregivers Should Begin Prior to Caregiving
Ideally, mental health support is an ongoing process that begins at the time of diagnosis, for both patients and caregivers. Wakefield recommends that caregivers speak to a professional early in the cancer journey to make a “strategy for survival” and identify pitfalls you may face, such as lack of communication or conflict resolution skills that are essential to maintaining a close relationship with the patient.
“After the caregiving begins,” Wakefield says, “I would recommend the caregiver see a professional as often as needed just to deal with the stressors related to caregiving. The caregiver may need help with boundary issues. This means sometimes they get over-involved and the patient pushes them away and then the caregiver gets their feelings hurt. Patients are sick and in pain, and they might take their anger out on the caregiver. Caregivers may need help to not take this personally but still know how to be helpful.”
If you’re not sure where to seek help, many hospitals and other patient facilities offer resources to support patients’ and caregivers’ mental well-being, including the following:
- Mind-body medicine
- Pastoral care
- Support groups
- Workout facilities
Tips for Supporting Your Mental and Emotional Health
Whether you’re a patient or caregiver, caring for your mental health is every bit as important as tending to your physical health. Toward that end, Wakefield recommends doing the following to stay emotionally resilient and mentally strong:
- Stay connected spiritually. “Your faith, prayer, worship, your church family and spiritual guidance can be a tremendous resource for seeing you through difficult times. It can be very helpful to stay connected to God [or another higher power],” he says.
- Seek social support. “According to crisis intervention literature, the No. 1 predictor of how well people make it through a crisis in their life is directly related to how much social support they have.” You can find social support via family, friends, church, support groups and even online forums.
- Exercise. “It’s a great way to burn off the negative frustrations of the day and be renewed physically and mentally. Exercise is one of the top three ways to treat anxiety and depression, and the number one way to combat cancer-related fatigue.” Even exercise as simple as walking has been found to improve anxiety and depression in cancer patients.
- Talk to someone who is a good listener and not judgmental. “This could be your partner, family member, friend or a professional. If you don’t have someone to talk to, try journaling your thoughts, feelings and struggles.”
- Reflect on past struggles. Think about what helped you get through hard times in the past and use those same strategies to increase your resiliency today, along with seeking to add additional coping skills each week.
- Don’t go it alone. Talk to a professional about your mental health.
- Continue to live your life. “Do things that give you energy. Do things that put a smile on your face. Don’t stop having fun. Continue with your hobbies and interests. Be around people who are encouraging. Stay away from people who pull you down. Avoid new stressors. Get rid of old stressors. Celebrate the small successes. Some people stop living but they are still breathing.”
- Practice relaxation techniques such as mindfulness, meditation, yoga, guided imagery, deep breathing and progressive muscle relaxation.
- Allow the patient to be independent as much as possible. Avoid doing things for the patient that they can do for themselves.
- Be aware of compassion fatigue, in which you may feel you’re becoming increasingly numb to or disconnected from the patient’s suffering. This is a form of traumatic stress that can occur as the result of being exposed to ongoing suffering and distress.
- Recruit other caregivers to be a part of the process, which can give you a much-needed break or additional social support.
- Take care of yourself by getting plenty of rest, exercising and eating a healthy, well-balanced diet. This will give you the energy and strength you need to continue to be a caregiver. “Don’t ignore your own health at the expense of caregiving.”
- Share your feelings with someone you trust. This person can provide an outlet where you can share your frustrations. “Have at least one focused, meaningful conversation each day.”
- Reflect on each month. Consider what changes you need to make to better support your mental and emotional needs.
- Make time to treat yourself. “Make a list of those things that energize you and do at least one of them each day.”
- Improve your stress management skills.
- Communicate openly with the patient.
- Establish healthy boundaries, including learning to say “no” when you need to.
- Cry when you need to. “Unexpressed grief is often at the core of compassion fatigue.”
- Surround yourself with humor. “Studies show that highly resilient people have a corresponding good sense of humor.”