Friday, November 02, 2007

Depression in cancer survivors and their partners

I caught a rerun of House the other night, in which House fakes cancer so he can participate in a clinical trial of an antidepressant that was to be "injected directly into the pleasure centre of (his) brain." When his game is exposed, oncologist Wilson explains to him that "depression in terminal cancer patients isn't that common ... It isn't the dying that gets to people, it's the dying alone."

I don't know the validity of that statement, but I can certainly imagine that terminal patients with a strong support group of family and friends cope better than those without. This study in the Lancet suggests patients participating in weekly support group therapy do fare better. But what about cancer survivors? How do they cope with a shift back to 'normal' routine?

Cancer survivors face unique challenges: Fear of recurrence, self-conciousness about appearance (weight change, hair loss or even loss of a limb), loneliness (if you feel others can't understand what you've been through) and even guilt about survival (when so many others don't make it) are all emotional issues that need to be dealt with on an ongoing basis post-treatment. These overwhelming emotions can lead to anxiety and depression and require support of family and friends. Sometimes that's not enough, and outside support groups (consisting of other cancer survivors who know what you're going through) are necessary. However the Mayo clinic offers the following caution when choosing a support group:
  • Promises of a sure cure for your disease or condition
  • Promises of quick solutions to your disease, condition or life situation
  • Meetings that are predominantly "gripe" sessions
  • A group leader or member who urges you to stop medical treatment
  • A charismatic group leader who demands cult-like allegiance
  • High fees to attend the group or having to purchase products or services

The Canadian Cancer Society offers peer support for cancer survivors and people living with cancer but there are many others out there.

It's not just cancer patients and survivors that need support. Friends and family are often bearing an emotional load themselves. Recent studies have shown that the social circle of cancer survivors, particularly partners, are also at risk for depression. In some cases, the mental health of partners was rated lower than the survivors themselves, and they were less likely to receive mental health treatment or support. This can put a great strain on relationships and magnify anxiety and depression in these pairs. This study was restricted to bone marrow transplant recipients and their partners, but the literature suggests it could be broadened to other cancer types.

Cancer is a complex disease, with complex issues lingering once clinic visits are finished. Support needs to extend outside the treatment room and is an ongoing process for patients and their loved ones even after treatments are finished and cancer is beaten.


Bayman said...

Funny you didn't mention research and clinical trials. The way I see it, depression is a natural consequence of being sick and feeling there's nothing you can do that has any hope of helping. A loss of hope.

Support is critical, but I think what sick people also need is to feel that there is action they or others can take to a)understand what is making them ill and b)understand what steps (no matter how small) they can take to improve their health.

Striving to overcome difficulties, no matter how insurmountable, is inspiring, accepting them without a fight is depressing. By supporting disease research society hopefully sends the message to those who suffer that their lives are worth fighting for - whether the are ultimately "cured" or not. I think that's how you fight depression.

Anonymous said...

At least feeling positive or depressed makes no difference for your survival according to all the studies done so far. Sometimes having to be positive about your cancer can also be a burden. By all means you have something to be depressed about. Always being positive sometimes has the unwanted side effect that you can't prepare yourself for your death and do/say the things you want with your familly.

Bayman said...

I guess sometimes it's about quality of life rather than long as we realize that having quality of life and a "positive" outlook doesn't mean you're not going to die someday. I guess that's true of life in general.

Or as the (fictitious)Roman Gladiator Maximus said, "Death smiles at us all. All a man can do is smile back."

Anonymous said...

As a woman, I know I would have an extremely hard time with the side-effects of the treatment process. It's a loss of feminity, of a woman's worth in some people's eyes. I heard of many women avoiding potentially life-saving treatment altogether because of their hair loss fear. I've had a history of cancer in my family so this subject is extremely personal for me. I'm a community ambassador with Pantene Beautiful Lengths, and together we are trying to gather 1 million inches of hair to provide wigs for women dealing with chemo related hair loss. We come in and deliver these wigs to these women and hopefully try and rebuild their confidence to give them a fighting chance in overcoming this serious illness, and the depression it can cause. If you are interested in donating or pledging please visit this site
Help support this amazing cause!

Anonymous said...

I am a survivor, and I know I am supose to be happy, after all I am one of the luck few who survived stage 4 cancer, but in the fall out of the aftermath, my husband of 35 years left, and I am about a stones throw from losing my home and my car, I working now, but I come in and cry for hours from the pain it creates, so when i hear "lucky survivor" excuse me if I just politly, nod thank you and walk away, I am greatful to my wonderful Dr.'s and their staff, I guess, I just expected my life to be normal again and it never will be.