Post-Cancer Depression: What to Do About It

Cancer survivors often face a number of challenges as they adjust to life post-treatment. One of the most common, but often overlooked, is post-cancer depression. Experts estimated that 1 in 5 cancer survivors will experience depression at some point during their cancer journey.

Depression can present itself in a number of ways, including feelings of sadness, hopelessness, anxiety, and fatigue. It’s often difficult for healthcare providers to notice depression among cancer patients and survivors because many depressive symptoms are so similar to cancer symptoms and side effects.

Admittedly, there is an enormous amount of information in this blog post. I hope you feel inspired and maybe even sense a shift from being a patient to a participant in your health as you stand on your own side searching for that new stable ground. 

How Post-Cancer Depression Manifests

Post-cancer depression comes with various different symptoms. 

These include:

  • Loss of appetite

  • Weight loss

  • Weight gain

  • Sluggishness

  • Changes in sleeping habits

  • Lack of passion or interest

Your healthcare providers may not notice, and let’s be honest, you might not even realize you are depressed. Rightfully so, active treatment might be over but the residual is still swirling in the veins, making the physical body tender to the touch, fogging the brain's ability to think clearly, etc. 

Chances are, however, you know something is not right. 

What to Do If You Think You Might Have Post-Cancer Depression 

If you're experiencing any of these symptoms, it's important to reach out for assistance. Help is available. Talk to any member of your healthcare team for direction or ask to be referred to a mental health professional. There are also a number of support groups and online resources available to help you cope with post-cancer depression. 

Admittedly, these are big and difficult steps to take when you are hurting. I know. You are not meant to suffer, and certainly not to suffer alone. Rebecca Palpant Shimkets, a Georgia-based health consultant working in  behavioral health, admits “We’re doing so much better [at helping people] during treatment and we have a long way to go post-treatment.” She adds, “People are resilient. The saddest part is that people wait so long and suffer so long.”

In the remainder of this article, I will talk about the causes of post-cancer depression, some tips for managing it and resources to direct you to the help you deserve.

Cancer Survivorship: Managing Your Emotions After Treatment

The diagnosis and treatment of cancer is often described as a roller coaster ride. Makes sense, right? Strapped in. Sent into the terror of grand highs and significant lows. All the while lacking complete control of our surroundings… Until we emerge woozy and tattered.

This is not a ride we take with arms up in the air and eyes wide open. More often it’s one that induces stress, hands gripped to the bar and eyes sealed shut, unable to express the emotions erupting inside. For most of us, even the screams stay silent.

Only after, with feet planted on solid ground, can we look back in amazement. And marvel… marvel at our courage. Gobsmacked to realize just how much this human capsule can bear. But getting to solid ground takes time.

We reorient slowly. We rise on wobbly legs in a new body. One carved by cancer—changed forever by the mixed cocktail of chemicals, radiation, surgery, and drugs. Recovering from cancer treatment is not just about our body, it’s also about healing our mind.

There is such enormous vulnerability inherent in this. It takes effort to shift our minds into the future. To begin planning long term again. To regain control and stability in this new changed person we stand in.

The necessity of cancer care follows us into survivorship. Unfortunately, the timing is totally out of sync. 

First, when treatment is finished we are not suddenly feeling our best—or anywhere near back to normal. As advanced and refined as treatments have become in the last 25 years, it’s understood that good cells are collateral damage of the treatment process. 

The treatment process, after all, saps our very constitution of vital energy, and treatments make it difficult to eat and sleep. Both are integral to our physical and mental defense and recovery systems.

Exhausting. Exhausted is how we emerge from our treatment.

Second, we often experience a sense of abandonment after treatment is over. This is normal. For months we were cared for by a healthcare team, (many people) that held our welfare in the center of their radar. Suddenly, we fall off the radar. Finding the right support is required at the very time we feel vulnerable and alone.

This is a tender time. For some cancer survivors, it is the darkest time of their cancer experience. If I had a nickel for every time a client said, “I felt so alone after my treatment finished.” This loneliness, left unaddressed, can spiral into depression.

And third, survivorship is confusing. A cancer paradox exists as we wish to show our loved ones we are “fixed”. There is an expectation from ourselves and others to “get back to normal”. Treatment is over does not mean one suddenly feels all better. Normal no longer exists and “better” feels very far away. 

The combination of physical exhaustion, shifting outside of our health team’s radar, experiencing loneliness, and not wanting to be a burden, sets the stage to ignore or avoid our emotions.

Emotions are not meant to be ignored, they are specifically designed to be expressed.

Cancer brings up a wide range of emotions that you are not used to dealing with. Following are some common emotions that cancer survivors experience and some tips for coping with these emotions along with resources for further assistance. 

Wherever you are on the cancer journey, know that you are not alone and help is available during this tumultuous transition.

Fear of Recurrence in Cancer Survivors

What is Cancer Recurrence?

Cancer recurrence is the return of the cancer that was previously diagnosed. After experiencing cancer, the fear of recurrence is a very common emotion.

It’s important to note that it is a normal worry—and by that, I mean it is a genuine, real thing to worry about. No one can control or predict the future. Learning to live with uncertainty takes time.

The intensity of the fear of recurrence depends on the specific medical situation as well as other factors such as knowledge and understanding of what to expect, and access to a supportive network. People that were anxious before cancer may face more worry and fear than others.

In the months that follow the end of treatment, there is a subliminal “what-if” in every ache and pain. There is more worry about recurrence right before appointments and scans even as time passes. Time, however, helps. The fear may never completely go away but as life resumes it slowly recedes. 

Knowing when your fear of recurrence is usually the strongest can help you prepare to deal with it. 

Often we worry more when:

  • We have an upcoming healthcare appointment.

  • Scans, blood tests, or medical procedures are scheduled.

  • When we hear or read something about cancer that is frightening.

  • Experience an odd pain in our body that we can’t explain.

  • Hear of someone that experienced recurrence.

Learning how to cope with this fear can help us build personal resources and resilience as we move forward.

Tips: Coping with Fear of Cancer Returning

Tip #1: Knowledge is Power

Learning about your cancer, the treatment you received, its long-term side effects, and the what and why of future surveillance can actually put your mind to rest. It is the unknowing that fuels the fear. 

Survivorship Care Plans were designed by the American Society of Clinical Oncology as a tool to be filled out and discussed at the end of treatment. If you have not had the opportunity, print the form and schedule an appointment with your care team to get it filled out. 

Tip #2: Express Yourself

Emotions are meant to be expressed. Suppressing or repressed feelings can be toxic for you. Being open and sharing your feelings with others will reduce their grip on you.

Some process their feelings by talking with family, friends, therapists, or other cancer survivors. If talking about your feelings is difficult you can also sort them out by writing them down on paper. The most important thing is to allow your emotions to move through you.

Tip #3: Focus on This Moment

Fear pulls us into the past or pushes us into the future. Taking 90 seconds in this moment to focus on what is good and right within you is like a warm bath to your nervous system. 

Here’s what to do:

If you find yourself filled with anxiety about recurrence or scanxiety, set a timer for 90 seconds and let yourself really feel all that you are feeling and thinking. (My heart is beating. I am so worried this pain in my abdomen is the cancer coming back. I don’t think I can go through that again, you get the picture.) 

When the timer goes off, pick yourself up and move to a different chair, or spot in the room. Mindfully take your body with you. Set a timer for 90 seconds and this time let yourself feel and think about what is going right in you and your body at this moment. (My fingers move, my heart is pumping blood into my organs, and my lungs inflate. I have a roof over my head. You get the picture.) 

When that timer goes off, you now have a choice. You can go back to where you started, it might be your reality at this moment, you enter from a place of calm where you have a choice.

Tip #4: Move Your Body

Moving your body releases feel-good endorphins, these are natural cannabis-like brain chemicals (endogenous cannabinoids) and other natural brain chemicals that can increase your well-being. 

Movement can also take your mind off worries so you can get out of the cycle of negative thoughts. 

Tip #5: Seek Professional Help

When the fear of recurrence is keeping you up at night or in any way feels paralyzing rendering you unable to engage in life, it is a sign you need professional help. 

It is helpful to find a therapist that is well-informed about issues regarding cancer. Ask to speak with an Oncology Social Worker who can provide referrals. 

What Resources Can We Use?

Cancer Hope Network is a not-for-profit organization that provides free and confidential one-on-one support to cancer patients and their families. They offer support by matching cancer patients or family members with trained volunteers who have already undergone and recovered from a similar experience.

Stress in Cancer Survivors

Stress is a normal human reaction that happens to everyone. We recognize and feel the symptoms of stress on the inside and out. It feels like Irritability, heart racing, inner voices, there is a sense of impending doom, often called catastrophizing, and we tend to get annoyed with the smallest of things. 

The term stress was coined in 1963 by Hans Selye, one of the founders of stress research. He defined stress as “the non-specific response of the body to any demand for change.”

Under stress our body ignites the “fight or flight” response involving the sympathetic nervous system whose main purpose is to conserve energy in order to prepare us for the challenge. Physiologically, this means our muscles tighten, our breath shortens, blood pressure rises and there is a surge of adrenaline to give energy to respond. 

When the threat is addressed and the danger subsides the body will naturally shift back to the parasympathetic nervous system otherwise known as “rest and digest”. 

Stress becomes a problem when stressors continue without relief or periods of relaxation. This is referred to as chronic stress. It entails repeated activation of the body’s stress response which involves a multitude of systems - immune, endocrine, and neural. 

If a body is always under stress it begins to suppress the immune system which creates vulnerability to disease. Reducing stressors, and addressing chronic stress is vital to your health on this cancer journey.

But stress isn’t bad as such. In her Ted talk, Dr. Kelly McGonigal advises us on how to make stress our friend. She explains that stress is a good thing from an evolutionary perspective. It serves the important function of protecting us from danger by equipping us with a response that helps the body adjust to new situations. To make friends with stress means we must learn to understand what it is trying to tell us. Learning to be in tune with the stress instead of swimming in the noise of it.

What Can We Do About Stress?

Awareness is the first and biggest step. Take some time to reflect on your level of stress. When do you feel stressed out or under stress? How does that show up in your body? How does stress affect your relationships? Remind yourself that stress is normal during and after cancer. Give yourself some grace, so much change is happening.

The next step is taking an interest in making changes to support our body in new ways. Some habits may need to change to support the change we have experienced. When we build physically stronger bodies, we’re able to build psychologically stronger minds. The other way around is also true. 

As you transition from treatment to survivorship give yourself a prescription for different types of MEDS.

  1. Mindfulness

  2. Exercise

  3. Diet

  4. Sleep and Support

Each has been scientifically proven to help reduce stress. Many cancer centers offer free courses in each of these areas. Ask your healthcare provider for more information. 

Here are some additional tips to reduce stress from the Mayo Clinic and Harvard Medical School:

  1. Get Active

  2. Eat a Healthy Diet

  3. Avoid Unhealthy Habits

  4. Meditate

  5. Laugh More

  6. Connect with Others

  7. Assert Yourself

  8. Try Yoga

  9. Get Enough Sleep

  10. Keep a Journal

  11. Get Musical

  12. Be Creative

  13. Seek Counseling

  14. Do a Relaxation Exercise

  15. Stretch Your Muscles

  16. Take a Mindfulness Break

  17. Go Out in Nature

  18. Counter Negative Thoughts

  19. Put Things in Perspective

  20. Reach Out for Help

Other Resources

Meditation Apps

Getting Help for Depression

After treatment, you may feel angry, tense or sad. For most people, these feelings fade with time and readjustment. Depression can be mild and temporary with periods of sadness, anger and/or grief, but it can also be more severe and lasting. 

The more severe type is called major depression or clinical depression. Major or clinical depression makes it difficult for a person to function, heal, and follow treatment plans. Treatments are available.

People who have had depression before are more likely to have depression after their cancer diagnosis.

According to National Cancer Institute a clinical diagnosis of major depression experiences specific symptoms that last longer than a two-week period:

  • Feeling sad most of the time.

  • Loss of pleasure and interest in activities you used to enjoy

  • Changes in eating and sleeping habits.

  • Slow physical and mental responses.

  • Feeling restless or jittery.

  • Unexplained tiredness.

  • Feeling worthless, hopeless, or helpless.

  • Feeling a lot of guilt.

  • Not being able to pay attention.

  • Thinking the same thoughts over and over.

  • Frequent thoughts of death or suicide.

From the Stanford Center for Integrative Medicine, Andrew Kneier, Ph.D. wrote a beautiful article about Coping With Depression after cancer. He offers four important ways to protect yourself from depression when you are dealing with cancer:

  • Try to become aware of your emotions, and then acknowledge and express these emotions with someone you feel close to. Depression often results from the suppression of painful and upsetting emotions. Research has shown that cancer patients who openly express their feelings and obtain support from others are much less likely to become depressed.

  • Maintain close connections and frequent contact with your loved ones and reach out for their support. Studies have demonstrated that interpersonal support is a strong buffer against feelings of isolation and depression.

  • Become an active participant in fostering your physical and emotional well-being. Discuss the treatment options with your doctors so that you are informed and can fully embrace the treatment plan, and consider supplemental approaches as well (such as acupuncture, better nutrition, herbal medicine, meditation, and guided imagery). Your active involvement in your recovery will help to counter the feelings of helplessness and passivity that often characterize depression.

  • Try to obtain as much exercise as possible. The physiological and mental benefits of exercise help to offset the depressing effect of a serious illness. One reason for this is that exercise increases the brain levels of endorphins, which are natural mood elevators.

Where to Get Help for Depression?

Depression is not to be addressed alone. Asking for help is difficult. A good place to start is your healthcare team. Talk to your oncologist, nurse, or oncology social worker. They know depression can be part of the cancer journey and should be able to give you a referral for a therapist, peer counselor, and/or support group. 

Other resources include:

Kathy WashburnComment