Although the therapies are getting better and the chances of recovery are rising, the diagnosis of cancer for patients and relatives is initially a shock. Many questions, but also fears, insecurity and a feeling of powerlessness are in the room. The upcoming therapies and the life with the disease will not only demand the body a lot, but also represent a psychological burden.
Psychological burden of cancer diagnosis and therapy
How the individual deals with exceptional situations, can hardly be foreseen. The cancer diagnosis means an incision and will at least in the following months change everyday life and determine the consciousness. In the first phase prior to therapy, when final diagnostic tests are performed, most cancer patients have feelings of fear, uncertainty and helplessness. Especially now it is of great value, if the persons concerned are well looked after medically and trust their doctors. You should be convinced that the best possible treatment strategy will be used. Possibly. It may be useful and reassuring to seek a second medical opinion.
The overall stressful mood will fluctuate again and again over the duration of cancer treatment and follow-up and, of course, also depends on what type of cancer is involved, what therapies are needed and how the course of therapy develops. It should not be underestimated how much physical side effects of the therapy can change self-awareness and self-esteem and affect the psyche.
In the course of cancer therapy, the treatment team always inquiries about the mental state. In addition, questionnaires that the cancer patient can voluntarily fill out can be used to determine the psychosocial burden. This makes it possible to detect early on whether help is needed
Patients who receive chemotherapy have, for example, to suffer from fatigue, weakness and decreased performance, often skin problems, nausea and hair loss. Radiotherapy also often leads to fatigue. However, these side effects are usually transient and resolve after the treatment cycle. Sometimes surgery is part of cancer therapy. In some cancers, the surgical removal of the tumor can lead to long-lasting or permanent physical changes and impairments that also have to be processed psychologically.
The most common cancers in Europe include breast, prostate and colorectal cancer. The particular mental stress of the patients becomes immediately apparent when one imagines the situation of those affected after such an intervention: a disfiguring or radical breast surgery, side effects such as impotence and incontinence after surgical removal of the prostate, fecal incontinence or an artificial bowel after removal of a carcinoma at the rectum. The change in body image, shame, and fear of losing sexual attractiveness often cause patients to retreat and possibly even turn away from partners.
Also, for relatives the psychological problems or their extent are not obviously recognizable, or they are wrongly evaluated. In addition, many sufferers find it difficult to admit the problems and to talk about fears and feelings. However, for the recovery process and to improve the quality of life, the psyche plays a crucial role. Therefore, psychological care of cancer patients is recommended as part of the overall therapy. What does this psycho-oncological care look like for the individual? As relaxation training, patient training, discussion groups or psychotherapeutic procedures are used, depends on the existing burden and the need of the patient.
In some patients, fears and persistently depressed mood and listlessness, it becomes a disease of its own. Depression and anxiety disorders, which may occur as a result of concomitant cancer disease, require independent therapy.
Cancer patients and their relatives can seek psycho-oncological care. Its goal is to help those affected to deal with the disease and to provide psychotherapeutic help as needed. First contact persons are usually the treating physicians and the nursing staff in the hospital or in the cancer center, who arrange the contact to specialists. Also, cancer counseling centers and specialized psychotherapeutic practices offer a psycho-oncological care.
Depression in cancer
The vast majority of cancer patients do not get mentally ill. There is no doubt that the risk of developing depression due to the cancer increases. Since there is no uniform clinical picture, depression often goes unnoticed for a long time.
Evidence such as depression, lack of drive or fear of the future are often attributed to the current crisis situation, especially in cancer patients. However, depression is a separate and serious condition of the central nervous system that needs to be treated. Otherwise – regardless of the course and therapy of the cancer – the psychological stress and the suffering pressure increase.
The patient falls over prolonged phases in a depressed, gloomy mood, can hardly rejoice and loses all motivation. There are also physical complaints such as persistent sleep disorders, dizziness, circulatory problems, pain or gastrointestinal problems. Also typical is a departure from family and friends and the retreat from social life.
Many seriously depressed people lose all courage and can carry themselves with suicidal thoughts. Moreover, studies show that depressive cancer patients follow the treatment instructions of the doctors much less accurately than cancer patients without depression. This endangers the success of cancer therapy and may affect quality of life, which in return can affect mood.
In order to break this cycle, it is important that the first signs of depression are properly assessed. Only a doctor can make the reliable diagnosis and classify the severity of the depression with the aid of a list of criteria. If necessary, he will then suggest a therapy that will help manage the depression and significantly improve the patient’s quality of life.
Whether there is a psychological burden with temporary phases of depression, is often indistinguishable to the medical layman. Relatives who are showing signs of depression should encourage the person concerned to contact a doctor
For the treatment of depression, there are different therapeutic approaches. For most patients a combination of psychotherapy and medical therapy makes sense. Psychotherapy should guide the patient to deal with his fears and insecurities and to positively change negative thinking and behavioral patterns.
The drugs used to treat depression are called antidepressants. They contain agents that interfere in the brain metabolism in different ways by influencing the activity of certain neurotransmitters. Thus, the disturbed in a depression stimulus transmission between the nerve cells can be regulated.
Depending on the acute disease situation and the prevailing symptoms, the doctor will select the medication and dosage. Often it takes a few weeks until the therapy strikes, and the depressive mood slowly improves.
The special situation of patients with colorectal cancer, which affects more than 400,000 men and over 300,000 women in Europe every year, has been addressed in a study Colon Cancer + Depression. The study report gives a general overview of the current treatment strategies for colorectal cancer and also addresses the particular psychological stress. Dejection, despair, anxiety and depression, which may be associated with the cancer and the consequences of the therapy, also require treatment and are part of cancer rehabilitation.