Quiet Doesn’t Come After The Storm: Post-Cancer Depression

Posted on March 6, 2012 by

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To use, granted, the lower end of the statistical range, at some point in their lives 10% of women and 5% of men, if left to their own devices, will develop depression.

But, according to the American Cancer Society, a whopping  25% of cancer survivors will develop the illness.

And that doesn’t touch the post-cancer anxiety.

Psycho-oncologist Jane Fletcher gave a presentation on the topic to the Clinical Oncological Society of Australia’s Annual Scientific Meeting. Her number sounds pretty familiar, as she estimates that around 25% of cancer patients meet the criteria for an anxiety disorder post-treatment, with 3% suffering full-blown post-traumatic stress disorder (or PTSD).

It was only when treatment ended . . .that the full impact of what had happened hit me. I felt cut adrift. There is an expectation that when you walk out of hospital on that final day of treatment, your cancer story has ended, but the reality is that in many ways you story is only just beginning. . . I passionately believe that more follow-up care is needed to give recognition to the post-treatment phase of cancer survivorship.”

And I thought to myself–she’s quite right–ideas for coping with the impact of cancer after the cancer “scare” is over–well, they’re just not out there. So here’s a post that addresses common “side effects” of a phase cancer patients spend their whole treatment desiring: life post-cancer.

So what do we do, knowing that depression and anxiety plague nearly a quarter of cancer survivors?

The fact that depression occurs so often in the survivor population is perhaps no surprise. People’s lives, as they battle cancer, become singularly focused–all energy goes into defeating the enemy: cancer. Each treatment, each moment, almost, goes into fighting for survival.

Oddly, when the enemy has been defeated, the survivor is left without a sense of purpose. How to re-build such an intensely concentrated, meaningful existence?

And when treatment finishes, survivors often find themselves relatively alone–their treatment team virtually vanishes, and friends who have driven your carpools, cooked your meals, held your hand, overlooked your emotional outbursts, now expect the cancer-free person to normal. The survivor feels alone–maybe even abandoned. One of my teachers in visualization techniques remarked, “There’s so much secondary gain from being sick, it’s wonder anyone wants to get better.”

And, of course, the all-encompassing fear: the cancer could return. During chemo/radiation you feel the cancers cells are being destroyed. Now what are they doing?

With the constant doctoring and fatigues and sickness, you haven’t had time to take stock.  Now, you may fully realize that you have come face to face with death–a terrifying thought that, if obsessive, can be debilitating.

Taken together, these reasons more than explain post-cancer mood disregulation. But new research suggests there may be an even more complex biological mechanism at work.

Cancer cells are busy secreting a number of chemicals that affect how our bodies function. Researcher Dr. Leah Pyter and colleagues from the University of Chicago theorized, they might be secreting chemicals that also impact how we think and feel.

Researchers studied their theory in–who else?–rats. Pyter and her team examined the behavior of rats with cancer, and noticed that a significant number of them demonstrated depressive behaviors, or the equivalent of rat-depressive behaviors, like burying marbles and a failure to swim. [I assume someone write the equivalent of a DSM for rats, determining that failure to swim meant depression. If that was a qualifier in humans half the kids at my summer camp would have been candidates for Zoloft.]

Interestingly, the rats with the tumors and the depressive behavior all had higher level of three particular types of cytokines. Cytokines, as far as I can tell (and that isn’t very far), are  substances secreted by specific cells of the immune system which carry signals between cells, and thus effect them. That’s the best I can do, which is way I shamefacedly link you up here to Wikipedia, which, frankly, I found particularly inscrutable.

depressed rat

Anyway, the cancer rats had higher levels [and I just include these here in case someone knows what I'm talking about--and can explain it to me] of three particular cytokines – IL-1β, IL-6 and TNFα – in their tumours, their blood and their brains.

As Pyter at al point out, these are the same cytokines that, at raised levels, cause emotional problems–in humans. So their theory goes that the increases in these cytokines over the period of time that the tumor is growing could be enough to yield depression and anxiety.

In short, and put in terms someone like myself can really grasp, if this holds true for humans, seems that the tumor itself could be secreting substances that throw off the cancer patient’s emotional balance–and even once the tumor’s gone the substances remain in the bloodstream, wreaking havoc with the survivor’s mood. No wonder the depression rates post-treatment are so high–the tumor is gone, but has not finished completely its dirty work.

If you want to look into this further–or just to check my interpretation of rat events–look for the paper with the particularly inviting title (you know I couldn’t make this up), “Peripheral tumors induce depressive-like behaviors and cytokine production and alter hypothalamic-pituitary-adrenal axis regulation” (for real) published in Proceedings  the National Academy of Sciences, June 2, 2009. I wish you luck.

But to return, for a moment, from the rodent world, to the world of humans.

As I read through the depression profiles for various cancer survivors, I saw symptoms that I’m used to seeing in depressed patients–and then I came up short.

Apparently post-cancer depression can have a number of negative effects: not enjoying life (or sex), difficulty sleeping–or debilitating fatigue, difficulty eating–or not going back to follow-up visits.

Does this jump out at you the same way as it did me? Yes, depression does impact one’s ability to take pleasure in life, disrupts sleep and eating–but did you get that last one?? Post-cancer depression can be so crippling that it can lead the patients to fail to take the steps to ensure that they will remain cancer free.

Now that, my friends, is a serious problem.

The most recent research directly addressed Hispanic women who had survived breast cancer. Those with depression were less likely than their counterparts to get screenings that could pick up signs of colorectal or ovarian cancer. But the issue applies across demographics.

So the mood disregulation that comes post-cancer is not only painful in itself and somehow surprising to the survivor’s friends and family–it actually has practical implications for the ability of the cancer to return–a fear that is already often pervasive and haunting.

Clearly, being aggressive about getting treatment of the depression and/or anxiety is of the utmost importance.

All the things I’ve suggested before surrounding depression I recommend again: set up a steady exercise schedule. Establish and maintain a healthy support system. Eat well. Laugh, which I’m sure you feel like doing when you’re depressed.

But do not neglect to follow up this issue medically. Talk about it with your doctors, so they can refer you for help. If they’re not proactive enough, do some research, and get yourself in to see a strong psychiatrist. Be open both to medication (often it will be a temporary thing), and to psychotherapy–again with an experienced therapist who’s comfortable with cancer issues (believe it or not, some therapists are so fearful of cancer themselves they can make matters worse). Attend a support group, for people just like you. If there isn’t one around your area–well, start one.

And hang on. Because you’re a survivor. You’ve beaten one of the toughest enemies. You can beat this, too, and, eventually, earn your right to enjoy the quiet after the storm.

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