Cancer causes excess mortality in those with mental illness in the United States[i][ii], and while incidence rates have been found to be comparable between people with and without a history of mental illness, cancer-related mortality is higher[iii] in people with mental illness. In addition to the physical impacts of cancer, fear of disease recurrence, alteration of one’s identity, and perceived loss of support from friends, family, and one’s providers can exacerbate pre-existing mental health issues and increase long-term risks associated with more severe psychological disorders[iv]. Supporting individuals with mental illness around their cancer diagnosis is an essential component of holistic care that can affect an individual’s long-term prognosis[v] and outcomes.
Effect of a Cancer Diagnosis on Mental Health
There can be significant psychosocial effects of a cancer diagnosis, especially amongst patients with a pre-existing mental health condition. According to The National Cancer Institute:
- One in three people with cancer experience mental or emotional distress. It is most common in breast cancer (42%) and head and neck cancer (41%) patients.[vi]
- Up to 25% of cancer survivors experience symptoms of depressionand up to 45% experience anxiety.
- Many cancer survivors also experience symptoms meeting the criteria for Post-Traumatic Stress Disorder (PTSD).
- Cancer survivors are twice as likely to die by suicide than the general population.
Managing the Mental Health Consequences of a Cancer Diagnosis
The stress that comes with a cancer diagnosis can be overwhelming. Managing the psychological effects can be key to ensuring longer survivorship. Studies have shown a decrease in symptoms of depression was associated with longer survival in patients with metastatic breast cancer.4 In another study, researchers examined the impact of psychologist-led small group sessions that offered strategies for reducing stress, improving mood, changing health-related behaviors and adhering to treatment and care.5 The breast cancer patients who participated in the groups had a 45% lower risk of their cancer coming back and a 56% lower risk of dying from breast cancer.
The Role of Mental Health Providers in Helping Patients Cope with a Cancer Diagnosis
Mental health professionals are an integral part of the care team for their patients managing a cancer diagnosis. They are able to work with their patients to identify positive coping mechanisms to manage stress, mitigate risky behaviors around smoking or other substance use, and encourage an active lifestyle which ultimately can lead to a better quality of life and survivorship post-cancer treatment. Mental health professionals can also encourage patients to manage their stress with effective coping strategies that have been proven to lead to lower levels of depression, anxiety, and symptoms related to cancer and treatment including:
- Mindfulness [vii]
- Relaxation techniques [viii]
- Cognitive Behavioral Therapy (CBT)
- Antidepressants and anti-anxiety medications
Other support services shown to improve mental health outcomes include:
- Counseling and engaging patients in problem-solving strategies in a supportive environment can help patient work through their grief, fear and other emotions.
- Leading and/or referring patients to support groups provides patients a chance to give and receive emotional support and learn from the experiences of others.
- Collaborating with the oncology care team to help patients communicate more effectively and ensure care coordination with all health care providers.
- Providing and explaining more information about the diagnosis to help patients make informed choices about treatment, enhance their understanding of the disease and treatment options and encourage adherence to treatment and follow up.[ix]
Available Resources for Mental Health Providers
A plethora of resources exists that can be used by mental health providers to help support their patients through a cancer diagnosis and survivorship including:
- Cancer Support Community (CSC) is a nonprofit network which provides social and emotional support and administers a toll-free helpline with educational resources for cancer patients and their families, friends, and caregivers. Learn more at https://www.cancersupportcommunity.org/.
- LIVESTRONGFoundation provides free, personalized cancer navigation services to patients, caregivers and providers. Patient navigators can provide assistance with managing medical expenses and insurance challenges, fertility preservation, understanding treatment options, and accessing emotional support. Learn more at https://www.livestrong.org/.
- American Cancer Society provides a wide variety of services from emotional support to the latest cancer information for those who have been touched by cancer 24 hours a day, 7 days a week. Learn more at https://www.cancer.org/.
- Leukemia Lymphoma Foundation (LLS) is the world’s largest voluntary health agency dedicated to blood cancer. LLS provides free information and support services to patients and their families. Learn more at http://www.llf.org.sg/.
- Susan G Komen For the Cure provides resources to patients, caregivers and providers to include interactive learning, educational materials and videos, breast cancer educational toolkits, helplines, screening tools and clinical trials resources. Learn more at https://ww5.komen.org/.
Additional information to support mental health providers around cancer control in mental health settings, resources including webinars, and opportunities to engage in individualized technical assistance can be found by visiting the National Behavioral Health Network for Tobacco and Cancer Control (NBHN) at https://www.bhthechange.org and becoming a member today!
[i] Druss BG, Zhao L, Von Esenwein S, Morrato EH, Marcus SC. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Med Care 2011;49(6):599–604.
[ii] Cunningham R, Peterson D, Sarfati D, Stanley J, Collings S. Premature mortality in adults using New Zealand Psychiatric Services. N Z Med J 2014;127(1394).
[iii] Lawrence D, Hancock K, Kisely S. Cancer and mental illness. In: Sartorius N, Holt R, Maj M, editors. Comorbidity of Mental and Physical Disorders. Key Issues in Mental HealthBasel: Karger; 2015. p. 88–98. http://dx.doi.org/10.1159/000365541.
[iv] Meldrum H. Communicating with patients experiencing mental distress. Oral presentation at: Oncology Nurse Advisor Navigation Summit; April 7-9, 2016; Orlando, FL.
[v] Meldrum H. Communicating with patients experiencing mental distress. Oral presentation at: Oncology Nurse Advisor Navigation Summit; April 7-9, 2016; Orlando, FL
Blog post written by Tasha Moses and Sarah Linden