Cancer diagnosis and treatment can be overwhelming and significantly impact a patient's mental health, leading to increased feelings of anxiety, depression, anger, and fear. The uncertainty of the disease, treatment side effects, and the potential for recurrence exacerbate these conditions. Anxiety can lead to physical symptoms like increased heart rate, sweating, and difficulty sleeping. Depression, characterized by sadness, hopelessness, and a lack of interest in activities, can be more frequent and challenging to manage during the treatment process.

Managing anxiety and depression during cancer treatment can be challenging, but it is essential to seek support from friends, family, and healthcare professionals. Self-care, such as engaging in activities like exercise, meditation, and hobbies, can help improve mental well-being. Maintaining social connections is crucial to prevent isolation and further feelings of depression. Staying informed about cancer treatments, treatment options, and support networks can help reduce anxiety and uncertainty. 

Cognitive-behavioral therapy (CBT) and other psychological treatments can help manage anxiety and depression. Maintaining a healthy lifestyle, including a healthy diet and regular exercise, can also be beneficial. By following the recommendations of your healthcare team, you can improve your mental health during cancer treatment.

Cancer diagnosis significantly impacts mental health, with high rates of depression and anxiety among cancer patients. Those without a prior psychiatric history are at a higher risk of common mental disorders, which can impact treatment, recovery, and quality of life. Those who have previously used psychiatric services are at greater risk. Mental health needs are often overlooked during and after cancer treatment, focusing on physical symptoms and side effects. Advances in early detection and improved treatments have led to longer lives with cancer, with the number of cancer survivors projected to rise in the United States.

This article argues that more research is needed to prevent, care, and treat co-morbid depression and anxiety among people with cancer. The number of people experiencing these conditions has increased exponentially, from 15.5 million in 2016 to 26.1 million in 2040. The article provides a current evidence review of systematic reviews relating to common mental disorders among people living with and beyond cancer. It covers factors that may increase the risk of experiencing co-morbid depression and anxiety, epidemiology, and potential care and treatment options. The review was conducted using English language articles from 2012 to 2017, with references scrutinized for additional papers and Google searches for important grey literature.

Depression and anxiety among people with cancer are influenced by various factors, including demographic, social, and economic factors. Individual risk factors include age, gender, unemployment, fewer educational qualifications, and lack of social support. Structural factors, such as healthcare costs and access to welfare support, also play a role. Psychological factors, such as pre-existing mental health problems and severity, contribute to the risk of depression. Individuals who have previously accessed mental health services before a cancer diagnosis experience excess mortality due to certain cancers, which may reflect late diagnosis, inadequate treatment, and higher rates of adverse health behaviors. 

Personality factors, such as neuroticism, and existing coping skills also contribute. The risk of suicide among people with cancer is higher than the general population for certain diagnoses with poorer prognoses, especially in the first 6 months after diagnosis. The individual psychological response to a cancer diagnosis is also significant, with feelings of hopelessness, loss of control, and uncertainty around survival and death. Anxiety around a cancer diagnosis can lead to sleep disturbances, increasing the risk of depression. Factors related to cancer and its treatment, such as the type of cancer, stage, and prognosis, also impact the development of depression and anxiety.

Depression and anxiety are common mental disorders among people with cancer, with a mean prevalence of 13% using diagnostic interviews and varying from 4 to 49% using all assessment methods. Factors such as treatment setting, type of cancer, and method used to screen for symptoms contribute to the wide variation in depression prevalence. The estimated prevalence of depression varies across treatment settings, with 3% in lung cancer patients and 31% in digestive tract cancer patients. 

There is no universal standardised tool for depression screening in cancer patients, and the method used likely to differ depending on the treatment setting. Common screening methods include semi-structured diagnostic interviews, the Hospital Anxiety and Depression Scale - depression subscale (HADSD), and the Center for Epidemiologic Studies Depression Scale (CESD).

 Depression tends to be highest during the acute phase and decreases following treatment, but this may differ depending on the type of cancer and prognosis. Depression during treatment was found to be 14%, 9% in the first year after diagnosis, and 8% a year or more after treatment in a meta-analysis of 211 studies.

The mental health outcomes of cancer patients are crucial, and fewer studies have examined anxiety. A systematic review found that anxiety was higher following treatment (27%), during treatment (26%), and lowest pretreatment (19%) in ovarian cancer patients. This may be due to reduced clinical consultations, potential transfer to a palliative setting, and fear of recurrence. Depression was highest before treatment (25%), during treatment (23%), and reduced following treatment (13%).

A similar review found that anxiety was highest pre-treatment (27%), lowered during treatment (15%), and post-treatment (18%). Rates of depression were relatively similar following treatment (18%), during treatment (15%), and pretreatment (17%).

A systematic review on the prevalence of psychological distress among testicular cancer survivors demonstrated that around one in five experienced clinically significant anxiety, compared to one in eight among general population controls. However, depression was no more prevalent among those surviving testicular cancer compared to the general population. In Scotland, the prevalence of depression was highest in patients with lung cancer (13%), followed by gynecological cancer (11%), breast cancer (9%), colorectal cancer (7%), and genitourinary cancer (6%).

The longer-term psychological impact of cancer has received comparatively little research. Few studies have focused specifically on younger cancer survivors, and more research is needed in this area. A representative study of young adult cancer survivors aged 15 to 39 years in the United States demonstrated that moderate and severe mental distress were significantly higher in those living with cancer for at least 5 years after diagnosis.

Many studies on the psychological impact of cancer have poor response rates, lack representativeness, and are based on small sample sizes. These studies often exclude patients with cognitive impairment or those who are too physically or mentally unwell to participate. Future research should use administrative health data, such as linking together cancer registries, inpatient and outpatient records, and prescribing data. There is also a lack of studies covering populations from low- and middle-income countries.

The estimated prevalence of comorbid common mental disorders may vary depending on the country studied, which may influence mental health inequalities among people with cancer. In a Scottish study, depression was found to be higher in the least advantaged groups (19%), compared to the most advantageous (10%). Cancer and comorbid anxiety were also unequally distributed; in the least advantaged groups, around 12% had both conditions, compared to 7% among the most advantaged. Further research is needed to quantify, monitor, and prevent inequalities among people with cancer.

To effectively manage and treat depression and anxiety among people with cancer, symptoms must first be identified. However, several social and clinical barriers have been reported, such as the lack of physician time for assessing symptoms, normalization of distress, and stigma surrounding mental health conditions. Screening for depression and anxiety among patients with cancer is only of value if it leads to effective treatment and support that improves patient outcomes.

The existing evidence for treating anxiety and depression among people with cancer is limited and of varying quality. Studies with small sample sizes mitigate against the detection of meaningful changes in patient outcomes and often suffer from a high rate of attrition, likely reflecting the high symptom burden and reduced survival in this patient population. Cognitive behavioural therapy (CBT) may be effective in reducing depression and anxiety and improving quality of life in patients with cancer in the short term, but potential long-term effects were only sustained for quality of life.

Studies on self-management of psychological distress among people with cancer have focused on the treatment phase, with fewer investigating interventions following treatment or at the end of life. Self-management interventions that have shown promise include education, monitoring, teaching, and counseling to help patients manage the short- and long-term physical and psychosocial effects of cancer.

The mental health of people living with and beyond cancer is a growing research and clinical priority. Effective treatment and management strategies may differ according to the demographic group affected. A report by CLIC (Cancer and Leukaemia in Childhood) Sargent surveyed 146 young people with cancer, finding that keeping in touch with friends and family, talking to others with similar experiences, and accessing the internet in hospital were reported to help maintain mental health during cancer treatment. However, young people reported that available services were not tailored to deal with those aged under 18 or the emotional impact of cancer. Additionally, there is a lack of suitable long-term emotional support. Just over 40% of the young people who took part did not access support for their mental health needs.

A more personalized approach to supporting the psychological health of people with cancer is needed. At diagnosis, the psychological health of patients should be considered alongside their physical health and sources of support offered. Evaluation of more recent personalised approaches to follow-up care is needed to understand the role they may have in preventing longer-term depression and anxiety amongst cancer survivors.

Funding is a key barrier affecting research progress in this area. As more people survive cancer, the risk of long-term and late effects of cancer treatment, such as secondary cancers, infertility, chronic pain, and insomnia, is likely to affect the mental wellbeing of cancer survivors, potentially contributing to depression and anxiety. Further research is needed to include less common types of cancer, younger people, and populations from low- and middle-income countries.

Living with cancer can be a daunting journey, not only physically but also emotionally. The psychological impact of a cancer diagnosis is profound, affecting patients, caregivers, and loved ones alike. Understanding and addressing the mental well-being of those affected by cancer is essential for comprehensive care and improved outcomes.

The Emotional Toll of Cancer:

Upon receiving a cancer diagnosis, individuals often experience a whirlwind of emotions ranging from shock and disbelief to fear and anxiety. Uncertainty about the future, concerns about treatment side effects, and the disruption of daily life can exacerbate these feelings. Additionally, the stigma associated with cancer and the fear of judgment from others can contribute to emotional distress.

Anxiety and Depression:

Anxiety and depression are common among cancer patients, with studies suggesting that up to one-third experience significant psychological distress. Symptoms may include persistent worry, changes in appetite or sleep patterns, feelings of hopelessness, and loss of interest in activities once enjoyed. Recognizing and addressing these symptoms is crucial for ensuring the well-being of patients throughout their cancer journey.

Coping Strategies:

Cancer patients employ various coping strategies to navigate the emotional challenges they face. These may include seeking social support from family and friends, engaging in relaxation techniques such as meditation or yoga, and participating in support groups with individuals facing similar experiences. Embracing a proactive approach to self-care, which may involve maintaining a healthy lifestyle, setting realistic goals, and practicing mindfulness, can also help alleviate stress and promote emotional well-being.

Supportive Care Services:

In recent years, there has been a growing recognition of the importance of supportive care services in oncology. Psycho-oncology programs, which integrate psychological and psychiatric support into cancer care, play a vital role in addressing the mental health needs of patients. These services may offer individual counseling, group therapy, or specialized interventions tailored to the unique challenges of living with cancer.

The Role of Healthcare Providers:

Healthcare providers play a crucial role in supporting the mental well-being of cancer patients. Effective communication, empathy, and validation of patients' emotions are essential components of patient-centered care. Screening for psychological distress using standardized tools can help identify individuals in need of additional support, enabling timely intervention and referral to appropriate services.

Looking Ahead:

As our understanding of the complex interplay between cancer and mental well-being continues to evolve, so too must our approach to care. By fostering open dialogue, promoting resilience, and integrating supportive services into cancer treatment plans, we can better address the emotional needs of those affected by cancer and improve their overall quality of life.

In conclusion, cancer is not just a physical disease—it profoundly impacts the emotional well-being of patients and their families. By acknowledging the psychological toll of cancer and implementing comprehensive support services, we can provide holistic care that addresses the needs of the whole person, fostering resilience and promoting healing throughout the cancer journey.

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