Why it's important to consider mental health before, during and after cancer

Jun 29, 2019

A cancer diagnosis is often life changing. From diagnosis through treatment and on to recovery, cancer patients face a specific set of challenges. The immediate focus is to beat the cancer, of course, and return the body to a healthy state. But what about the patient’s mental health?

We talk about the specific mental health challenges facing cancer patients on “Take Care” with Dr. Claudia Trudel-Fitzgerald, a research scientist at Harvard T.H. Chan School of Public Health and clinical psychologist at Ordre des Psychologues du Quebec.

She said there are three key parts of cancer care that are important when you think about mental health:

  • Physical exams/diagnosis
  • Treatment
  • Post treatment

“You can understand there is a lot of uncertainty about how things will unfold,” Trudel-Fitzgerald. “People can experience a lot of anxiety and when the diagnosis is finally made they can experience some certain depressive symptoms – especially if the prognosis is not really good.”

This is also the same time that sleep can become an issue for patients. There is a lot to worry about, from treatment costs to outcomes and that can disturb regular sleep patterns.

During treatment, physical changes are often accompanied by mental changes, including anxiety and depression. Sleep can continue to be a struggle during this second stage for those undergoing chemotherapy.

Trudel-Fitzgerald notes that although many of the changes during the treatment stage are physical, they can have impacts on mental health as well.

Less is known about the third phase – transitioning after treatments are completed.

“Most of the time this period is perceived as a relief or good news – the treatments are over. But we know more and more that this period can be difficult too in terms of mental health,” Trudel-Fitzgerald.

Patients report that they lack social support during this last period of cancer care, by the medical team (as appointments become farther apart) and by family and friends.

The connection between mental health and cancer

“Some studies will show an association between poor mental health or negative emotions and greater risk of cancer or worst prognosis, for example, and other studies will find no association,” Trudel-Fitzgerald said.

This has been a bit confusing for scientists, she explained, partially because there is evidence showing that your mental state has an effect on cardiovascular disease outcomes. In the case of cancer, part of the issue is the follow up length for studies.

“We need studies with a really long follow up period to be able to capture those associations and most of the time studies are not long enough for that,” Trudel-Fitzgerald said.