We all do know that being a cancer survivor means that you are at an increased risk to suffer serious psychological distress such as anxiety and depression The surprise is that this increased susceptibility can extend even a decade after the treatment ends.
Survivors who are diagnosed in their younger years, unmarried, had less than a high school education, were uninsured, had other illnesses or had difficulty doing the activities of daily living were at the highest risk of psychological problems. However, even we older men who might not fit these categories still are at a greater risk for psychological difficulties than the general population.
A recent study appears in the July 27 issue of the Archives of Internal Medicine examining this increased risk in cancer survivors. The study was conducted at Brigham and Women’s Hospital and Dana-Farber Cancer Institute in Boston.
The researchers gauged the long-term psychological impact of cancer by analyzing the mental health and medical data on 4,636 adults who’d survived cancer and 122,220 who had never had cancer. All the date used in this study was collected between 2002 and 2006 by the National Health Interview Survey, which is conducted yearly by the U.S. Census Bureau.
During a follow-up period of at least five years and an average of 12 years, about 5.6 percent of cancer survivors were found to have experienced severe psychological distress within the previous month, compared with only 3 percent of those without cancer.
Dr. James Zabora, a former associate professor of oncology at Johns Hopkins School of Medicine, who has researched cancer and mental health issues, said the study was well done but that the measure of mental health has not been scientifically validated for use in cancer survivors. In fact, he said, he suspected the incidence of mental health issues among cancer survivors might be higher.
Zabora said that, “When you are faced with a serious stressor, in order for you to respond to it, you have to define what it means for you. That process depends on how many resources you have to manage that stressor. The younger you are, the less experience you have dealing with stressors. The lower your education, the more difficult it is to understand the complex nature of the disease. If you’re unmarried, you may have less support.”
We all know from our own personal experience that being diagnosed with any cancer and then getting through the treatments is among the most trying experiences any of us could experience. With the grace of God, we hope that many of the symptoms from prostate cancer treatment will subside, however for many of us the side effects never disappear, but even get worse. Our treatment protocols can cause both immediate and delayed problems.
Cancer can also bring about job loss as well as significant changes to our relationships, including family roles and sexual intimacy. In addition, for those of us who have had a recurrence we need to find a way to deal with or mortality. What better way is there to bring about psychological problems is there?
In this study, 9 percent of long-term cancer survivors and 6 percent of individuals without cancer reported seeing or talking to a mental health professional within the previous year. One-third of cancer survivors with serious psychological distress reported using mental health services, while 18 percent said they would like to, but were unable to because they could not afford mental health care.
Where does this leave us? Clearly, we need to have our doctors, both primary care and oncologists, take the time to screen for psychological distress in their patients and then make appropriate referrals.
Support groups do have a roll, but they are not therapy groups and most group leaders do not have the training needed to provide the level of support that is sometimes required. However, there should be an effort to train group leaders to recognize those group members in need of additional psychological assistance and then to know how to refer them to an appropriate resources. Group leaders may also benefit from learning basic skills in stress management techniques, such as deep breathing and progressive muscle relaxation.
Having cancer is tough and getting through the treatment is even tougher. We need to acknowledge that these stressors are real and need to be accepted and dealt with by our professionals as well as the community.
Joel T Nowak MA, MSW
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