Depression is a disabling illness that affects about 15% to 25% of cancer patients. It affects men and women with cancer equally. People who face a diagnosis of cancer will experience different levels of stress and emotional upset. Important issues in the life of any person with cancer may include the following:

• Fear of death.
• Interruption of life plans.
• Changes in body image and self-esteem.
• Changes in social role and lifestyle.
• Money and legal concerns.

Everyone who is diagnosed with cancer will react to these issues in different ways and may not experience serious depression or anxiety.

Patients who are receiving palliative care for cancer may have frequent feelings of depression and anxiety, leading to a much lower quality of life. Patients in palliative care who suffer from depression report being more troubled about their physical symptoms, relationships, and beliefs about life.

Just as patients need to be evaluated for depression throughout their treatment, so do family caregivers. Caregivers have been found to experience a good deal more anxiety and depression than people who are not caring for cancer patients. Children are also affected when a parent with cancer develops depression. A study of women with breast cancer showed that children of depressed patients were the most likely to have emotional and behavioral problems themselves.

There are many misconceptions about cancer and how people cope with it, such as the following:

• All people with cancer are depressed.
• Depression in a person with cancer is normal.
• Treatment does not help the depression.
• Everyone with cancer faces suffering and a painful death.

Sadness and grief are normal reactions to the crises faced during cancer, and will be experienced at times by all people. Because sadness is common, it is important to distinguish between normal levels of sadness and depression. An important part of cancer care is the recognition of depression that needs to be treated. Some people may have more trouble adjusting to the diagnosis of cancer than others may. Major depression is not simply sadness or a blue mood. Major depression affects about 25% of patients and has common symptoms that can be diagnosed and treated. Symptoms of depression that are noticed when a patient is diagnosed with cancer may be a sign that the patient had a depression problem before the diagnosis of cancer.

All people will experience reactions of sadness and grief periodically throughout diagnosis, treatment, and survival of cancer. When people find out they have cancer, they often have feelings of disbelief, denial, or despair. They may also experience difficulty sleeping, loss of appetite, anxiety, and a preoccupation with worries about the future. These symptoms and fears usually lessen as a person adjusts to the diagnosis. Signs that a person has adjusted to the diagnosis include an ability to maintain active involvement in daily life activities, and an ability to continue functioning as spouse, parent, employee, or other roles by incorporating treatment into his or her schedule. If the family of a patient diagnosed with cancer is able to express feelings openly and solve problems effectively, both the patient and family members have less depression. Good communication within the family reduces anxiety. A person who cannot adjust to the diagnosis after a long period of time, and who loses interest in usual activities, may be depressed. Mild symptoms of depression can be distressing and may be helped with counseling. Even patients without obvious symptoms of depression may benefit from counseling; however, when symptoms are intense and long-lasting, or when they keep coming back, more intensive treatment is important.

Glossary Terms

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

A desire to satisfy a physical or mental need, such as for food, sex, or adventure.

The way a person thinks about his or her body and how it looks to others.

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

To adjust to new situations and overcome problems.

The process by which a professional counselor helps a person cope with mental or emotional distress, and understand and solve personal problems.

In psychiatry, a state in which a person is unable or unwilling to see the truth or reality about an issue or situation.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

The process of identifying a disease by the signs and symptoms.

The normal response to a major loss, such as the death of a loved one. Grief may also be felt by a person with a serious, long-term illness or with a terminal illness. It may include feelings of great sadness, anger, guilt, and despair. Physical problems, such as not being able to sleep and changes in appetite, may also be part of grief.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of palliative care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, supportive care, and symptom management.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

A feeling of self-worth, self-confidence, and self-respect.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.