Cancer and Mental Health: “Adjusting to A New Normal”

Cancer: prevention and early detection

Cancer can happen to anyone. But lowering your risk is affected by the lifestyle choices you make :

1. Using any kind of tobacco puts you on top of the list for cancer. As you already know, smoking or even second-hand smoking were linked to various types of cancer including cancers of the lung, mouth, throat, larynx,….. So staying away from tobacco is a crucial part of cancer prevention.
2. Eating a balanced diet, maintaining a healthy weight, limiting processed meats, and limiting alcohol intakes.
3. Skin cancer is one of the most preventable cancers if you take the necessary precautions essentially by limiting sun exposure, but not completely. You still need sunlight to survive!
4. Getting vaccinated against certain viruses including Hepatitis B that can cause liver cancer and HPV (Human Papillomavirus) which can cause cervical and other genital cancers as well as squamous cell cancers of the head and neck.
5. Avoid risky behaviors that can lead to infections that in turn might increase the risk of getting cancer. (like practicing unprotected sex and sharing needles)

For early detection, screening is the best way to find the cancers that are in the early stages of the disease in asymptomatic patients. Generally, men don’t need to be concerned about screening before the age of 45, and the same average goes to women who may have the choice to start annual breast cancer screening at around 40 to 44 years of age.

Let’s talk research!

Major or clinical depression makes it hard for a person to function and follow treatment plans. It happens to about 1 in 4 people living with cancer.

People with mental illnesses have an increased mortality possibility from cancer, which cannot always be explained by an increased incidence. But possible explanations include either delays in detection or initial presentation leading to more advanced staging at the time of diagnosis or difficulties in communication or access to healthcare.

And lastly, Chemobrain affects up to 75% of patients put under treatment with 35% of said patients reporting symptoms post-treatment.

What’s chemo brain?

Chemo brain can be described as thinking and memory problems that can happen during and post-cancer treatment. But symptoms are subtle and often go unnoticed, essentially they are seen in patients as a difficulty remembering dates, names, phone numbers, trouble concentrating, multitasking, etc.

And while the exact cause for chemo brain is still to be discovered, many possible factors may contribute to the signs and symptoms and memory problems in cancer survivors:

1. Cancer itself, either in the case of brain cancers or as a consequence of cancer-related anxiety and depression, can contribute to the appearance of thinking and memory problems.
2. The cancer treatment, especially chemotherapy, anthracycline was proved to negatively affect verbal memory.
3. Complications can arise from the treatment, like anemia, infection, fatigue, sleep problems, or hormonal changes.
4. And finally, other causes like inherited susceptibility to chemo brain play a role.

Now, there are no tests to diagnose chemo brain, and cancer survivors who experience these symptoms often score within normal ranges on memory tests. But doctors may recommend blood tests, brain scans or other tests to eliminate the probability of the presence of other causes of the memory problems.

For the treatment part, treating Chemo brain focuses on helping through ways of coping with symptoms. Cancer and cancer treatment can lead to other conditions, such as anaemia, depression, sleep problems and early menopause, which may worsen memory problems. Controlling these other factors may make it easier to cope with the chemo brain. 

And unfortunately, no medications have been approved to treat chemo brain. In the worst-case scenario, Medications approved for other conditions like Alzheimer’s, ADD (Attention Deficit Disorder), ADHD (Attention Deficit Hyperactivity Disorder), may be considered.

Cancer x Mental Health

Life-altering illnesses in general are chronic illnesses that will have an impact on one’s quality of life everyday. These kinds of illnesses, like cancer, amplify the need for the patient diagnosed to get very involved in the treatment plan. And often there can be an acute intensive medical treatment, followed by months or years of follow-up treatments. So not only does the patient’s life course change for months or years, receiving this diagnosis can also change the lives of the people around them.

And when patients receive diagnoses like cancer, it can have a huge toll on their mental health, for many reasons. The first one is that when they receive the diagnosis, there is often a period of grief and adjustment. They previously had short or long term goals, a whole different view of what their life will be in the future, so they are shocked by a diagnosis that can alter this course that they previously  had in mind. They now have to adjust by doing whatever’s necessary or best for them as new cancer patients. The second reason is that it sometimes could be a financial stressor. Not everything is covered. Especially in Lebanon where the current economic crisis is happening and people can barely find basic medication in pharmacies. The third reason is that sometimes a newly diagnosed cancer patient with a history of mental health issues like depression or anxiety before they got diagnosed, the diagnosis will simply make it worse. 

Next comes waiting. People start off recognizing a symptom, and they might go see their doctor. they might have some tests done. and sometimes they get a finding that seems like it could be cancer, that often is followed by a biopsy, and then a definitive diagnosis of cancer can be made. But even after that people often need more tests, called staging tests that help figure out not only how big the tumor is, but whether it’s spread to any lymph nodes or spread elsewhere in the body. And nowadays sometimes even more tests are done like genetic testing which can often help the oncologists decide the right treatment plan to choose. You can see there’s a lot of waiting and as you might already know it can be terrible for people during this period of stagnancy.

One of the problems that these patients encounter when dealing with these mental health impacts, is that these psychological symptoms can interfere with how someone engages in their medical treatment. So it’s a matter of adherence. They may not adhere to their pills, appointments, testing, physical therapy… and that can have a huge impact on the outcome of the plan of care they’re following.

Tips to cope with a cancer diagnosis

1. Get organized
   • Keeping up with appointments on top of everyday responsibilities can be overwhelming, especially during the time you might be undergoing a treatment when chemo-brain symptoms are at their peak. Try as much as you can to stay organized. Whether by planning in a journal, using the calendar app on your phone… Whatever you feel most comfortable with, as long as it works for you.
2. Understand who’s part of the team
   • Several different players can be involved in the team, and it’s really important to understand who they are and what their roles are. 
3. Get informed, the right way
   • Uncertainty is what fuels anxiety. But it’s so important to go to trustworthy sources. It’s not that blogs and other sites, whether mainstream or obscure, are necessarily badly intentioned, but they’re not necessarily vetted, and they don’t obligatorily have the type of evidence-based information that you’ll get on other more reputable sites. 
4. Be kind to yourself
   • It’s very important to keep a routine. And if that routine happens to involve healthy eating, exercise and spending time with family or other things that you enjoy, all the better.

How to act when informed by a loved one that they have cancer

In the moment of getting that news, we’d all like to think we’re graceful. Some of us might cry, scream or yell. We don’t know how we’re going to react, we’d like to think we will but I don’t think that there’s a should. A gold standard to strive for is to not bring more distress into the life of the person who’s already experiencing the illness, to be as empathic as possible, and to find out how you can be helpful to them even if that just means doing nothing.