The Psychological Consequences of Cancer in Adults
Having cancer can be a distressing and stressful experience for patients and their family members, and can lead to a variety of psychosocial difficulties. While there are many different types of cancer – over 200 – each with its own particularities, there are some similarities in their psychological consequences. For example, most cancer patients report some symptoms of anxiety (e.g., fear of recurrence and of dying) and/or depression to varying degrees. Cancer and its treatment can also produce other symptoms with a strong psychological component such as insomnia, fatigue, pain, sexual difficulties, trouble concentrating, and memory problems. Body-altering cancer treatments (like mastectomy, oral facial surgery) can also lead to problems of self-esteem and body image.
Cancer-related Factors that Increase the Risk of Psychological Distress
The Canadian Association of Psychosocial Oncology (CAPO), along with many other countries throughout the world, has endorsed ‘psychological distress’ as the ‘Sixth Vital Sign’ to be assessed at crucial times of the cancer care trajectory with every patient. Numerous factors can contribute to the risk of psychological distress, such as:
- Receiving a cancer diagnosis at a young age is more likely to interfere with life projects (family, career) and can bring with it psychological difficulties. In addition, young people are often parents and have children to take care of, which may be more difficult when they are ill. Cancer treatment administered at a younger age can also result in premature menopause and infertility and have a negative impact on one’s sense of femininity and masculinity, which can be very distressful.
- Cancer affects men and women differently. Studies have shown higher rates of psychological distress (including symptoms of depression and anxiety) in women with cancer. Research also suggests that men tend to show their psychological distress differently with more irritability, low sexual interest, extra devotion to work, and substance abuse. It also appears to be harder for men to reveal their distress and ask for help.
- People who have suffered from a past psychological disorder are at a greater risk of experiencing psychological distress in reaction to cancer.
- A more advanced cancer at diagnosis and having experienced a cancer recurrence have been found to be associated with greater psychological distress, a greater fear of cancer recurrence and lower quality of life.
- Cancer treatments have many side effects that may increase psychological difficulties. For example, treatment-induced menopause (or “andropause” in men) is a side effect that may impact mood, sleep, sexual functioning, concentration, and memory. Fatigue is another undesirable effect of cancer treatment that has been shown to be associated with increased psychological disturbances and impaired quality of life. Pain is another distressful symptom that may due to the cancer itself but also to its treatment. Following cancer treatment (e.g., chemotherapy), individuals often report having cognitive difficulties. While most cognitive impairments are short term, some remain long-term and can affect one’s ability to work at the same level as prior to treatment for cancer.
- The quantity and quality of social support (practical help, emotional support, information) from the people in one’s circle may be affected by cancer. Some close friends or relatives may be uncomfortable with the disease and keep their distance. Others may become closer. It is easier to live with cancer with an adequate social support.
- “Passive” coping strategies such as behavioural avoidance (e.g., not reading about cancer, not asking questions to your oncologist about the illness) and cognitive avoidance (e.g., trying not to think about cancer) have been shown to be less effective coping strategies. It is often better to confront reality, even if this is harder to do at first.
Does Stress Cause Cancer? Do You Need to Keep a Positive Attitude to be Cured?
Some people believe that stress or other psychological factors (like past traumas, grief, depression) may have caused their cancer. Although this belief is very common, numerous studies have looked at this and have not established a link between stress and the onset or progression of cancer. Cancer is a very complex disease. It has many causes, including certain genes, hormones, viruses, behaviours (e.g., smoking, sedentary lifestyle, exposure to sunlight) and environmental factors (e.g., asbestos). Cancer arises from a combination of these factors that vary from person to person.
Another widely held belief is that a person’s attitude plays a determining role in recovery and that a positive attitude and fighting spirit will give a better chance of being cured. Once again, there is no scientific evidence for this idea in the literature.
Why is it important to change these beliefs? Because studies have shown that they increase the risk of psychological distress associated with cancer. More precisely, blaming yourself for your cancer (for example, believing you got cancer because you have been unable to cope with your stress) is associated with more psychological symptoms like depression and anxiety. Similarly, the belief that a cure will depend on your mental attitude can be very detrimental because it’s impossible to be positive all the time when you’re suffering from a disease like cancer. As soon as a negative feeling arises, which is completely normal even in the absence of cancer, it brings with it a strong sense of guilt (“it will be my fault if my cancer returns, I’m too stressed”) which may lead to a sense of hopelessness and symptoms of depression and anxiety. On the other hand, if you have too many negative thoughts, leading to persistent feelings of depression, anxiety, guilt and anger, there are effective strategies to reduce their impact. This may not affect your longevity, but will clearly improve your quality of life.
What Kinds of Interventions Can Help People with Cancer?
Anyone with cancer may experience some psychological distress, but not all need professional help. If your worries, sadness or other difficulties are severe or are affecting your daily functioning and quality of life, speaking with a psychosocial counsellor such as a psychologist is a good idea.
A number of psychological treatments have been shown to be effective in the treatment of cancer-related distress, depression, and anxiety. Cancer centres throughout Canada all have counselling services for cancer patients and their family members and can either provide specific interventions and/or have information on how best to access specific services locally. For example:
- Psychotherapy is an intervention that allows an individual, a family, a couple, or a group to talk openly and confidentially about their concerns and feelings with a trained professional. The question as to whether psychotherapy is best when used alone or in combination with an anti-depressant/anti-anxiety medication depends on the problem and its severity. Examples of specific psychotherapeutic interventions include cognitive-behavioural therapy (CBT) and mindfulness-based interventions.
- The efficacy of CBT in helping people cope with cancer is well established. If you choose this type of psychological intervention you will learn how to modify certain behaviours. For example, if you have reduced your activities, a behaviour that increases the likelihood of depression, you will be encouraged to reintroduce pleasant and energizing activities into your daily schedule. Also, if you have a tendency to have negative thoughts, cognitive strategies will help you question and change them into more realistic interpretations. For example, if you are worried about your cancer returning and dying from it, you will learn to look at the real chances of something like that actually happening and to better live with this uncertainty.
- Although the efficacy of mindfulness-based interventions has been less studied in the context of cancer, they can be very beneficial. If you opt for this approach you will learn how to concentrate on the present moment and to be more accepting of your negative emotions. Mindfulness-based interventions have gained in popularity and are often offered in cancer centers. There are also several smartphone apps available.
- New and emerging strategies for therapy and self-management such as professionally facilitated on-line support groups (e.g., CancerChatCanada; https://cancerchat.desouzainstitute.com ) and telemedicine-facilitated counselling via videoconferencing (e.g., Skype, Facetime) from you home with a trained psychosocial oncology counsellor are becoming more and more available.
- Support groups allow you to share your experience with other people living with the disease and can help you to feel less alone. You can contact the Canadian Cancer Society (www.cancer.ca) to learn about the services they can provide and the support resources offered in your community.
- Anti-depressants and anti-anxiety medications are often prescribed to patients with cancer to reduce their psychological distress, help them sleep better, and to reduce some of cancer treatments’ side effects (e.g., antidepressants for hot flashes), especially when these problems are severe. All medications have side effects. If the side effects that you experience are too disturbing or if you prefer not to take a medication, talk to your doctor about effective alternatives. It is often more effective to combine medication with psychotherapy.
- Physical exercise is particularly effective in reducing the fatigue associated with cancer and can have beneficial effects on many other symptoms like anxiety, depression and insomnia, although it isn’t generally sufficient to treat severe psychological disturbances. It’s important to start gradually and, ideally, to seek the services of a professional (e.g., kinesiologist) who can help you prepare a personalized program, make sure that exercise is safe for you, and follow you in your training.
- Wellness interventions such as yoga and relaxation favor well-being and the release of tension. More general interventions like these can produce positive effects but they are rarely enough to treat severe psychological distress.
- Consulting a couple or a sex therapist can be very helpful to better cope with the effects of cancer and its treatment on the quality of your conjugal relationship and your sexual functioning.
Where can I get more information?
- Canadian Cancer Society; cancer.ca
- Savard, J. (2010). Faire face au cancer avec la pensée réaliste. Montréal : Flammarion Québec.
You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial, and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, please visit: http://www.cpa.ca/public/whatisapsychologist/PTassociations
This fact sheet has been prepared for Canadian Psychological Association by Dr. Josée Savard, School of Psychology, Université Laval, CHU de Québec-Université Laval Research Center and Université Laval Cancer Research Center.
The author and the CPA would like to thank Dr. Scott Sellick, Thunder Bay Regional Health Sciences Centre for his assistance during the development of the first version of this fact sheet.
Revised: June 2019
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