by Anne Katz PhD, RN
It is well established that depression is a common experience for those with cancer. Depression rates among survivors are two to five times greater than the general population; it has been suggested that as many as 38% of cancer survivors experience depression [Boyajian 2010]. Survivors experiencing depression may experience poorer quality of life than non-depressed survivors as well as higher rates of cancer progression and even death [Pirl, 2009]. Anxiety is also acknowledged as a significant problem and is often associated specifically with fear of recurrence that can persist for years after diagnosis (Glaser et al., 2013).
A recent study from Australia (Boyes et al., 2913) examined these issues in more than 1,000 cancer survivors who were approaching the end of treatment or were in the early post-treatment phase. Anxiety and depression were measured at two points – 6 months and 12 months after diagnosis. The study found that anxiety and depression persisted at both time points, times when it would be expected that the trauma of diagnosis and treatment decision making would be over. At both times, 20% of survivors experienced anxiety and 13% were depressed. A further 9% showed signs of both anxiety and depression. This suggests that anxiety is a bigger problem for cancer survivors than depression.
Another study (Mitchell et al., 2013) pooled the results of 43 separate studies resulting in a sample of 51,381 cancer survivors compared to healthy controls or partners. This meta-analysis found 11.6% of survivors were depressed compared to 10.2% of controls. The prevalence of anxiety was higher with 17.9% of cancer survivors reporting anxiety compared to 13.9% of controls. Of interest is that the spouses/partners of survivors showed similar levels of these symptoms. Once again this provides evidence that anxiety is of more concern in the survivorship population after years of survivorship.
What do survivors who are experiencing depression and/or anxiety do about it? While a discussion about the psychosocial effects of cancer is the standard of care (Jacobsen and Wagner, 2012) it is suggested that this does not occur routinely. In a recent study (Forsythe et al.,m2013), researchers found that 55% of survivors reported that they had not had a discussion with their health care provider about this aspect of survivorship and they had not been referred for counseling or to a support group. Only a third had talked about psychosocial aspects of their cancer with their health care provider and 4.4% had seen a counselor or attended a support group. It should be noted that in this study, 73% of those surveyed stated that they did not want or need counseling or support but the primary barrier for 93% of the sample was lack of knowledge about psychosocial services or lack of availability.
Canadian sources support the important role of psychosocial care for cancer survivors along the disease trajectory (Turnbull Macdonald et al., 2012; CAPO, 2010). But how well are we doing in this regard? Do you routinely ask about distress, depression, anxiety or sexual functioning when you see your patients in follow up? For the survivors reading this article, how often are you asked about emotional status or psychosocial functioning? I welcome comments from you, our readers. I suspect they may be illuminating.
Boyajian, R. (2010). Depression’s impact on survival in patients with cancer. Clinical Journal of Oncology Nursing, 14 (5), 649 – 652.
Boyes, A., Girgis, A., D’Este, C., Zucca, A., Lecathelinais, C. & Carey, M. (2013). Prevalence and predictors of the short-term trajectory of anxiety and depression in the first year after a cancer diagnosis: A population-based longitudinal study. Journal of Clinical Oncology, doi: 10.1200/JCO.2012.44.7540
CAPO (2010). Standards of Psychosocial Health Services for Persons with Cancer and Their Families. Available at http://capo.ca/CAPOstandards.pdf
Forsythe, L., Kent. E., Eaver, K., Buchanan, N., Hawkins, N., Rodriguez, J., Ryerson, A. & Rowland, J. (2013). Receipt of psychosocial care among survivors in the United States. Journal of Clinical Oncology, 31 (16), 1961-1969. Doi: 10.1200/JCO.2012.46.2101
Glaser, A., Fraser, L., Corner, J. et al. (2013). Patient-reported out comes of cancer survivors in England 15 years after diagnosis: A cross-sectional survey. BMJ Open, 3, e002317.
Mitchell, A., Ferguson, D., Gill, J., Paul, J. & Symonds, P. (2013). Depression and anxiety in long-term cancer survivors compared with spouse and healthy controls: A systematic review and meta-analysis. The Lancet Oncology. Published online: http://dx.doi.org/10.1016/S1470-2045(13)70244-4
Pirl, W., Greer, J., Temel., J., Yeap, B. & Gilman, S. (2009). Journal of Clinical Oncology, 27, 4130 – 4134.
Turnbull Macdonald, G., Baldassarre, F., Brown, P., Hatton-Bauer, J., Gren E. & Lebel, S. (2012). Psychosocial care for cancer: a framework to guide practice, and actionable recommendations for Ontario. Current Oncology, 19 (4) 209-216. Available at: http://www.current-oncology.com/index.php/oncology/article/view/981/988. Date accessed: 24 Jun. 2013. doi:10.3747/co.19.981.
Dr Anne Katz is a clinical nurse specialist and AASECT-certified sexuality counsellor at CancerCare Manitoba. She has written 2 books on the topic of cancer survivorship (After You Ring the Bell: Ten Challenges for the Cancer Survivor [Hygeia Media] and Surviving after Cancer: Living the New Normal [Rowman & Littlefield]) and 3 on cancer and sexuality.
Dr. Katz’ professional life is focused on providing information, education and counselling to people with cancer and their partners about sexual changes that can occur during and after treatment. But there is another important aspect to this work; Dr. Katz wants every cancer patient to be able to have a discussion about sexuality with their health care providers. And so she travels across North America (as well as Europe and the Caribbean!) teaching health care providers to ask their patients about this important part of quality of life.
If you’d like to know more about Dr. Katz and the work she does, or if you’d like her to come to your city or town, health care facility or doctor’s office, you can contact her by email.
“I am always eager to spread the word and break the silence.”