Depression in cancer patients
- davorkust
- Sep 26
- 4 min read
Updated: Sep 29
Authors: Dr. Vanja Putarek, MA in Psychology; Antonija Vrdoljak, MA in Psychology
Sadness, low mood, or apathy are common phenomena that people experience throughout their lives. However, when a bad mood and apathy become very pronounced (e.g., they affect the individual's functioning and daily activities) and long-lasting (usually lasting more than two weeks), depression may have developed. Depression is a mood disorder in which, in addition to sadness and unpleasant feelings, problems with memory and concentration, pessimism, passivity, feelings of worthlessness and withdrawal from society, changes in appetite, fatigue, difficulty sleeping, apathy, and loss of interest in things that used to bring joy to the person may occur. Sometimes, people with depression may also have thoughts of death or suicide.
It is especially difficult to distinguish sadness from depression in cancer patients. Some of the consequences of therapy, such as fatigue and loss of appetite and energy, are similar to symptoms of depression, but may not be related to it. Similarly, unpleasant feelings are often present after a person learns of a cancer diagnosis or receives bad news related to treatment, but it is common for this initial sense of shock to subside after a while. However, while sadness is an expected and common reaction, depression is not. Clinical depression occurs in 20-25% of people with cancer, but the symptoms are often ignored. This approach is particularly worrying given that research results show that oncology patients with depression are less likely to accept prescribed treatments, which can adversely affect the outcome of treatment.
When a person notices depressive symptoms, it is important to seek professional help. Since depression is caused by various factors, in the treatment of depression, experts will identify those that are most pronounced in an individual. Sometimes depression can have biological causes - some forms of cancer (e.g. thyroid cancer) or treatments can affect hormone levels in the body, which can lead to depressive symptoms. In this case, it is necessary to talk to doctors to find a way to reduce the intensity of unpleasant emotions.
However, depression can also occur if a person thinks in a biased way (e.g., noticing the negative aspects of a situation and ignoring the positive; predicting catastrophic outcomes in a situation; thinking in “all or nothing” terms, such as “If I don’t get better after the first type of therapy, it means I never will”). Therefore, it is important to determine which biases are present in a person and to what extent.
Furthermore, in the treatment of depression, behaviors that are not beneficial to the person and contribute to the maintenance of depression will be identified (e.g. spending most of the time lying in bed; frequent and intense thinking about negative events - ruminating; frequent watching TV, series or films on the computer). One of the important goals of the therapeutic process is to gradually increase the frequency and intensity of the person's beneficial behaviors. To achieve this goal, the person can first record the activities/behaviors that they engage in during the day. They can then make a list of activities that they currently enjoy, those that they used to enjoy and activities that they would like to try, and based on this list, a weekly schedule of planned activities can be created, including selected beneficial and enjoyable activities. The list of enjoyable and beneficial activities is individual and tailored to the person, and may include: visiting a museum, walking, going to the hairdresser, cooking, decorating the apartment/house, running, hiking, going to the gym, gardening, reading a book, using relaxation techniques (e.g. abdominal breathing), relaxing in a bath, taking photos, drawing or painting, going on a trip, adopting a dog, spending time with loved ones (with as little focus on the negative aspects of the situation or conversation as possible and including a variety of topics in the conversations, not just topics that evoke unpleasant memories and feelings).
The person then engages in the planned activities according to the schedule and records how much they enjoyed them. It is also important to note that when they first engage in useful and enjoyable activities that they have been avoiding, the person may not enjoy them as much as before, but over time, as they continue to be active, the enjoyment increases. Therefore, it is useful for the person to be persistent and not to give up on plans immediately after an activity does not bring them pleasure.
Pleasant and useful activities are gradually introduced into the schedule and they replace less useful activities (such as the aforementioned lying in bed). It would be advisable for the person not to choose too many difficult activities, so as not to reduce motivation and so that the person does not become overloaded and exhausted.
Since people with depression often do not reward themselves for positive (useful) behaviors and believe that they should be punished for failures, self-reward can also be applied. The person chooses the rewards themselves and applies the selected reward after completing a task.
During treatment, the specialist can identify various specific difficulties of the person that need to be worked on, as well as determine the need for medication, in consultation with the oncologist. Although going to a specialist is often a difficult step, through treatment the person can significantly increase their satisfaction with themselves and their life, so it would be important to contact a specialist as soon as possible if they notice depressive symptoms.
References
1. Bottomley, A. (1998). Depression in cancer patients: a literature review. European Journal of Cancer Care 7, 181-191.
2. Leahy, R. L., Holland, S. J. i McGinn, L. K. (2014). Planovi tretmana i intervencije za depresiju i anksiozne poremećaje. Jastrebarsko: Naklada Slap.
3. Pitman, A., Suleman, S., Hyde, N., i Hodgkiss, A. (2018). Depression and anxiety in patients with cancer. BMJ, doi:10.1136/bmj.k1415.
6. https://www.cancer.org/treatment/treatments-and-side-effects/emotional-side-effects/anxiety-fear-depression.html
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