For those who have been diagnosed with cancer, coping with illness can bring unexpected and difficult challenges. Both the treatment for cancer and its aftermath sometimes involve emotional difficulties that can take patients and families by surprise. Some survivors find that the period after cancer treatment ends is even more emotionally difficult than being in the midst of treatment. Depression and anxiety in cancer survivors are not uncommon.
Cancer survivorship is a term often used to describe the period after treatment has concluded (but is often used more broadly to include people who are in current treament). Being a cancer survivor brings its own share of challenges. Some of these challenges are psychological — after cancer treatment, it can be emotionally challenging to pick up life where it left off.
Other challenges are interpersonal — other people who know you went through cancer treatment may not be sure how to relate with you now. Some will assume you want to talk about it in great depth. Others will assume you don’t want to talk about it at all. Still others will be uncomfortable with the topic themselves.
Anxiety in cancer survivors
Fear of recurrence
It is quite common for cancer survivors to have anxiety for months or years after the conclusion of treatment. One way this anxiety can present is in the form of “fear of recurrence.” Survivors with fear of recurrence often suffer from heightened anxiety whenever they are due for a follow-up or surveillance scan. Even though the oncologist may have stated that the odds of recurrence are extremely low, the anxiety can get out of control.
Post-traumatic stress disorder (PTSD)
After treatment is over, some survivors experience nightmares, flashbacks, changes in behavior, or emotional disturbances related to their cancer or its treatment. These are symptoms of post-traumatic stress, and can create a real problem for people at times. Some survivors have PTSD for years after their treatment is over, not knowing that effective help is available. PTSD can be particularly challenging for cancer survivors because people around them expect them to be “all better,” and grateful. The reality is often more complicated.
The symptoms of PTSD can involve changes in behavior. For example, some survivors describe taking steps like unnecessarily driving all the way across town to avoid driving by the hospital where they received treatment. Others describe that they cannot bring themselves to even look at some of the belongings they had with them in the hospital while they were inpatients. Some survivors describe skipping any news articles or commercials about cancer for years after their treatment.
Other PTSD symptoms can be more emotional — for example, feeling overwhelmed whenever the topic of cancer comes up. Some survivors describe a sense of dread, or a strong feeling that they won’t be around long, even though doctors have told them otherwise. When problems like this start to really impact your life, it’s good to seek professional help.
Depression in cancer survivors
Depression is more likely to occur shortly after diagnosis or during treatment than it is to occur afterward. However, depression can certainly be a problem for survivors as well, regardless of their prognosis. Going through diagnosis and treatment upends our way of life and sometimes our world view. Taken together, these changes can leave us feeling depressed.
Additionally, some of the physical changes that are part of cancer treatment can leave us more likely to become depressed. During treatment, the physiological impact of chemotherapy can produce changes that mimic depression or lead to depression. After treatment is over, many survivors are left with bodies that are different than they were. Adjusting to this “new normal” is challenging and can lead to depression. However, there are effective treatments (both medication and psychotherapy) that can help survivors manage depressive symptoms and successfully adjust to their post-cancer reality.
Last updated: May 15, 2020 by Paul Greene, Ph.D.
Dr. Greene previously served as a faculty member and researcher at the Mount Sinai School of Medicine specializing in the psychological difficulties of cancer and survivorship.