Cancer often has a profound impact on the mental and emotional well-being of those who receive a diagnosis. In patients who have historically struggled with mental illness, cancer may exacerbate already existing issues. A cancer diagnosis may also cause symptoms of a mental health disorder to emerge in those who have not previously experienced mental illness. Most patients can be expected to experience some impact on their mental health due to their diagnosis (eg, sadness, worrying), but some may develop a mental health disorder such as anxiety, depression, and/or post-traumatic stress disorder. Research shows that an average of 30% to 35% of cancer patients suffer from a psychiatric or neuropsychiatric disorder, with variance among the stages of cancer.1 Studies also show that mental health issues are minimized in the cancer care field, as professionals may misidentify mental health symptoms (hopelessness, helplessness, suicidal ideation, excessive worrying) as normal emotional responses to a cancer diagnosis,2 which may lead to patients not receiving the treatment they need.

Emotional distress and mental health disorders can have profound impacts on patients, beyond their emotional and mental wellbeing. Research has shown that cancer patients with mental health symptoms have poorer health outcomes, including decreased adherence to treatment. One study showed increased mortality rates in cancer patients who developed a psychiatric disorder after the cancer diagnosis, which highlights the importance of early recognition and treatment of mental health symptoms.3

Recognizing Symptoms


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Understanding that a patient is experiencing mental health symptoms is key to assisting them in getting treatment. Asking them how they’ve been feeling emotionally or how they’ve been coping with the diagnosis and treatment can be a meaningful way to start a conversation. Letting the patient know that you’re available to support them can help them feel safe enough to open up about any issues that they’ve been experiencing. 

Certain symptoms to look out for may be sadness, frequent crying, irritability, excessive worrying, isolation from loved ones, changes in sleep, appetite, concentration, and motivation, excessive guilt, helplessness, hopelessness, and thoughts of suicide. However, some mental health symptoms may overlap with symptoms related to cancer or side effects from treatment, including appetite, weight, and sleep changes, as well as changes in concentration and motivation. If you are concerned about your patient but are unsure if they may be exhibiting mental health symptoms, you can raise the issue to another healthcare professional or mental health professional, if available.

If your patient discloses thoughts of suicide, it’s best to notify a mental health professional right away or call emergency services.

How to Help

Many patients are ill-prepared for the emotional impact that cancer may have on them. One study found that only 40% of cancer survivors reported that their medical teams discussed the impact cancer could have on their relationships or emotional wellbeing and that a major barrier to getting support was lack of knowledge about resources.4 Starting a discussion with patients about the potential mental health impact of cancer and resources that are available can be helpful at any stage of treatment.

The best way to assist patients may vary based on the setting. Mentioning your concerns to the patient’s primary point of contact (such as their oncologist) is a good first step, as the provider may be comfortable discussing mental health treatment options with patients, including medication or counseling. As an oncology nurse, you may also feel comfortable raising the issue of mental health to the patient directly during a regular one-on-one visit. In an inpatient setting, making a referral for a psychiatry consult or to the social worker may be appropriate. Some oncology practices have a psychosocial component to them that offer oncology-specific counseling, support groups, or psychiatry.

For settings where none of the above are available, you can assist your patient in getting connected to mental health services. Patients can call their insurance companies and request a list of in-network mental health practitioners or clinics. They can also search for local providers using Psychology Today, or use the internet to search for local behavioral health clinics in their area.

There are also a number of other ways oncology patients can get support for free. Many organizations, including Imerman Angels and 4th Angel, provide peer support, which connects the patient to a patient or survivor who is trained to mentor and provide emotional and practical support. Most of these organizations seek to match patients with a peer who has similar age range and diagnosis.

Patients can also seek support through online support groups or communities, often which function as message boards and allow patients to share and connect with others with similar experiences. CancerCare offers online groups, as does Cancer Support Community. In person or virtual support groups may be offered in hospitals, or through local chapters of cancer support organizations.

If a patient expresses suicidal ideation, patients can be given the number for the National Suicide Prevention Lifeline: 800-273-8255, a service that is available 24/7.

Finally, the way the medical team interacts with patients can have an impact on their mental health. Being supportive, encouraging, and creating space to discuss mental health are key to communicating to your patient that you are here to support them in a holistic way. Facilitating discussions about the issue of mental health can help patients get the support they need.

References

  1. Caruso R, Nanni MG, Riba MB, Sabato S, Grassi L. The burden of psychosocial morbidity related to cancer: patient and family issues. Int Rev Psychiatry. 2017;29(5):389-402. doi:10.1080/09540261.2017.1288090
  2. Grassi L, Spiegel D, Riba M. Advancing psychosocial care in cancer patients. F1000Research. Published online December 4, 2017. doi:10.12688/f1000research.11902.1
  3. Lee SA, Nam CM, Kim YH, Kim TH, Jan SI, Park EC. Impact of onset of psychiatric disorders and psychiatric treatment on mortality among patients with cancer. Oncologist. 2020;25(4):e733-e742. doi:10.1634/theoncoloist.2019-0396
  4. Forsythe LP, Kent EE, Weaver KE, et al. Receipt of psychosocial care among cancer survivors in the United States. J Clin Oncol. 2013;31(16):1961-1969. doi:10.1200/JCO.2012.46.2101