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Increasingly, health care providers are realizing the many mental health issues involved in a cancer diagnosis. It starts with the adjustment of hearing a diagnosis and understanding what it means and continues through the grueling nature of most cancer treatments and the uncertainty and worry that the cancer will come back or spread.

“Cancer itself can cause people to become anxious or depressed. The treatments can contribute to mood changes, adjustment problems, even delirium in some cases, and so there’s a wide range of mental health issues that can affect patients,”

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CHICAGO, IL -- August 22, 2006 -- The selective serotonin reuptake inhibitor Celexa (citalopram) shows efficacy in treating depression in patients with recently-diagnosed head and neck cancer, according to research presented here at the 2006 annual meeting of the American Head and Neck Society (AHNS).

"Depression is a significant problem: it decreases immune function, adherence to therapy, and the ability of patients to seek medical attention, and it may even decrease survival," said Bill Lydiatt, MD, associate professor, head and neck surgery, University of Nebraska Medical Center, Omaha, Nebraska.

Previous studies have shown that 19% of all hospital suicides in cancer patients occur in those with head and neck cancer, who make up 2% to 3% of all cancer patients, said Dr. Lydiatt, who presented scientific the findings at the conference on August 18th.

The high suicide rate among head and neck cancer patients occurs because the disease "impairs the most basic aspects of your humanity, including speech, swallowing, and facial appearance," he explained. more...

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Originally posted by Adele:
Hi everyone.
I really would appreciate any feed back.
I am 2 weeks past surgery , having had a tumour removed at the base of mouth. all was said to have gone well and i have a flap from my wrist transplanted there. i was told that all was a success, but now they say i need 6 weeks of radio therapy as well which i was assured was not going to be the case.
I am very scared as i am still very unwell from surgery and the radi0 therapy sounds very aggresive. i cannot imagine ever healing .
does anyone have any experience?

• 15 or 88% suffered depression, only 2 did not suffer from it.
• 7 or 41% received no help for it
• 8 or 47% suffered depression for more than 12 months

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Struggles for Well-Being Among Long-Term Cancer Survivors

August 6, 2009 — Three new studies highlight some of the less-than-obvious threats to the well-being of long-term (≥ 5 years) cancer survivors and cast some light on the potential red flags for the clinicians who care for them.

In the first study, long-term cancer survivors were found to have nearly twice the risk of experiencing severe psychological distress as members of the general population without cancer.

Specifically, 5.6% of the cancer survivors screened positive for severe psychological distress, compared with 3% of people without cancer, according to the study published in the July 27 issue of Archives of Internal Medicine. Survivors younger than 45 years of age at diagnosis are at especially high risk.

The investigators used 2002 to 2006 data from the National Health Interview Survey, a cross-sectional survey conducted in person annually by the US Census Bureau. The survey reveals psychological distress that occurred in the 30 days preceding the interview.

A second study comparing long-term survivors and people without a history of cancer had a conflicting finding: survivors do not appear to have elevated rates of major depressive disorder (MDD).

However, these survivors of adult-onset cancers may experience greater impairment from depression than those without cancer. This study was published online July 27 in the Journal of Clinical Oncology.

This study used 2001 to 2003 data from another nationally representative survey, the National Comorbidity Survey-Replication.

The third study indicates that there is a high prevalence of suboptimal health behaviors, including poor diet and lack of exercise, among older (≥ 65 years) long-term survivors of breast, prostate, and colorectal cancer.

Older cancer survivors in the study, all of whom were interested in lifestyle modification, reported a median of only 10 minutes of moderate to vigorous exercise per week, and only 7% had Healthy Eating Index scores above 80, which is indicative of healthful eating habits relative to national guidelines. The results of the study were published online July 27, 2009, in Cancer.

These data come from the ongoing Reach Out to Enhance Wellness (RENEW) trial, a National Cancer Institute–supported study that is examining whether a home-based diet-and-exercise intervention consisting of printed materials and telephone counseling can reduce functional decline and improve quality of life among survivors.

Severe Psychological Distress: Young Patients at Higher Risk

In the first study, published in the Archives of Internal Medicine, the researchers reviewed health information from 4636 long-term survivors of adult-onset cancer and 122,220 respondents never diagnosed with cancer.

Long-term survivors of cancer were more likely to experience serious psychological distress if they were younger, unmarried, had less than a high-school education, were uninsured, had more comorbidities, or had difficulty performing instrumental activities of daily living, according to the study authors, led by Karen E. Hoffman, MD, from Brigham and Women's Hospital and the Dana-Farber Cancer Institute in Boston, Massachusetts.

The most pronounced factor is a younger age at diagnosis; long-term cancer survivors younger than 45 years of age at diagnosis are 5.6 times more likely to experience severe psychological distress than survivors 65 years and older at diagnosis.

The study was first presented at the 2008 annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO), and was reported on by Medscape Oncology at the time.

The vulnerability of younger people to psychological problems has a logic to it, said a clinician at the meeting.

"I speculate that younger people are more susceptible because of a vulnerability of youth that in part comes from the feeling of not having lived a full life. The concept of fairness comes into play. [Older people] may be likely to feel that they have lived most of their life. A younger person may be likely to feel cheated," Louis Harrison, MD, from Beth Israel Medical Center in New York City, and chair of the ASTRO board of directors, told Medscape Oncology.

The fact that oncologists might not be the primary doctor for most long-term cancer survivors requires some professional coordination, suggest the authors of this study.

"Because long-term survivors may not be seen by oncologists as frequently as they were during treatment, or at all, the increased risk of serious psychological distress and the need to screen for serious psychological distress should be communicated to primary-care physicians and other care providers," they comment.

Major Depressive Disorder and Long-Term Survival

In the second study, published in the Journal of Clinical Oncology, face-to-face interviews were conducted for the National Comorbidity Survey-Replication, from which 243 long-term survivors and 4890 adults without a cancer history were identified.

MDD was defined as at least 2 weeks of persistently low mood and loss of interest and at least 5 of the following symptoms: sleep disturbance, feelings of guilt/hopelessness/helplessness, low energy, poor concentration, appetite disturbance, psychomotor retardation/agitation, and suicidal thoughts.

Participants who met criteria for a MDD episode within the 12 months preceding the interview were asked to describe the episode. Participants were asked to rate how impairment from MDD affected their ability to take care of their house/apartment, work, and social life.

The investigators found that the odds of MDD did not differ between long-term survivors and those without a history of cancer. After adjustment for demographic variables and medical comorbidities, survivors did not have increased odds of MDD in the preceding 12 months (odds ratio, 0.99; 95% confidence interval, 0.55 to 1.79), report the authors, led by William F. Pirl, MD, from the Massachusetts General Hospital Cancer Center in Boston.

However, a substantial number of individuals in the respective populations (5% to 7%) had experienced MDD in the preceding 12 months, the authors add.

Greater levels of impairment, on average, were also reported by survivors who experienced MDD in the preceding 12 months, especially in terms of work impairment, write the authors; however, the difference was not statistically significant.

Poor Health Habits Among Older Survivors

In the third study, which was published in Cancer, 753 long-term survivors of breast, prostate, and colorectal cancer completed 2 baseline telephone interviews to assess their eligibility for RENEW, a diet and exercise intervention trial. The interviews assessed exercise, diet, weight, and quality of life among these older patients.

Greater exercise and better diet quality were associated with better physical quality-of-life outcomes, such as better vitality and physical functioning (P < .05), and greater body mass index was associated with reduced physical quality of life (P < .001), report the authors, led by Catherine E. Mosher, PhD, from the Memorial Sloan-Kettering Cancer Center in New York City.

Ultimately, the results of a number of ongoing randomized clinical trials, including the RENEW trial, will reveal the extent to which lifestyle modifications prevent functional decline among older cancer survivors, note the authors.

The researchers have disclosed no relevant financial relationships.

Cancer. Published online before print July 27, 2009. Abstract Arch Intern Med. 2009;169:1274-1281. Abstract J Clin Oncol. Published online before print July 27, 2009. Abstract