By: Wendy Baer, MD
The authors, Suppli et al, should be applauded for their contribution to the literature on cancer survivorship and mental health. Over 13 million people in the United States are living after cancer diagnosis and treatment. National organizations such as the American Cancer Society and the National Comprehensive Cancer Network are focusing on issues in survivorship. One of the most important messages from the JCO study is validation that survivorship from breast cancer is a challenging. In my practice at the Winship Cancer Institute I hear regularly about survivors having more trouble with mood, energy and concentration after treatment is finished. A common remark is “I should be better by now, but I am just not my normal self.” My hope is that the JCO study provides clinicians with research evidence they need to feel motivated to address mental health issues in survivors of breast cancer even years after acute phase treatment is complete. Screening patients at follow up appointments during survivorship for psychological distress should be a routine part of care.
The use of presentation to the hospital for depressive symptoms as a marker of psychological distress after cancer treatment likely underestimates the prevalence of suffering in breast cancer survivors. Typically only the people with the most severe depressive symptoms, including suicidal ideation, go to the hospital or emergency room. The goal of future research on survivorship should be to identify distressed patients and provide treatment long before need hospital level care for depression. The critical message for patients and family is that depressive disorders are treatable and therefore should be screened for and diagnosed even after cancer treatment is complete.
How do you know if you need to make an appointment with a psychiatrist during survivorship from breast cancer? If you are having trouble seeing anything positive, if the obstacles to healing seem insurmountable, or if your worry interferes with work, sleep and fun, get a referral from your oncologist. Seeing a psychiatrist does not mean you have to start an antidepressant; talk therapy works equally well for many people. Thinking through your cancer experience and putting the journey into words may be incredibly healing. In some cases breast cancer can actually motivate women to thoughtfully consider what they care about and how they want to spend their time. I have seen women in survivorship change jobs for the better, find healthier relationships and learn to find joy in everyday, simple pleasures.
In conclusion, the JCO study demonstrates that the oncology community should look for depression in women in survivorship from breast cancer. The at risk groups, younger and older women, those with advanced disease and other medical problems, would do well to focus on their mental health throughout their cancer experience.
The hotline for people with a mental health crisis in Georgia is 800 715 4225. The national hotline for people in crisis is 800 273 TALK.
Wendy Baer, MD, is the medical director of psychiatric oncology at the Winship Cancer Institute of Emory University in Atlanta. Dr. Baer helps patients and their families deal with the stress of receiving a cancer diagnosis and going through treatment. Her expertise in treating clinical depression and anxiety helps people manage emotions, behaviors and relationships during difficult times.