Depression and Cancer Survivorship

TON July 2015 Vol 8 No 4

The two most depressing times of my life were when I was first diagnosed with cancer and when I completed cancer treatment. The first episode is understandable, but the second dive took me by surprise. I had endured for months to get to the point of treatment completion and thought I would celebrate the opportunity to finally get back to my normal life. Instead, I quickly discovered my old life wasn’t there anymore. I felt especially vulnerable, and no one (not even me) understood how I was feeling. I knew it was up to me to climb out of that hole, and little by little, that’s what I did.

Depression often goes hand in hand with a cancer diagnosis. At some point, for some period (brief or extended), the fear, helplessness, loss of control, sadness, and anxiety combine to overwhelm us. As survivors, we are often isolated with our depression because those dear people who were by our sides during treatment think the ordeal is over and are often anxious to see us get back to our precancer lives. While there is no going back, it is essential that we move forward.

While we may feel entirely alone, there are many who have embarked on this same path before us. Their experiences, insights, and understanding can help ease our way. Following are some key strategies for rising above the depression that may come with surviving cancer. I found some of these strategies helpful in my own survivorship. Others I learned about by doing research and listening to others.

Keep a Positive Attitude
We’ve all heard this advice before when facing hard times. I don’t know if it was a message playing in my head or that I simply knew instinctively that my attitude needed to improve. I felt that my health depended on it, and while no one is suggesting that we cause or cure cancer with our thoughts, researchers from the University of Miami are studying the role of depression in systemic inflammation and inflammatory molecules produced by breast cancers. The ultimate goal is to identify any biological links between depression and breast cancer progression that determine the risk of cancer recurrence and/or metastasis.1,2

Knowing and doing are not the same, and doing is not easy when your mind is a racetrack of doubt, anxiety, and fear. I had already been dealt one of the things I feared most in life with my cancer diagnosis. Who was to say I shouldn’t prepare myself for worse?

It turned out that I was the one to say. I knew I didn’t want to live whatever amount of time I had left worrying about the time I had left. In order to get a grip on the worrying, I took steps to slow, stop, and change the direction of my thoughts, which in turn calmed my anxiety and created space for feelings of optimism.

Seek Out Supportive Relationships
The support of my family and friends was extremely important during treatment, but once my treatment ended, I needed something more. From the perspective of those who love me, the hard part was behind me. Meanwhile, I was starting to see that the real work was ahead of me.

I sought out other cancer survivors, people who would understand why I wasn’t feeling celebratory or relieved. I was fortunate to have a friend who, like me, was a young breast cancer survivor. We shared not only the cancer experience, but also cancer survivorship in the context of parenting young children. This relationship was pivotal to my emotional healing. Over the years, we mentored others and eventually formed a support group for young women cancer survivors. These women remain some of my closest friends, and I know I can always turn to them when I need support. Being among others who in some way share our experiences is fundamental to avoiding a sense of isolation with our depression.

Peer-mentoring programs like Imerman Angels (http://imermanangels.org/) assist in matching cancer patients, survivors, and caregivers for one-on-one support. For those who prefer groups, the American Cancer Society (http://www.cancer.org/) is a great resource to find local cancer support group meetings. Many local hospitals will offer support groups and access to social workers, and there are many regional and local organizations dedicated to connecting cancer survivors with one another.

Challenge Negative Thinking
I had never considered myself a negative person, but after my cancer diagnosis, negative thinking about my health and long-term survival was a real issue. I had to learn to stop negative thought patterns when they crept into my head. I actively sought to distract myself from thoughts that would cause me worry or concern about recurrence. I also worked at not putting too much pressure on myself to be perfect and instead allowing myself to be me, flaws and all. I needed as much positive influence around me as possible, so I made a concerted effort to surround myself with optimistic people.

Rest, Relax, and Practice Mindfulness
To help frame a positive state of mind, I knew I had to prioritize adequate sleep and downtime. I had done this for healing during treatment and found that it was also extremely important for maintaining a healthy attitude and positive mood.

I incorporated relaxation and meditation into my daily routine. I tried a few different things to help me focus on clearing my mind of chatter and practicing mindfulness and attention to the present. Listening to meditation recordings, doing yoga, tai chi, qigong, and labyrinth walking—I tried them all and found many helpful tools for relaxing myself and controlling my thoughts.

Plan for Fun
Prioritizing fun in my life wasn’t so easy when I had two little kids to care for, but I made efforts to choose activities that were fun for them and me. In most ways, having cancer as a young mother is incredibly hard, but in other ways, it can make survivorship slightly easier in that there simply isn’t as much time or space to dwell on fear and sadness. I had little choice but to keep busy, but I made an extra effort to have a list of go-to activities that not only met the needs of my children, but also helped to boost my own mood. Some ideas are spending time in nature, listening or dancing to music, playing with family pets, and anything fun and spontaneous!

Get Regular Exercise
My oncologist encouraged me to walk at least 30 minutes every day. Even this was a challenge for someone like me, who was never a fan of exercise. To keep myself on track, I partnered with a friend who became my workout buddy and a key source of motivation. On days when I don’t have a friend to join me in exercise, I will listen to an audio book about something I wish to learn or to music that I enjoy. Being outside, spending time with friends, listening to a good book or music, I find myself increasingly motivated to do this thing that I once dreaded. To top it off, I always feel a bit of an emotional high after exercising.

Eat a Healthy, Mood-Boosting Diet
When we’re feeling depressed, many of us reach for our go-to comfort foods. Oftentimes, these foods provide some quick gratification that is usually followed by an equally quick crash in energy and mood. Making balanced and healthy food choices helps us to avoid steep emotional fluctuations.

HelpGuide.org, a nonprofit mental health and well-being resource, suggests we sculpt our diet to boost our mood. They recommend that we avoid skipping meals and minimize sugar and refined carbohydrates in our diets. They suggest eating complex carbohydrates and foods that are rich in omega-3 fatty acids, B vitamins, magnesium, tryptophan, serotonin, thiamine, magnesium, and folate—all nutrients that can help to stabilize our moods.

Stay Busy
Staying busy without being stressed was key to diverting my thoughts in a positive direction. To help occupy my time when my kids were at school, I volunteered to help others and eventually turned my passion for helping others into a full-time role.

I found that taking on responsibilities gave me a sense of accomplishment and purpose. A bit of volunteer work was perfect for me shortly after completing my treatment because it kept me occupied without the pressures that would have come with a full-time occupation.

If volunteering for a cause that interests you is appealing, VolunteerMatch.org is a wonderful resource that connects volunteers with organizations they support and tasks they enjoy.

Get Additional Help
One of the biggest dilemmas a person with depression might face is whether to reveal the condition to others, and, if so, to whom. There are many perceived social stigmas that surround depression, so it’s not surprising that two-thirds of those with depression never seek professional help. We talk ourselves out of seeking treatment by telling ourselves we will get over it in time. We may think that because we don’t feel sad all the time, we don’t need support or help. Most often it is our embarrassment about our depression that keeps us from discussing it with our doctors.

Speaking to our medical team can be an important first step in connecting with the people, organizations, and resources that can help us. An ever-increasing number of tools are available to help cancer survivors address and cope with depression. Survivorship plans emphasize taking time to have discussions with patients about their psychosocial needs and making necessary recommendations for follow-up care and support resources. Cancer support programs like the Cancer Support Community (http://www.cancersup portcommunity.org/) offer many in-person and online/teleconference programs to help equip patients with a variety of tools to help manage anxiety and stress. In addition, emerging websites have taken research-based mood-boosting concepts and put them into apps that can be accessed via a smartphone (Happify, IMoodJournal, Smiling Mind).

Full Circle
Depression is a very real and common component of cancer survivorship. There are numerous ways to rise above that depression, but reaching out for help is an important first step. Other survivors will relate to our feelings in ways that family members and friends may not, while professionals can help us to identify tools and strategies that will set us on the path to brighter days.

Angela Long is the founder and creator of Breast Investigators. Breast Investigators serves as a comprehensive resource guide to help those affected by breast cancer readily gain access to quality information, care, assistance, and support. Visit www.BreastInvestigators.com.

References
1. Gregoire C. Stress management may have long-term benefits for cancer survivors. The Huffington Post website. http://www.huffingtonpost.com/2015/03/24/stress-cancer_n_6924632.html. Updated March 24, 2015. Accessed May 31, 2015.
2. Sylvester physicians to investigate breast cancer and depression connection. University of Miami Health System/University of Miami Miller School of Medicine website. http://med.miami.edu/news/sylvester-physicians-to-investigate-breast-cancer-and-depression-connection. Published October 1, 2014. Accessed May 31, 2015.

 

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