Addressing Mental Disorders in Patients with Cancer

TON - December 2021 Vol 14, No 6

Cancer and mental disorders have a symbiotic relationship. In the same way that psychiatric disorders, such as anxiety or depression, can be brought on by a cancer diagnosis, cancer and its treatment can exacerbate an underlying mental condition, according to Kathleen Murphy-Ende, PhD, PsyD, AOCNP, PMHNP, Clinical Psychologist and Nurse Practitioner, University of Wisconsin Department of Psychiatry, Madison. She discussed the topic at the 2021 Oncology Nursing Society Bridge virtual meeting.

Treating cancer and a mental disorder at the same time can be exhausting for the patient and for the provider, but the key to dealing with this challenging situation is often simple communication.

Mental Disorders and Cancer

According to Dr Murphy-Ende, oncologists and psychiatrics should be working closely and communicating about their patients. Most important, patients should not feel shy about speaking up: they should remind their physicians about what medications they take, why they are taking those medications, and how often. Doing so can prevent any potentially dangerous drug–drug interactions, as well as ensure that patients receive appropriate treatment for their cancer and their psychological conditions.

As many as 85% of patients with cancer have psychiatric disorders or significant psychological distress, she said, and existing mental disorders are already present in at least one-third of patients diagnosed with cancer. However, it is estimated that less than 50% of patients with cancer who have mental disorders or emotional distress are identified and referred for appropriate care.

What Is a Mental Disorder?

Mental disorders refer to a wide range of conditions that affect mood, thinking, and behavior. The Diagnostic & Statistical Manual of Mental Disorders is used by psychologists to classify conditions such as anxiety, depression, or posttraumatic stress disorder (PTSD), and offer guidance on how to treat them.

“The reason this is done is not to label people,” Dr Murphy-Ende said. “It’s really so we can understand and communicate about certain disorders and conditions.”

It is a lot like classifying a certain type of cancer, she explained. Just as a person with prostate cancer would not benefit from a treatment for patients with breast cancer, a person with bipolar disorder, for example, will not benefit from a treatment for another mental condition, such as anxiety.

In patients with cancer, the “side effects of [cancer] treatment can really clearly mimic a mental disorder,” she said. Therefore, physicians must be careful to distinguish between treatment-related side effects and any other causes before making a psychiatric diagnosis.

Depression and Anxiety

Depression and anxiety are 2 extremely common disorders and are closely related. “Sometimes people are depressed because they have anxiety, or they have anxiety because they’re depressed,” Dr Murphy-Ende explained. Both conditions can negatively affect mood, concentration, and sleep, and lead to a high level of irritability.

“But for people who have an underlying anxiety disorder and then get a diagnosis of cancer, they’re really facing a difficult time,” she said. “At that time, it’s very appropriate to start medication for anxiety.”

Anxiety and depressive disorders can be effectively treated with drugs known as selective serotonin reuptake inhibitors and benzodiazepines, as well as with cognitive behavioral therapy.

“So, it saddens me to see it missed or undertreated, or for patients to simply be resistant to taking treatment,” she said.

Posttraumatic Stress Disorder

PTSD is typically caused by traumatic, unexpected events that lead to a perceived loss of personal control and safety. Understandably, the unexpected diagnosis of, and often-aggressive treatment for, cancer can lead to thoughts of loss of control and safety, ultimately resulting in a PTSD diagnosis.

Approximately 8% of adults in the United States have PTSD, but it is difficult to get an accurate rate of this disorder among patients with cancer, because it is often not diagnosed or reported. However, some estimates of cancer-related PTSD are as high as more than one-third of patients.

“In my practice, I see a fair amount of PTSD in people with cancer. It may be a previous diagnosis that’s been made worse, or it may be a new diagnosis related to cancer and its treatment,” she said. “These might seem like artificial labels, but they’re really helpful in separating out what exactly is going on with patients, because that informs our treatment.”

Patient Advocacy

Patients who have mental disorders plus cancer should advocate for themselves during cancer treatment. These conditions are very common, and patients should feel comfortable talking with their oncologists and cancer care providers about any difficulties such as anxiety, depression, or PTSD, to make sure they receive appropriate treatment.

For example, stopping certain psychiatric medications suddenly can be incredibly dangerous. If patients are told to stop taking their anxiety or depression medications before cancer surgery, it is important for them to broach the topic with their healthcare team. This can lead to a discussion about other treatment options, such as not stopping the medications in certain cases, or ensuring that the medications will be used again the minute surgery is over.

“This is not the time to be taking medications away that people have been stable on for a long period of time,” Dr Murphy-Ende emphasized.

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