Sunday, February 4, 2018 was the 18th annual World Cancer Day, and with it came media coverage of cancer survival rates continuing to improve in North America. In fact, according to the American Cancer Society, trends in five-year relative survival rates for women after breast cancer have increased from 75 percent in 1975-1977 to 91 percent in 2006-2012. Similarly, numbers of male survivors of prostate cancer compared over the same periods of time have increased from 68 to 99 percent.
Yet with all this positive news, it may be surprising to know that for many cancer survivors, when the treatments are finished, the side effects to their mental health may be long-term or permanent.
A day before World Cancer Day, Canada's CTV News reported on Canadian ovarian cancer survivor Charlotte Cook-Dowsett, one of a growing number of patients who are living proof of a “medical system [that] is doing better than ever at curing cancer”. The problem, the news source stated, is that the system “does a poor job of providing mental health care after [patients] get the all-clear”.
According to CTV News, research indicates 70 percent of survivors face challenges to their mental health resulting from their diseases and treatments, and 80 percent experience such lasting and non-treated effects as fatigue and reduced sexual health. Roughly 20 percent report symptoms of Post-Traumatic Stress Disorder.
In Cook-Dowsett’s case, she “felt cast adrift when the surgery and chemotherapy ended,” and she was left to find her own reinforcements. "When you're going through the treatment, you have this warrior attitude . . . and you're surrounded by a community of support," CTV News quoted the Winnipeg, Manitoba woman.
"But when the cancer is gone and the chemo is done . . . the community support isn't as strong because they feel you are done," she asserted. Yet, for Cook-Dowsett, the anxiety and depression had just begun.
CTV News also quoted Jackie Manthorne, president of the Canadian Cancer Survivor Network and a cancer survivor herself, who echoed Cook-Dowsett’s post-treatment experiences, saying there are many who “feel abandoned” after successful treatments for the disease.
"There isn't one survivor who won't tell you that they don't fear recurrence," she said. "They're dealing with an illness that they know sometimes kills people." Besides influencing their own mental and emotional well-being, Manthorne said, “cancer can also strain relationships with partners and children”.
In her September 2017 article for the National Alliance on Mental Illness (NAMI), Laura Greenstein, the organization’s communication coordinator, wrote that “cancer survivors are more than twice as likely to have mental health problems compared to adults without cancer”.
For patients who recover from the disease, Greenstein explained, many will suffer anxiety that persists for years. “Surviving cancer is a traumatic event: You live in fear that you might not survive,” she wrote. “You worry about your family. You lose your independence. You watch as your body weakens and your physical appearance declines.”
Greenstein wrote about Heather Von St. James who not only beat her disease, malignant pleural mesothelioma, but as an 11-year survivor—she had long outlived the original 15-month prognosis. She “faced unease about a future she never planned alongside her husband and daughter, Lily,” Greenstein said. “And in the wake of survivorship, she uncovered debilitating mental health symptoms.”
Von St. James ended up seeking the assistance of professional mental health services after her own attempts to cope with her mental health challenges proved unsuccessful. “While working with a counselor specializing in post-cancer care, Heather received a diagnosis of PTSD and anxiety,” Greenstein added, and she now advocates for cancer survivors’ mental health support.
Professors Michelle J. Naughton and Kathryn E. Weaver, in their 2014 journal article for the U.S. National Library of Medicine, recognized that with greater medical advances and more patients surviving their cancer diagnoses, the disease and the management of post-treatment symptoms and/or recurrences should result in cancer being labelled as a chronic disease, i.e., one that requires long-term patient care, even after recovery.
“For cancer survivors, as for individuals without a history of cancer, physical health directly influences mental health status and overall quality of life,” they wrote. “Physical symptoms are more likely to be detected and treated by health care providers, as the mental health and social consequences of illness are less well recognized.”
According to Naughton and Weaver, population studies indicate “cancer survivors are more than twice as likely to have disabling psychological problems compared with adults without cancer, and individuals who have both cancer and other chronic illnesses have a risk of psychological disability that is nearly six times higher than that of adults without cancer.”
The two professors suggested “screening for mental health morbidity” and overall screening for mental health challenges should be “better integrated” into the patient’s treatment and “survivorship”.
Dr. Gary Rodin is a psychiatrist who heads up the Supportive Care department at the Princess Margaret Cancer Centre, a teaching hospital and scientific research facility in Toronto, Canada. In a June 2017 article for The Toronto Star newspaper, writer Peter Goffin explained that Rodin “is part of a [specialized] field known as psychosocial oncology--identifying and treating the mental, emotional and social impacts of cancer”.
Rodin believes supportive care for a patient “needs to be systemic and routine”, providing proactive instead of reactive assistance. “We need to be sure this happens across . . . cancer care,” he added. Because . . . we need to make sure there is a continuum of support throughout the whole process.”
American Cancer Society. (Retrieved February 3, 2018). Cancer Statistics 2017 Slide Presentation. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2017.html
CTV News.ca Staff. (February 3, 2018). CTV News. ‘They feel abandoned’: Cancer survivors say post-treatment support is lacking. https://www.ctvnews.ca/health/they-feel-abandoned-cancer-survivors-say-post-treatment-support-is-lacking-1.3788402
Goffin, P., (June 12, 2017). The Toronto Star. Cancer survivors struggle with mental health issues. https://www.thestar.com/news/gta/2017/06/12/cancer-survivors-struggle-with-mental-health-issues.html
Greenstein, L., (September 25, 2017). National Alliance on Mental Illness. Life After Survival: Why Cancer Survivors Need Mental Health Care. https://www.nami.org/Blogs/NAMI-Blog/September-2017/Life-After-Survival-Why-Cancer-Survivors-Need-Men
Naughton, M.J., Ph.D., M.P.H., & Weaver, K.E., Ph.D., M.P.H., (July-August, 2014). U.S. National Library of Medicine. Physical and Mental Health Among Cancer Survivors. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4503227/