- Mood swings
- Anxiety and fear of recurrence
- Social isolation
- Substance abuse
- Body image
- Return to work
- Interaction with spouse, family, friends, co-workers
- Economic impact
Coping with depression
Many people with cancer feel sad or depressed. This is a normal response to any serious illness. Depression is one of the most difficult issues faced by a patient with cancer. Yet the social stigma associated with admitting depression makes it difficult to reach out and seek therapy.
A lecture about life challenges after laryngectomy including how to cope with depression can be viewed on YouTube.
Some of the signs of depression include:
- A feeling of helplessness and hopelessness, or that life has no meaning
- No interest in being with family or friends
- Inability to communicate
- Difficulty paying attention
- No interest in the hobbies and activities one used to enjoy
- A loss of appetite, or no interest in food
- Crying for long periods of time, or many times each day
- Sleep problems, either sleeping too much or too little
- Changes in energy level and apathy
- Wide mood swings raging from elation to despair
- Feeling isolated
- Changes in sexual desire
- Thoughts of suicide, including making plans or taking action to kill oneself, as well as frequently thinking about death and dying.
Coping with and overcoming depression is very important, not only for the well-being of the patient, but also may facilitate recovery, and increase one's chance for longer survival and ultimate cure. There is growing scientific evidence of a connection between mind and body. Although many of these connections are not yet understood, it is well recognized that individuals who are motivated to get better and exhibit a positive attitude recover faster from serious illnesses, live longer and sometimes survive immense odds. Indeed, it has been shown that this effect may be mediated by alterations in the cellular immune responses and a decrease in natural killer cell activity.
There are, of course many reasons to feel depressed after learning one's cancer diagnosis and, then,living with it. It is a devastating illness for patients and their families, even more so because medicine has not yet found a cure for most types of cancer. By the time the disease has been discovered, it is too late for prevention and, if the cancer has been discovered at an advanced stage, the risk of dissemination is high and the chance of ultimate cure significantly decreased.
Some people get “stuck” at a certain stage, such as depression or anger. It is important to move on and get to the final stage of acceptance and eventually hope. This is why professional help as well as understanding and help, by family and friends are important.
Patients have to face their ultimate mortality, sometimes for the first time in their lives. They are forced to deal with the illness and its immediate and long term consequences. Paradoxically, feeling depressed after learning about the diagnosis allows the patient to accept the new reality. Not caring any more makes it easier to live with an uncertain future. Yet, while thinking that “I do not care anymore “ may make it temporary easier, for a while such a coping mechanism may interfere with seeking appropriate care and can lead to a rapid decline in one's quality of life.
Hopefully a patient can find the strength within to fight depression. Immediately after a laryngectomy individuals may be overwhelmed by new daily tasks and realities. They often experience a mourning period for their many losses, which include their voice and their prim state of health. They also have to accept many permanent deficits including not being able to speak "normally". Some may feel that they have a choice between succumbing to a creeping depression or becoming proactive and returning to life. A desire to get better and overcome a handicap can be the driving force to reversing the downhill trend. Depression may recur, requiring a continuous struggle to overcome it.
Some of the ways laryngectomee and head and neck cancer patients can overcome depression include:
- Avoid substance abuse
- Seek help from your doctor, nurse, or a member of your health care team with whom you feel comfortable
- Exclude medical causes (e.g., hypothyroidism, side effect of medication)
- Determine to become proactive
- Minimize stress
- Set an example for others
- Return to previous activities
- Talk to a psychologist or social worker
- Consider antidepressant medication
- Seek support from family, friends, professional, colleagues, fellow laryngectomees, and support groups
- Develop leisure activities
- Build personal relationships
- Keep physically fit and active
- Social reintegration with family and friends
- Find purposeful projects
Support by family members and friends is very important. Continuous involvement and contribution to others lives can be invigorating. One can draw strength from enjoying, interacting and impacting the lives of their children and grandchildren. Setting an example to one’s children and grandchildren not to give up in the face of adversity can be the driving force to be proactive and resist depression.
Getting involved in activities one liked before the surgery can provider a continuous purpose for life. Participating in the activities of a local laryngectomee club can be a new source of support, advice and friendship. A list of local laryngectomee clubs in North America and throughout the world is available at the International Association of Laryngectomee website.
Seeking the help of a mental health professional such as a social worker, psychologist or psychiatrist can also be very helpful. There are many treatment options available to treat the depression. These include psychotherapy, medications, and transcranial magnetic stimulation. Having a caring and competent physician and a speech and language pathologist who can provide continuous follow-up is very important. Their involvement can help patients deal with emerging medical and speech problems and can contribute to their sense of well-being.
I found ways by which I can use the set back in my life in a positive way. I realized that I have much to contribute to others. By lecturing and writing about my experiences and sharing them with other laryngectomees and health care providers, others can learn and benefit from my experience.
The suicide rate in cancer patients is twice of that of the general population according to recent studies. These studies clearly point to the urgent need to recognize and treat psychiatric problems such as depression and suicidal ideation in patients.
The relative increase in suicide risk was highest in the first 5 years after cancer diagnosis and declined gradually after that. However, the risk remained elevated for 15 years after a cancer diagnosis. Higher suicide rates among patients with cancer were associated with being male, white, or unmarried. Among men, higher suicide rates were noted with increasing age at diagnosis. Suicide rates were also higher among patients with advanced disease at diagnosis.
Coping with uncertain future
Once one has been diagnosed with cancer and even after successful treatment, it is difficult and close to impossible to completely free oneself from the fear that it may return. Some people are better than others in living with this uncertainty; those who adjust well end up being happier and are more able to go on with their lives than those who do not.
One of the difficult challenges is waiting for the results of an important test or scan (i.e., PET or CT). Many individuals feel anxiety and are worried during the waiting period. Hopefully, the results of such tests are made available without a long delay.
What makes predicting the future difficult is that the scans used to detect cancer (positron emission tomography or PET, magnetic resonance imaging or MRI, and computed tomography or CT ) only detect cancer that is larger than one centimeter; physicians may miss a small lesion located at a site that is difficult to visualize.
Patients have therefore to accept the reality that the cancer may return and that physical examination and vigilance are the best ways of monitoring their condition.
What often helps with coping with a new symptom (unless it is urgent) is to wait a few days before seeking medical assistance. In general the majority of new symptoms will go away within a short period. Over time, most people learn not to panic and to use past experience, common sense, and their knowledge to rationalize and understand their symptoms.
Hopefully, over time, one gets better in coping with an uncertain future and learns to accept it, and live with it, striking a balance between fear and acceptance.
Some suggestions how to cope with the uncertain future include:
- Recurrent, unwanted distressing memories of the traumatic event
- Reliving the traumatic event as if it were happening again (flashbacks)
- Upsetting dreams about the traumatic event
- Severe emotional distress or physical reactions to thing that reminds one of the event
- Trying to avoid thinking or talking about the traumatic event
- Avoiding places, activities or individuals that remind one of the traumatic event
- Negative changes in thinking and mood
- Negative feelings about oneself or other persons
- Inability to have positive emotions
- Feeling emotionally numbness
- Lack of interest in activities one used to enjoy
- Hopelessness about one’s future
- Memory problems, including not remembering everything about the traumatic event
- Difficulty maintaining close relationships
- Irritability, angry outbursts or aggressive behavior
- Always being on guard for danger
- Overwhelming guilt or shame
- Self-destructive behavior, such as overdrinking or risk taking
- Trouble concentrating
- Trouble sleeping
- Being easily startled or frightened
Sharing the diagnosis with others
Coping and adjusting to one’s disfigurement
- Members of the health care team (physicians, nurses, and speech and language pathologists) can answer and clarify questions about treatment, work, or other activities.
- Social workers, counselors, or members of the clergy can be helpful if one wishes to share one's feelings or concerns. Social workers can suggest resources for financial aid, transportation, home care, and emotional support.
- Support groups for laryngectomees and other individuals with head and neck cancer meet with patients and their family members and share what they have learned about coping with cancer. Groups may also offer support in person, over the telephone, or on the Internet. Member of the health care team may be able to help in finding support groups.
(by Itzhak Brook MD, published in The Los Angeles Times, May 23, 2011)