Although there are many improvements in the cancer treatment, cancer is still the most feared disease... Some cancer patients may face multiple psychological problems, especially depression and anxiety disorders.

Cancer is a disease that no one can easily accept as their own diagnosis, its often thought "it happens to others and never will happen to me". Therefore, after being diagnosed, it is hard to accept both the disease and the lifestyle changes brought by the treatment. At this stage, many psychological disorders may occur. We discussed psychological problems in cancer patients with Esra Uğurlu Koçer, MD, Psychiatry Specialist at Bayındır Hospital Icerenkoy, our specialist explained the effects of these problems on treatment, the influence of cancer to the patients and patient relatives and treatment options.

Fear, creates the need for psychological support.
Psychiatry Specialist Esra Uğurlu Koçer, MD, emphasizes that, "Cancer patients need very serious support from their family, friends and medical staff, especially when the diagnosis is newly determined! Although the disease usually manifests itself with some symptoms, no one is prepared to believe or accept the fact that having cancer. When the diagnosis is made, the patient is directly confronted with a traumatic situation of the disease, which leads to the development of an “acute stress reaction”. From this moment, the person is in need of serious support. It is important to support cancer patients, even if they do not verbally express their despair much or do not share their worries with the others. Despite many advances in the treatment, cancer remains the most feared disease. We still do not know much about the disease and it is sometimes difficult to talk about the prognosis and results of therapy. The treatment process severely affects quality of life due to its many side effects and difficult treatment process. The patient also needs support due to the job loss and decrease in quality of life during the treatment process. Relatives of the patient, as well as medical staff, need to show empathy to the patient and should try to understand patient’s feelings. Accurate information is also very important at this point. Information about the disease process and the side effects of drugs should be precisely explained in all details by the doctor to the patient and patient’s family."

Depression comes first
“Although many psychiatric disorders can be seen in cancer patients, the most common conditions are depression and anxiety disorders and their symptoms. According to the results of numerous studies on cancer cases, (although their prevalence varies), the prevalence of depression increases from 3%-4% to 60%, and anxiety and adaptation disorders also acquire a wide range of spectrum" says, E.U.Koçer, MD, and adds that, “Psychiatric symptoms do not usually appear in the first shock phase. During this period, patient and their relatives are engaged in search of the treatment. With the beginning of treatment processes, the appearance of medication side effects can trigger depressive thoughts. So, depression symptoms may occur. In later stages, depression becomes more prominent.”

Young people and women need more psychological support
Psychiatrist Esra Uğurlu Koçer, MD, says that cancer treatment is not a process that can be entirely provided by only with specialist of one medical branch, but that it needs multiprofessional teams such as multidisciplinary cancer care teams that come together to plan and coordinate the patient’s care. E.U.Koçer,MD is stressing one more time the importance of receiving psychological support, "As well as the team of physicians who follows the treatment of the patient, it is also appropriate to have a psychiatrist, psychologist or clinical psychologist in this team. Especially in those patients who have previously had a psychiatric diagnosis, who have had a depression attack or have had another attack such as anxiety disorder in their medical history. Young people and women are the highest risk group in this situation and they must be offered psychological support. In fact, all patients need psychological support at some stages. Basically, even when we have a simple flu, our body's resistance decreases, and we become more emotionally fragile and oversensitive. In diseases such as cancer that require continuous follow-up and have long treatment processes, these resentments and fragilities may increase, need for support might become of a crucial importance."

Accelerates the process of treatment
If the diagnosis of depression, which is one of the most common psychiatric diseases in cancer patients, is not diagnosed in a timely manner and cancer treatment is not started appropriately, these affect the person's compliance with treatment, quality of life and even benefits of the treatment. Untreated depression increases the progression of cancer and consequently complicates the treatment. When the patient's compliance with treatment is impaired, the body integrity (physical and spiritual) also deteriorates, and hospitalization process becomes longer.

Cancer diagnosis also affects family members and friends
A cancer diagnosis has a profound effect on not only the patient, but also on his or her family; those who may also need psychological support. "It is hard to see a loved one -mother, spouse, father or children- becoming sick. Family members experience disruption in different aspects of their life. All family members are affected by the treatment processes as much as the patient who stayed in the hospital or underwent surgery due to cancer. It changes people's lives in every sense; in terms of quality of life, in terms of functionality, in terms of sustaining job and emotionally. Sometimes this leads to change in family roles. For example, a mother may begin to act like a child. In this case, children often have to take on the functions of a parent. Spouses start to take on responsibilities that they have not encountered before. Of course, it can be difficult to deal with all this stress," said Psychiatrist Esra Ugurlu Koçer, MD, and adding, "Getting psychological support will not change the diagnosis, the course of the disease, or the experiences that you and your family are going through, but it will help you cope better with the situation and significantly improve the quality of life during this period.  

Depression reduces resistance to the disease
E.U.Koçer, MD,  says that positive outlook has positive effects on the disease, in this way the patient adapts to treatment, follows the doctor’s recommendations, and wanting to be treated and cured brings the patient into interaction with treatment. "Depressed mood disrupts this harmony," E.U.Koçer, MD,  said, explaining the effects of this: " A depressed person may refuse treatment, this condition can lead to rejection of eating and drinking. The most important symptoms of depression are reluctance, malaise, demoralization. These symptoms may be accompanied by a lack of appetite and sleep disorders. The person’s tolerance level decreases. After a while, the body’s defense mechanism begins to weaken. Lack of a balanced diet during cancer decreases resistance to the disease. Decreased resistance facilitates many possible adverse effects. In other words, psychological problems experienced by the person may indirectly lead to many negative effects associated with cancer. Therefore, the length of hospitalization might be longer, infections may occur. People may not benefit enough from treatment. The quality of life might be affected negatively. It is more difficult to recover from the disease if the person has malnutrition, sleeping problems and very serious intolerance."

Keep a positive attitude with treatment
In the treatment of psychological disorders in patients with cancer, both medication and psychotherapy treatment should be provided simultaneously. "In some cases, when the person is seriously depressed, it is imperative to provide drug support, to ease psychological discomfort connected with treatment," emphasizes E.U.Koçer, MD. When the process of accepting the disease, concerns and fear of death are added to this state, in addition to the drug treatment, psychotherapy methods should be included as well. Cancer patients can be treated with regular follow-up, appropriate support of drugs and psychotherapy as long as it is compatible with disease and drug side effects and treatment processes. The decisive factor here is the patient’s willingness to undergo treatment.