Transcription:
Depression and Anxiety in Cancer Patients

Melanie Cole (Host): Getting through cancer treatment can be draining for everyone involved. Handling everyday personal needs, answering others questions about a diagnosis, and dealing with work or home life can suddenly become exhausting and can cause depression and anxiety. My guest today is Dr. Kimberly Shapiro. She's an assistant clinical professor at the Department of Supportive Care Medicine at City of Hope. Welcome to the show, Dr. Shapiro. What are some of the unique challenges when it comes to depression, anxiety, and the exhausting regimens of cancer treatment that you see with cancer patients and their loved ones?

Dr. Kimberly Shapiro (Guest):  Thanks so much for having me, Melanie. Depression and anxiety in cancer patients is actually quite common. Up to one in four cancer patients can experience a depressive episode at some point during their treatment, starting from diagnosis all the way into remission. This is a high risk population already undergoing a huge amount of stress, physical stress, and mental stress. If there's already a depressive or anxiety disorder on board, that can even lead to worsening of it. It's a very interesting population and, just like you said, in addition to the patient themselves, they're also dealing with family members, they have to go to a job, they have to take care of their kids, take care of their spouse, and take care of their home life. So, a cancer diagnosis can be devastating on so many fronts and cause a lot of stress at the get go. What's great about my job is that at City of Hope, we’re a specialized center where the psychiatrists here, this is what we see every day. We see that it's common but we also see that these things are very treatable. What I would say to a cancer patient is, it is very normal and very common to experience feelings of depression and anxiety about your diagnosis, about your treatment, and about your prognosis. When a mental health professional would want to be involved is when the depressive symptoms become more of a syndrome where you'll have difficulty sleeping, eating, and feeling excessively hopeless or helpless. Having no energy, no ability to concentrate. This is when a normal depressed mood turns into something a little more serious that we would want to intervene and get treated more quickly. Same goes for anxiety. The patient is feeling nervous about their cancer diagnosis going into a doctor's office that's very common. I would never want to pathologize that. That is very common and normal. When anxiety starts to become an issue is if a patient is persistently worrying, worrying about worrying. Obsessing about things, having difficulty making decisions. Maybe feeling excessively irritable, finding themselves sweating and panicking throughout the day. With both of depression and anxiety, what psychiatrist and all mental health professionals get concerned about is when a patient feels like it's interfering with their life. That could mean anything from getting in the way of your relationships, getting in the way of your ability to take care of yourself, getting in the way of your ability to do your job because of the excess of all these symptoms.

Melanie:  Dr. Shapiro, along those lines is it true or this is just strictly your opinion or theory, that the more positive an attitude that if somebody is feeling this incredible anxiety and depression that you're describing can affect the outcome of their treatment?

Dr. Shapiro:  That's an excellent question. A lot of patients and their loved ones think that if a patient just adopts a positive attitude or feels that they can just overcome it, then it's enough. And, while I would never discount that, I think it's a wonderful thing to have if you're optimistic and hopeful about your treatment but it's really not enough and that is scientific proven. That's not my opinion. That is proven in the medical literature that a positive attitude is not enough. These symptoms can become incredibly overwhelming and just trying to think yourself out of it or shake it off won't work. It could be helpful to adopt a positive attitude and prayer, and other sort of supportive measures can be very-very useful but when the anxiety and depression become overwhelming to a patient, then it's just not enough.

Melanie:  Then give us some working tips that you tell cancer patients and their families every single day about things that they can do to go along with their treatment whether it's getting support, or looking into meditational management, or nutrition and exercise. Give the tips that you give these families every day about dealing with this.

Dr. Shapiro:  Very good. I think the first thing is, if these symptoms are becoming overwhelming to patients or family members are noticing patients are withdrawn, they're not interested in things they used to be interested in, they are having feelings of panic and obsessive thoughts, an inability to sleep, an inability to eat, that is the time to go and see a mental health professional and get an evaluation. There are so many treatments that are available. Medications are one of them. Obviously, I believe in that; that's part of my job but they're not everything. Medications, anti-depressants, other things to target like sleep can be very helpful. That's the first thing. The second thing a mental health professional could provide is individual psychotherapy or group therapy, and there is a lot of scientific data actually that shows that therapy can change your brain just as much as medications. So, patients who are very concerned about drug/drug interactions with their cancer treatment or don't feel like they want to be on medications for a variety of reasons, they're not the only thing and therapy can be very, very useful. There's targeted therapy to work on depression and anxiety also. It doesn't need to be the kind of therapy that you see necessarily in the movies, where you're lying on a couch and someone's analyzing you for hours. There can be very short-term therapy that can be very useful. So, that's a mental health professional side. Things patients can do at home are actually incredibly effective, like exercise. It gets your endorphins going. It can actually improve your mood and decrease anxiety alone. Exercise is an excellent treatment for both mood and anxiety and should be part of any comprehensive treatment plan of those two issues. I'm not saying you have to go out and run a marathon but even something like taking a walk a few times a week for thirty minutes. Yoga is an excellent exercise that patients can do. It’s low impact and it has excellent benefit on anxiety and mood. Other things that are maybe a little less mainstream but I think are becoming more popular these days are meditation and breathing exercises can be very useful to calm down panic in the moment and keeping your anxiety down overall throughout the day. Like I said, this is not an opinion. All of these things have scientific data backing them that they're very, very useful and accepted by the medical community. Something that may be a little more alternative but also very interesting is hypnosis, and there are certain therapists that that is their speciality and they can work on anxiety or certain things that are bothering patients. Patients can even quit smoking with hypnosis if they're not interested in other avenues. Also I would say a healthy diet and working with your doctor on a diet, and if patients are doing vitamins or other supplement just to always clear those with your physician.

Melanie:  Dr. Shapiro, I'd like to get back to that but, as much as this is for patients, what do you tell their caregivers and their families? And, maybe that's for a whole separate segment but the stress on the caregivers is sometimes just absolutely extreme. What do you tell them about dealing with that stress as well, watching their loved ones go through these treatments?

Dr. Shapiro:  That's a wonderful question. Another thing which was the last thing I was going to get to is social support. It is very important for patients and actually outcome data shows that cancer patients do better with more social support. So, it does take a village to take care of a cancer patient and, like you said, families, friends, and caretakers can become very involved and there's a lot of research going on caretaker burnout. That is a real thing where caretakers feel that they not only can't take care of their patients anymore or their family member but stop being able to take care of themselves. There's a very high incidence of depression in caretakers. At your local hospital, there is often information on caretaker support and there are many support groups popping up throughout our region and, I would imagine throughout the country, teaching caretakers how to also take care of themselves and prevent burnout. I think some of the things are just general self-care; making sure that there is time to take care of yourself; getting good sleep; healthy diet and exercise; and doing some of those stress-reducing activities that they enjoy and making that part of their daily plan, like a prescription. If a doctor told you to take a medication, you would do it. If a doctor told a caretaker, “You need to take an hour out to go and play cards with your friends or go to that exercise class that you enjoy. That's a really important part of your day.” Depending, of course, on the severity of whoever they're taking care of--their illness and there are, of course, variables but caretakers should take care of themselves, also, at the same time. We always say in psychiatry, “You can't give from an empty cup. If you have nothing left to give, it's very hard to take care of your loved one as well.”

Melanie:  Absolutely and that's such great advice. In just the last few minutes, wrap it up for us. Give your best advice for patients and their families about dealing with that anxiety and depression that can come with cancer treatment, and why they should come to City of Hope for their care?

Dr. Shapiro:  The best thing is to communicate it--everything. The patient should communicate their needs. A family should communicate their feelings and get everything out in the open. If you're a patient or even the caregiver starts to notice that the patient isn't doing well. They're not acting the way they normally act and you start to get concerned, don't hesitate. The City of Hope has a very robust supportive care department. There are so many people here to help you, and no one is alone. Patients are not alone, the families are not alone. There are psychiatrists here. There are supportive care physician, social workers, psycho therapist, group leaders. There's a ton of information here at the Biller Family Resource Center, about ways to take care of yourself during and post cancer treatment and also resources for families and caregivers. So, make your needs known and be open to ideas and sharing them, and I think there's a lot of resources available for both cancer patients and their loved ones and their families, and we understand that here. This is what we do. It's a wonderful place. If you happen to be treated here, it's a wonderful place to be treated for patients and families. There's just such a huge push toward taking care of the whole patient and I really enjoy that about working here. I feel that we can make a very positive difference in patients’ lives.

Melanie:  Thank you so much, Dr. Shapiro, for being with us today. It's really great and such important information. You're listening to City of Hope Radio. For more information, you can go to www.cityofhope.org. That's www.cityofhope.org. This is Melanie Cole. Thanks so much for listening.