MENTAL HEALTH

Cancer patients with depression have resources

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Reuters Health - Cancer patients who experience depression can use both therapy and lifestyle tools to help support their mental health, according to a new patient resource from the JAMA Oncology journal.

People with cancer, as well as their doctors, need to remember that mental health is as important as physical health for these patients, the authors note.

"Understandably, cancer treatment is primarily focused on obtaining medical remission," said Rachel Roos Pokorney, a therapist based in New York City who co-wrote the one-page primer intended for patients.

The page is based on recommendations given by the American Cancer Society and the National Institute of Mental Health.

"There is still an unfortunate lack of awareness about the importance of treating the mental along with the physical, both in general and in regards to cancer patients," she told Reuters Health.

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The patient resource explains that physical changes, limitations from symptoms and treatment and uncertainty about the future all put cancer patients at risk for depression.

But nontherapeutic tools, such as physical activity, a healthy diet, and a strong social network can help the body, improve mood and reduce stress, the authors write.

"There is a basic connection that the mind and body have that is very important to remember," Pokorney said. "It is of the utmost importance to always take care of your mind by taking care of your body, and vice versa. This is especially important for cancer patients."

Therapeutic tools, such as medication, support groups and individual therapy, can help as well. In fact, social workers, psychiatrists and psychologists are becoming more involved with cancer-based care in recent years, she said.

"As cancer treatment advances, there are more cancer survivors who are in need of long-term care, which is no longer limited to physical symptoms," said Gleneara Bates of Columbia University Medical Center in New York City, who co-authored the patient page with Pokorney.

"The emotional burden of cancer has real-life effects on not just patients but their primary caregivers and family members," she told Reuters Health by email. "Cancer has historically been seen as an 'old man's disease,' and this is no longer the case."

Bates and Pokorney note that using cognitive behavioral therapy and dialectical behavioral therapy to help patients identify and manage their emotions and thoughts to improve depressive symptoms is gaining support - both as a result of evidence-based studies and the rising mindfulness trend.

"Treatment for cancer-related depression is not one-size-fits-all," Bates said. "Patients and health care providers should discuss all aspects of mental health to find the best combination."

Cancer patients may often experience depressive symptoms after treatment has ended, said Dr. Lynne Padgett, strategic director of hospital systems for the American Cancer Society in Atlanta, Georgia.

"Patients may experience symptoms when everything should be 'OK' because of the long-lasting effects of cancer and the treatments," Dr. Padgett, who was not involved in the patient resource, told Reuters Health. "The symptoms are often not classical and don't meet the criteria for a depression diagnosis."

The Commission on Cancer, an accreditation group that is part of the American College of Surgeons and issues guidelines for cancer care, expanded its emphasis on treating psychosocial distress and mental health in a 2015 guideline update. Since then, cancer centers have stepped up their assessments of mental health, she said.

With more assessments and greater awareness, new psychosocial treatments and referrals have increased as well, Dr. Padgett said. Oncologists and primary care physicians can turn to social workers, cancer wellness centers and rehabilitative physical therapy centers to help cancer patients with mental health questions.

"Oncologists don't have to feel overwhelmed or treat these symptoms," she said. "Those who are trained in mood and psychosocial health can do that."

"Unfortunately, depression has been highly stigmatized, and folks can be reluctant to seek treatment," Bates said. "Having this conversation is important because it allows us to normalize mental health treatment."

The patient resource was published January 12 online.