Treatment Snapshot
March 24, 2010
Excerpt from "Only 10 Seconds to Care"
December 23, 2009 – Wendy Harpham, MD
Cancer as a Turning Point
December 23, 2009 – Don Vaughan
Best Face Forward
December 23, 2009 – Lacey Meyer
Recipes from Chef Hans Rueffert
December 20, 2009
A Skinny Chef You Can Trust
December 22, 2009 – Karen Patterson
Getting Help
December 23, 2009 – Jo Cavallo
Stress Reducers
December 23, 2009 – Laurie M. Fisher
Cisforcupid.com
December 23, 2009 – Lacey Meyer
Only 10 Seconds to Care: Help and Hope for Busy Clinicians
December 23, 2009 – Kathy LaTour
Flavored-Cigarette Ban Takes Effect, With More to Come
December 23, 2009 – Lacey Meyer
Stress, Depression & PTSD
December 23, 2009 – Laurie M. Fisher
Imaging Strategies: The Bigger Picture
December 23, 2009 – Laura Beil
Herceptin Combinations Improve Survival, Lessen Heart Toxicity
December 23, 2009 – Laura Beil
Integrative Techniques: A Sampler
December 23, 2009 – Marc Silver
Drug Therapies
December 23, 2009 – Elizabeth Whittington
Letters from Our Readers
December 23, 2009
Treatment Updates
December 23, 2009 – Staff Reports
CDC picks up the tab for colon cancer screening
December 23, 2009 – Lacey Meyer
Mutant Tissue Wanted
December 23, 2009 – Kathy LaTour
The More You Know
December 23, 2009 – Helen Osborne
Patients' Songs Take Flight
December 23, 2009 – Bunmi Ishola
Q&A: Cervical Cancer Vaccine
December 23, 2009 – Len Lichtenfeld, MD
Comfort in Strange Places
December 23, 2009 – Susie Kasinski Drummond
The 'Price' is $1 Million
December 23, 2009 – Lacey Meyer
Pancreatic Cancer Symposia
December 23, 2009
Tired of Being Tired?
December 23, 2009 – Lacey Meyer
Message From the Editor
December 23, 2009 – Debu Tripathy, MD
Beneficial Brew
December 23, 2009 – Lena Huang
Gut Reaction
December 23, 2009 – Karen Patterson
Today's Lesson: Cancer
December 23, 2009 – Bunmi Ishola
Uncertain Obligations
December 23, 2009 – Jo Cavallo
Beyond Face Value
December 22, 2009 – Terry Healey
Cancer's Silver Lining
December 22, 2009 – Don Vaughan
Kids Allowed
December 21, 2009 – Marc Silver
Layman's Terms
December 23, 2009 – Charlotte Huff
All Stressed Out
December 23, 2009 – Laurie M. Fisher
Bad Neighbors
December 22, 2009 – Laura Beil
Treatment Snapshot
March 24, 2010
Excerpt from "Only 10 Seconds to Care"
December 23, 2009 – Wendy Harpham, MD
Cancer as a Turning Point
December 23, 2009 – Don Vaughan
Best Face Forward
December 23, 2009 – Lacey Meyer
Recipes from Chef Hans Rueffert
December 20, 2009
A Skinny Chef You Can Trust
December 22, 2009 – Karen Patterson
Getting Help
December 23, 2009 – Jo Cavallo
Stress Reducers
December 23, 2009 – Laurie M. Fisher
Cisforcupid.com
December 23, 2009 – Lacey Meyer
Only 10 Seconds to Care: Help and Hope for Busy Clinicians
December 23, 2009 – Kathy LaTour
Flavored-Cigarette Ban Takes Effect, With More to Come
December 23, 2009 – Lacey Meyer
Currently Viewing
Stress, Depression & PTSD
December 23, 2009 – Laurie M. Fisher
Herceptin Combinations Improve Survival, Lessen Heart Toxicity
December 23, 2009 – Laura Beil
Integrative Techniques: A Sampler
December 23, 2009 – Marc Silver
Drug Therapies
December 23, 2009 – Elizabeth Whittington
Letters from Our Readers
December 23, 2009
Treatment Updates
December 23, 2009 – Staff Reports
CDC picks up the tab for colon cancer screening
December 23, 2009 – Lacey Meyer
Mutant Tissue Wanted
December 23, 2009 – Kathy LaTour
The More You Know
December 23, 2009 – Helen Osborne
Patients' Songs Take Flight
December 23, 2009 – Bunmi Ishola
Q&A: Cervical Cancer Vaccine
December 23, 2009 – Len Lichtenfeld, MD
Comfort in Strange Places
December 23, 2009 – Susie Kasinski Drummond
The 'Price' is $1 Million
December 23, 2009 – Lacey Meyer
Pancreatic Cancer Symposia
December 23, 2009
Tired of Being Tired?
December 23, 2009 – Lacey Meyer
Message From the Editor
December 23, 2009 – Debu Tripathy, MD
Beneficial Brew
December 23, 2009 – Lena Huang
Gut Reaction
December 23, 2009 – Karen Patterson
Today's Lesson: Cancer
December 23, 2009 – Bunmi Ishola
Uncertain Obligations
December 23, 2009 – Jo Cavallo
Beyond Face Value
December 22, 2009 – Terry Healey
Cancer's Silver Lining
December 22, 2009 – Don Vaughan
Kids Allowed
December 21, 2009 – Marc Silver
Layman's Terms
December 23, 2009 – Charlotte Huff
All Stressed Out
December 23, 2009 – Laurie M. Fisher
Bad Neighbors
December 22, 2009 – Laura Beil

Stress, Depression & PTSD

The depth and duration of stress may lead to depression.

BY Laurie M. Fisher
PUBLISHED December 23, 2009

The depth and duration of stress may lead to depression, which occurs at a rate approximately three to five times greater in cancer patients than the general population, says Michael Irwin, MD, director of The Cousins Center for Psycho­neuroimmunology UCLA Semel Institute for Neuroscience and Human Behavior. “Unfortunately, depression remains largely underdiagnosed and undertreated in cancer patients, and chronic depression might impact disease progression,” he says.

Michael Burke, MD, clinical director of psychiatric oncology at the Emory Winship Cancer Institute in Atlanta, says there is a difference between a depressed mood, which is transient, and the syndrome of depression, when patients report a sadness or lack of interest as well as significant changes in four or more brain-regulated functions, such as mood, cognition, sleep, appetite, self-image, psychological thought patterns, energy, concentration, memory, decision-making, interest, motivation, and self-protection.  

“Few would ignore cardiac symptoms if they were in the middle of cancer treatment. Why ignore brain symptoms like depression that can be effectively treated so the person can feel better during a difficult time?” Burke says.

Barbara L. Andersen, PhD, a professor of psychology at Ohio State University in Columbus, conducted a separate analysis of women with breast cancer who showed major depression as part of a larger study to determine if psychological interventions impacted survival. What was discovered, she says, was that reducing stress and depressive symptoms resulted in a better immune profile, meaning how well the immune system is functioning, and psychological profile. “The reduction in symptoms at four months and then measuring inflammation at eight and 12 months showed that when we reduced the depressive symptoms early, then later on, inflammation was less.”

Aside from depression, Burke says 3 to 10 percent of adult cancer patients have post-traumatic stress disorder (PTSD), an anxiety disorder that develops in reaction to physical injury or severe mental or emotional distress, such as military combat, violent assault, natural disaster, or other life-threatening events.

"Cancer is a perfect storm when it comes to how it affects the brain."

PTSD in cancer survivors may be expressed by reliving the cancer experience in nightmares or flashbacks, continuously thinking about it, avoiding places, events, and people connected to the cancer experience, and/or being continuously overexcited, fearful, irritable, and unable to sleep. To be diagnosed as PTSD, these symptoms must last for at least one month and cause significant problems in the patient’s personal relationships, employment, or other important areas of daily life. Patients who have these symptoms for less than one month may develop PTSD later. 

Burke says cancer patients with PTSD may avoid going to health appointments, ignore appropriate self-exams, or refuse to talk about or even say the word “cancer”—reactions that can lead to poor health behaviors, such as alcohol and drug use to numb the person’s emotions, lack of self-care, and emotional distancing.

Burke focuses on four components of therapy for these patients. First, he helps patients work on grieving the losses of cancer, which may be temporary or permanent. “They need to grieve that loss so they can deal with their new normal to redefine themselves,” he says. Next, he encourages survivors to define themselves not by what they can’t do, but by what they can do. Third, the survivors need to normalize the cancer experience by learning to accept that they might not feel great, even if they have survived cancer. Fourth, they must process what has occurred.

“Cancer is a perfect storm when it comes to how it affects the brain,” Burke explains. “The brain has been affected by chemotherapy, radiation, surgeries, cancer itself, and other inflammatory processes. The brain regulates so many functions, including thought, cognition, motivation, energy, and sleep. When there is a brain dysfunction, such as depression or PTSD, it needs to be treated, so that even the sickest patient with cancer can improve their quality of life.”

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