Cancer and Depression

This morning, I read an advice column in which the person writing asked about her friend who keeps canceling plans due to depression, and the column author asked the letter writer if she would react the same way if her friend had a chronic or long term illness; the column author specifically mentioned cancer and asked if the letter writer would have the same opinion of the friend canceling if it was due to cancer treatment instead of depression.

This was my response to the column: “I've been clinically depressed. I've also had cancer. The comparison between the two, in terms of showing up for invitations, is extremely apt.

Returning to depression, specifically: as with many other chronic illnesses, it waxes and wanes. Accepting an invitation on Monday, with every intention of following through, does not mean that the person will be capable of actually attending on Friday.

Your friend has trusted you with her medical diagnosis; please don't drop her now because her medical condition prevents her from following through in the way you would prefer. Instead, do what you would do for anyone with a different chronic illness: ask her what you can do to support her. Then follow through on it.

It's okay to be frustrated; it's certainly understandable to be frustrated when you're continually being stood up. Just remember that the underlying cause is medical, and not a personal rejection or intentional discourtesy.”

This holds true for cancer too, and for any other long-term or chronic illness. So much of any illness is invisible, especially the less-physical side effects and long-term aftereffects. Nausea is easy to see; so are significant changes in weight, hair color or texture, weakness in or loss of use in an extremity, things like that. Things like depression, fatigue, anxiety, immune conditions, and so on, are much harder to see, and can be very hard to explain.

Comments like “But you’re cured now, what are you worried about?” are common, and explaining invisible issues can be very difficult. It also gets tiring, repeating the same thing over and over, both to people who have heard it and don’t understand, and to people who haven’t heard it yet. So is explaining why it’s necessary to avoid anyone who might be sick, because cancer treatment can have a significant, negative impact on the immune system, and only being exposed to illnesses can make it clear just how bad the impact is, or isn’t - and knowing that if it’s bad, it could lead to hospitalization.

Chronic medical conditions can often cause depression and anxiety; they can also worsen preexisting depression and anxiety, as they have for me. I have follicular lymphoma, a form of blood cancer that is considered very treatable, but chronic and incurable. It’s been five years since I finished treatment and was declared NED (No Evidence of Disease - the medical term for remission). It could come back any time. Or it could never come back. Or something else could develop due to the side effects of the chemotherapy and immunotherapy used to treat cancer. Or I could be exposed to some illness that my still-somewhat compromised immune system can’t handle. No one knows. It provokes a fair amount of anxiety. Sometimes that anxiety worsens into depression - and yes, sometimes that causes me to make plans I can’t follow through on.

The author of this column brought up a very valid point: that illness is illness, regardless of cause. This is a very important point that needs to be repeated: illness is illness, and past illness can cause problems into the future. It’s trite, but please be kind; you never really know what someone else is going through.

This piece reflects the author’s personal experience and perspective. For medical advice, please consult your health care provider.

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