The invisible weight of cancer: the toll on mental health

When people hear that someone they know has been diagnosed with cancer, they often think about the physical symptoms, discomfort and treatment side effects that must be endured. But the burden of a cancer diagnosis extends beyond the physical. For most patients, the emotional toll of their condition also impacts their mental health.

Here are some common feelings that patients with cancer may struggle with, and ways to deal with them. 

In addition to physical symptoms and side effects, it is normal for patients to feel overwhelmed as they navigate their cancer journey.(Credit: iStock.com/Jacob Wackerhausen) 

What cancer does to the mind

1.      Low mood

Cancer is not a one-time challenge but a series of them. Patients face one stressful event after another, such as getting diagnosed with cancer, different phases of treatment and having to return to their lives post-treatment with some side effects. The impact cancer has on an individual can cause stress and bring up difficult emotions.

For example, some may experience social isolation because they are too unwell to maintain the routine they had before their diagnosis, such as going to work or socialising with friends. Others may feel self-conscious about changes to their physical appearance, such as hair loss due to chemotherapy or scarring from surgery. The social isolation and loss of identity can snowball and result in the patient feeling low or depressed. 

2.      Feelings of anxiousness

The cancer journey is uncertain. It is hard to predict what an individual’s response will be to treatment or what the next scan will show. This can cause patients to feel intense anxiety.

It is common for patients to experience what is known as ‘scanxiety’, which is the feeling of dread before or during scans, and waiting for the results. They may also worry about not being able to afford treatment or how friends, relatives or colleagues may view them differently. Not being in control of such uncertainties can cause a cancer patient to worry or ruminate. 

Even survivors who have been cancer-free for years can develop a fear of cancer recurrence. The persistent, underlying worry that their condition may return or worsen, can become heightened when they go for follow-up scans. For most, these feelings dissipate over time, however there may also be instances where they start to interfere with everyday life.

3.      Fear

Some patients may become afraid due to negative experiences they encounter while receiving treatment. For instance, if a patient develops an adverse reaction to a certain cancer treatment, it may cause them to feel apprehensive about their next treatment cycle or even trying new cancer therapies. This may lead to experiences like panic or phobia.

How to get help

Patients and cancer survivors need to know that they are not alone and it is common to experience these negative feelings. According to Ms Tan Yee Pin, Senior Principal Clinical Psychologist and Senior Master Medical Social Worker, Department of Psychosocial Oncology (DPO), NCCS, a cancer diagnosis is inherently stressful, and it is normal to experience low mood, anxiousness or fear at different points of the cancer journey.

What is important is that the emotions remain proportional to the situation. For example, it may be normal to lose sleep for a few days or even a couple of weeks leading up to a scan. But if sleeplessness persists for months, it is time to reach out for support from the care team.

Similarly, it is normal to dread going to the hospital for treatment and consultations because you associate it with difficult news or painful procedures. However, if this feeling of dread makes you unable to leave your house altogether, it is important to speak to a clinical psychologist or medical social worker who can help you cope. 

If you’ve struggled with mental health before

A history of mental health conditions can indicate greater sensitivity to stress.

If this applies to you, Dr Irene Teo, Principal Psychologist, DPO, NCCS, advises, “It may help to mentally and emotionally prepare yourself, as a cancer diagnosis and treatment can bring up significant physical, emotional and practical challenges. This is especially important if you have a psychiatric history, or previously had difficulty with low mood or anxiety.”

She added, “Building up your support system would be helpful. This can include engaging with your existing social circle of family and friends or joining a cancer support group where you will meet others with similar experiences. These avenues of support usually can provide understanding, comfort and help.”

It is also good to let your oncologist know about your mental health history so that they can be sensitive to your needs and help by coordinating care with your mental health care provider, if necessary. 

You don’t have to face this alone

Clinical psychologists and medical social workers at NCCS’ Department of Psychosocial Oncology help cancer patients cope with the mental health challenges that arise during the treatment journey.

Medical social workers provide a wide range of services to help navigate the practical, emotional and social challenges that can arise. This may include financial assistance, transport arrangements, home care support and connection to community services. They also provide emotional support for patients who are adjusting to changes in roles and relationships along the cancer journey.

Medical social workers play an important role in supporting families through the cancer journey as well, as a cancer diagnosis can also bring about caregiver stress and affect family dynamics or young children.

Clinical psychologists use talk therapy to help patients identify the source of their distressing emotions and work through them in a healthy way. When the feelings are overwhelming or cause dysfunction, they can introduce psychological and behavioural skills to alleviate anxiety and mood, or improve symptoms like sleep and fatigue. They also draw on approaches such as cognitive behavioural therapy, acceptance and commitment therapy, or meaning-centred therapy.

The work of our clinical psychologists and medical social workers are complementary with the shared goal of caring for the psychosocial well-being of patients, and are an integral part of the multi-disciplinary oncology team in caring for cancer patients.

If you would like to make an appointment with a clinical psychologist or medical social worker from the Department of Psychosocial Oncology at NCCS, please call 6436 8088 or book online. A doctor’s referral is not required.

Additional support is also available through patient support programmes with monthly support group meetings, activities and events. For more information on support groups and activities, click here. To learn more, call 6306 1777 or email patientsupport@nccs.com.sg.