Understanding Cancer How to Cope - Survivor Lung Cancer Packs a Psychological Punch

How to Care for Your Psychological Health After Being Diagnosed with Lung Cancer

man looking out a windowThe diagnosis of lung cancer is a stressful and life-changing event for the person diagnosed, and for their entire family, with psychological, social, and emotional challenges. People with lung cancer describe having to find a new sense of “normal” because the disease has such far-reaching effects on all aspects of daily life. This life-threatening illness can also have severe effects on psychological health.

The stress associated with cancer can manifest physically and psychologically. Although the psychological changes may be more difficult to recognize, they are just as important as the physical ones and should be addressed. It is very common for people diagnosed with cancer to have emotional and psychological distress. It may occur immediately after diagnosis and continue throughout treatment, and may worsen as the condition deteriorates. Many of the drugs used in cancer treatment can affect the balance of chemicals in the brain and contribute to changes in behavior, mood, sleep patterns, and anxiety levels.

Psychological distress may cause a lack of motivation to engage in meaningful activities, a reduction in cognitive and social functioning, and an overall increased level of fatigue. It is important that you have an open discussion with your healthcare team about all aspects of treatment, and that activities that are meaningful to you are identified. If treatment and side effects prevent you from engaging in these activities, psychological distress levels and coping ability can be drastically affected. 

Depression is especially common in people with lung cancer, and those receiving a lung cancer diagnosis may experience higher levels of distress compared with other cancer diagnoses, in part because of the advanced stage of the cancer at diagnosis and the heavy burden of symptoms frequently associated with lung cancer. Functional impairment, which is the inability to carry out functional activities, is the most important risk factor for the development of depression. For every increment of physical impairment, the risk of depression is increased by 41 percent because the person can no longer perform the same level of activities as before diagnosis or treatment. They must rely on others, and this loss of independence can lead to distress and depression.
Although the psychological changes may be more difficult to recognize, they are just as important as the physical ones and should be addressed.A cancer diagnosis generates feelings of sadness, anger, anxiety, and fear. People with cancer and their families struggle with quickly having to define, put into context, comprehend, and make important decisions. The initial adaptation to a diagnosis can be influenced by pre-exiting psychological factors. People who have a history of depressive disorders (diagnosed or undiagnosed) should be carefully monitored throughout the cancer course, because the events associated with the diagnosis may serve as triggers for depression. A history of depressive disorders can be worsened or aggravated by the cancer course. 

A cancer diagnosis and treatment may cause cognitive changes. Chemo brain is a term often used to describe a group of symptoms related to effects of cancer treatment. Symptoms include levels of forgetfulness, difficulty concentrating, and difficulty with multitasking. This can become a very distressing and lingering symptom.

There may be unmet psychological burdens experienced in tobacco-related disease, including elements of blame or guilt that people place on themselves. This can severely affect coping ability and the seeking of supportive services. Early assessment and treatment of these symptoms are crucial for maintaining quality of life. There are treatments and strategies that can help people better cope throughout the cancer course.

Distress
The overall psychological burden of the cancer experience is referred to as distress. Distress is a multi-factorial emotional, psychological, social, and spiritual experience that can interfere with the ability to cope with a cancer diagnosis and treatment. There are many symptoms of cancer-related distress. People can feel general denial, sadness, anger, fear, or vulnerability. These feelings are normal responses to coping with the disease. This generalized distress can progress to more severe depression and anxiety, and cause an inability to cope with daily life.

Distress can affect quality of life during the entire course of the illness. Many cancer survivors continue to suffer from sadness, often severe enough to require intervention. The end of treatment can also be a time of heightened distress because there is uncertainty about cancer recurrence. Furthermore, responsibilities that are often placed on hold during treatment must now be addressed. In addition, survivors may face the loss of a strong support system because of decreased contact with members of the treatment team, family, or friends.

Psychological issues often are unreported for many reasons, including the general stigma about psychological issues or feeling that symptoms are expected. Although there are varied levels of distress, mild symptoms may affect normal daily activities, and this should be discussed with the healthcare team. Mild distress includes fear, uncertainty, worry, sadness, poor sleep, poor concentration, or thinking much about the illness. Mild distress can become severe, so it is important to evaluate distress levels frequently, identify distress early, and intervene. Early evaluation and screening can lead to timely management of distress and minimize interference with daily activities. 

Strategies for Self-Help 
The National Comprehensive Cancer Network recommends screening all people with cancer for psychological distress at each follow-up visit. The Distress Thermometer is a standardized survey frequently used to measure and evaluate distress. The Distress Thermometer quantifies stress on a scale from 0 to 10 (0, no distress; 10, extreme distress), based on the answer to the question, “How is your level of distress today?” or “How has your level of distress been during the past week?” Greater distress is associated with negative outcomes, including non-adherence to treatment recommendations, poor satisfaction with overall care, and decreased quality of life.

Your healthcare team may include professionals who are experts in psycho-oncology, including social workers, chaplains, palliative care specialists, psychologists, and psychiatrists. Experts in this field can assess and provide critical support for people with lung cancer and their families. 

A person’s coping style and perceived social support are two important factors positively associated with adaption to distress. Social supports, community resources, and support groups may be helpful, including teleconference calls, personal counseling, and group meetings. The choice of resource is based on the survivor’s comfort level and availability of community resources. 

Expressing emotions may help you and your family cope with the disease. Each individual may cope differently with each situation, frequently within the context of the individual’s social structure. A good support system may help people with lung cancer openly discuss new symptoms and may help in the recognition of new or abnormal symptoms.

Anxiety
Anxiety is a normal response to a diagnosis of cancer, but it often is inadequately treated, can impede daily functioning, and can have a substantial negative effect on quality of life. Anxiety can manifest as physical symptoms, such as gastrointestinal disturbances, restlessness, sweats, palpitations, dyspnea, and panic attacks. It also can manifest as behavioral symptoms, such as feelings of uneasiness, restlessness, loss of concentration, excessive intrusive thoughts, and seeking continual reassurance or comfort from outside. Some anxiety is normal, but persistent anxiety that disrupts daily functioning is termed maladaptive anxiety and requires intervention.

Anxiety can occur at any time in a person’s cancer course, including at the time of diagnosis, during treatment, and throughout survivorship, when anxiety may center around the possibility of recurrent cancer. Your healthcare team can assess your symptoms and determine the primary causes of your anxiety. Antianxiety medication and antidepressants may be prescribed.

Depression
Depression may include feelings of sadness, lack of interest in normal activities, fatigue, and low energy. Reactive depressive symptoms, including denial and anger, may be a normal reaction to a stressful and unexpected event. These symptoms become problematic when they interfere with normal life and daily living. 

Depression is often under reported and undertreated. This may be attributable to the perceived stigma associated with the disease. The National Comprehensive Cancer Network reports the following symptoms associated with depression: 
• low mood
• difficulty concentrating and remembering
• irritability
• loss of sexual interest
• changes in emotions
• loss of interest in social activities
• changes in sleep
• loss of energy and motivation
• fatigue
• anxiety
• feelings of hopelessness
• frequent or excessive worry
• panic attacks
• physical symptoms, such as upset stomach
• increased interest in alcohol

There are antidepressant drugs, antianxiety medications, and self-help techniques that can help a person cope with depression. Cognitive behavioral therapies, relaxation, and improving problem-solving skills may also be useful. Cognitive behavioral therapy may improve coping and decrease psychological symptoms. 

Be reassured that acknowledging psychological symptoms and talking with members of your healthcare team are not signs of weakness. Addressing symptoms and developing coping skills can have a positive effect on the cancer course and improve outcomes. In addition, supportive care is invaluable to survivors and families who are coping with lung cancer.


Excerpted with permission from Lung Cancer Choices, 3rd Edition, © Caring Ambassadors Program Inc., lungcancercap.org

This article was published in Coping® with Cancer magazine, May/June 2018.