Mental Health Tools for Cancer Survivors
- Stage four breast cancer survivor Shannen Doherty has said there are days when she feels “depressed” during her cancer journey. Thankfully, she’s found ways to cope.
- Things like grief and depression are not uncommon for cancer warriors to experience – Shannen Doherty is certainly not alone in her struggles. It’s important to know there are tools to help.
- Talk therapy can help patients work through and process the emotions their feeling, and support groups can connect people with others going through similar situations, which can bring comfort and relieve feelings of isolation.
- One way doctors can tailor mental health medications for their patients is through genetic testing, which can help doctors see how likely a patient is to respond to different types of psychiatric medications.
- Regularly meditating allows people to start to become more aware of the emotions in the physical body and the thoughts running through the mind, to acknowledge their thoughts as they arise, and then gently let them go.
Over the years, Doherty has bravely let fans in on her cancer journey. And she’s previously talked about feeling depressed since her cancer returned.Read More
Another friend was helping her to stay active. Overall, she felt like she had been successful in finding ways to address her emotional well-being.
“It's been a productive great week,” she explained. “I feel better. My skin is alive and so am I.”
Shannen Doherty’s Cancer Journey
Shannen Doherty’s initial breast cancer diagnosis arrived in 2015 after she discovered a lump in her breast. For treatment, she had hormone therapy, a single mastectomy (the removal of all breast tissue from one breast), chemotherapy and radiation.
Things were looking good in 2017 when she achieved remission status, but, sadly, the disease returned two years later in 2019. This time around, her breast cancer was metastatic, or stage four.
Having metastatic breast cancer means the cancer has spread, or metastasized, beyond the breasts to other parts of the body. Most often, it spreads to the bones, liver and lungs, but it can also spread to places like the brain.
Learning About Metastatic Breast Cancer
- What is Metastatic Breast Cancer?
- What are the Treatment Options for Late-Stage Breast Cancer?
- How To Treat Metastatic Breast Cancer: The Drug Trodelvy Shows A Promising Boost In Survival Rates
- For Some Advanced Breast Cancers Powered By Estrogen, The Drug Camizestrant Shows Promise Actually Degrading The Hormone
- Elacestrant (Orserdu) Offers Hope for Patients With a Stubborn Form of Metastatic Breast Cancer
Metastatic breast cancer doesn’t technically have a cure, but there are many treatment options out there that can help patients live long, good lives with the disease. Some of those options include things like hormone therapy, chemotherapy, targeted drugs and immunotherapy, as well as a combination of treatments.
"With advanced disease, the goal of treatment is to keep you as stable as possible, slow the tumor growth and improve your quality of life," SurvivorNet advisor Dr. Elizabeth Comen, an oncologist with Memorial Sloan Kettering Cancer Center, said of managing metastatic breast cancer. "I have so many patients who are living with their cancerâ€¦ It isn't just about living, but living well."
Most recently, Doherty’s cancer has spread, or metastasized, to her brain. As a result, she’s undergone both radiation and surgery in the form of a craniotomy to improve her prognosis. According to Dr. Kimberly Hoang, board-certified neurosurgeon at Emory University School of Medicine, a craniotomy is “a procedure to cut out a tumor” on the brain that may be particularly useful “if the tumor is causing symptoms or if it's large.”
“A couple of decades ago, to have a brain metastasis was a very bad prognosis for patients,” Dr. Hoang said. “They didn't live for more than a couple of months, so it was a very terminal thing. Thanks to a lot of advancements in microsurgery we do and radiationâ€¦patients are living longer.”
Coping With Depression During a Cancer Journey
Things like grief and depression are not uncommon for cancer warriors to experience – Shannen Doherty is certainly not alone in her struggles.
Dr. Scott Irwin, a psychiatrist and Director of Supportive Care Services at Cedars-Sinai Medical Center, says it’s crucial for patients to talk to their care team about their mental health.
Mental Health: Overcoming Depression
“We all get depressed from time to time, have a sad day, feeling down and blue that’s part of normal human emotion, part of normal life,” Dr. Irwin explained.
“Some of us, when we’re dealing with difficult things such as a diagnosis of cancer, may be sad or down or blue more often. And sometimes it gets to the point where that depression can be a little bit overwhelming, and we help them through therapy, through non-medication interventions.”
There are many ways to address mental health issues as a cancer survivor. Options may include:
- Practicing mindfulness
- Talking with a therapist
- Joining a support group
- Medication, such as antidepressants
When doctors and patients together decide that medication is necessary, it’s important that doctors choose wisely.
“I often try to choose medications with the lowest side effect profile,” Dr. Irwin said.
“If patients are getting hormonal therapy, there’s particular antidepressants that we can’t use because they may lower the effectiveness of that hormonal therapy and so we choose antidepressants that don’t impact the cancer care.”
This shows how important it is to have communication between everyone you’re seeing, so they can be on the same page about your treatment and options.
Another way doctors can tailor mental health medications for their patients is through genetic testing. Psychiatrist Dr. Lori Plutchik says genetic testing through companies like Genomind can help doctors understand how likely it is a patient may respond to different types of psychiatric medications.
"Doing the genetic testing has absolutely transformed the landscape of psycho-pharmacology," Dr. Plutchik told SurvivorNet. "It's something that I highly recommend for anybody who is taking medication, whether they are being treated for cancer, or not.”
Dr. Plutchik also explained that genetic testing can be specifically helpful for cancer patients because it may help avoid trial and error when it comes to choosing a mental health medication that does not interfere with their cancer treatment.
“So, a person who is dealing with this and may have to go on chemotherapy has already enough on their plate that they don’t really want to start dealing with trial and error with medications,” she said.
“So, it gives me information about which medications are likely to work without having problematic side effects, and it also gives information about interactions between any of the psych medications that we choose and the chemotherapy agents that they may be taking.”
Whether you're coping with an illness, an emotional problem, or life transition, a support group can be a place where people in the same boat, or a similar situation, can come together.
But maybe you're a little unsure or skeptical about joining a group. What will it be like? Are you expected to share your story?
Dr. Amy McNally, gynecologic oncologist with Minnesota Oncology, tries to reassure her patients that chances are, they'll derive some benefit.
"I think in a support group you're going to find women who are in similar situations but yet can share their unique stories," she says.
Just being there is worth it. "You don't have to share a thing. You can just sit and listenor you can be part of the conversation and offer your thoughts. And it can be different every time you go"it's your choice as to how or whether to participate and what you decide to get out of the group.
McNally thinks it can be helpful and comforting to be around people who know what you've been through, or are going through, and that in and of itself is reason enough to try it out.
“People that are struggling with coping with the experience, coping with body image should reach out to their doctors, find a therapist in the community,” says Dr. Irwin.
A patient navigator or social worker can also help connect you with a mental health professional that you can talk to to help process your emotions.
“It’s about meeting the individual patient where they are and their feelings, how they’ve always dealt with their body image, what the body image changes mean now in their lives and their relationships, and how they can move forward given the new reality,” Dr. Irwin said.
Jon Kabat Zinn, founder of the eight-week stress-reduction program, Mindfulness-Based Stress Reduction (MBSR), a course that has entered the mainstream of health care, scientific study, and public policy, describes mindfulness as "paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally."
Mindfulness is often suggested for cancer patients to reduce high levels of anxiety and distress associated with diagnosis, treatment, and anticipation of possible disease recurrence.
Both the American Society of Clinical Oncology and the Society of Integrative Oncology recommend meditation as part of a multidisciplinary approach to reduce stress, depression, and mood disturbance, and to improve the quality of life in cancer patients. But the question remains: does it really work? We think it does.
5 tips for practicing mindfulness:
- Choose one daily activity to practice mindfully (e.g. eating your lunch, brushing your teeth or taking a shower). During this activity notice your breath and activity of your mind for a few moments.
- Take a pause throughout your day. During your day, find a moment to stop and take 5 deep breaths with your eyes closed.
- Kindly acknowledge a moment you're experiencing a difficulty by putting your hand on your heart and saying, "I feel my pain. How can I be kind to myself in this moment?"
- Get curious about your emotions. Experiment with welcoming your emotions as they come, instead of pushing them away.
- Become aware when you're in a rush. Ask yourself, "Do I really need to hurry?"
Regularly meditating allows people to start to become more aware of the emotions in the physical body and the thoughts running through the mind, to acknowledge their thoughts as they arise, and then gently let them go.
Shannon Masur, a colon cancer and Lynch Syndrome survivor, describes this as "â€¦ when a thought comes in, to feel it, feel the fear, but let it go after a few seconds."
All of this is said to result in an overall reduction in stress and anxiety in the body. It may also help patients to control problems such as pain, difficulty sleeping, tiredness, feeling sick and high blood pressure.
For help getting started with meditation, here’s a guided session to try.
WATCH: A Guided Meditation for the SurvivorNet Community
Overall, don’t forget to prioritize your mental health when facing cancer. You might feel like your mind is the least of your worries while fighting the disease, but it’s important to know just how big of an impact your mental well-being can have on your health as a whole.
“Actually, there’s data that if you have extra stress or depression that you may not recover or you have a higher risk or recurrence,” Dr. Irwin said. “So… in treating the depression, we’re actually impacting the cancer care outcomes.”