Fist Anxiety, Then Depression
Posted 12/31/2012
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I love it when I come across a study that confirms that I/we have known all along. This one, from Spain, looked at the psychological reactions/coping of people at two specific points of cancer: at diagnosis and two to four weeks after completing treatment. These were people with all kinds of cancer, and they actually found that those with head and neck cancers had the most difficult times. This makes sense if you know anything about those diseases; the treatments can be very, very tough, and everyone worries about the possible visible disfigurement. Not to minimize our experience in any way, but breast cancer is a bit easier to manage.
I love it when I come across a study that confirms that I/we have known all along. This one, from Spain, looked at the psychological reactions/coping of people at two specific points of cancer: at diagnosis and two to four weeks after completing treatment. These were people with all kinds of cancer, and they actually found that those with head and neck cancers had the most difficult times. This makes sense if you know anything about those diseases; the treatments can be very, very tough, and everyone worries about the possible visible disfigurement. Not to minimize our experience in any way, but breast cancer is a bit easier to manage.
Think back to the first days or weeks after learning of your breast cancer. I am pretty sure that you, like me, like most if not all of us, were terrified. We all expect that we are going to die of this illness, and that death may well be quite soon. Beyond that biggest fear, we are scared about the treatments, about manging our family and work responsibilities, about money, about how we will possibly cope. As a bit more time passes, things generally settle down. It is always easier to have a plan, no matter what the plan may be. With that knowledge, we begin to organize our lives and somehow put one foot in front of the other to get through it.
And then the treatment is done, and often depression sets in. I don't mean clinical depression of the sort that demands medications, but something much more similar to PTSD (Post Traumatic Stress Disorder). Once the crisis abates, we look back at what we have been through, begin to take stock of ourselves and our life changes and let ourselves really feel and experience what has happened. This is very tough. It gets better, I promise, but not immediately. Remember the general rule that it takes at least as long as the total duration of treatment to feel fully psychologically and physically recovered. And, forgive the plug here, if you have not done so, this is an excellent timne to read my book After Breast Cancer: A Commonsense Guide to Life After Treatment.
Here is the abstract from the study and a link to read more:
First Anxiety, Afterwards Depression: Psychological Distress in Cancer Patients at Diagnosis and after Medical Treatment
Francisco Gil1*†, Gema Costa2, Ines Hilker1 & Llucia Benito3 1Psycho-oncology Unit, Duran i Reynals Hospital, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain 2Department of Psychiatry, Hospital de Mataró, Mataró, Barcelona, Spain Control and Preventive Service, Duran i Reynals Hospital, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
Abstract
Objective: The purpose of this study was to assess psychosocial changes at two particular moments: at cancer diagnosis and 2–4weeks after having finished treatment.
Material and methods: A total of 67 cancer outpatients were assessed in this study. The inclusion/exclusion criteria were as follows: ambulatory cancer patients aged 18 years or older and receiving medical treatment. Patients with a performance status <50 or with cognitive impairment (≥3 errors in the Pfeiffer Questionnaire) were excluded. The inclusion period ranged from 1 April 2005 to 30 April 2007. The scales used were the 14-item Hospital Anxiety and Scale (HADS), which has two subscales for anxiety (seven items) and for depression (seven items), the Quality of Life Short Form36 Questionnaire, the Mental Adjustment Scale and theMedical Outcomes Study Questionnaire for measuring social support. All data were compared with sociodemographic and medical characteristics.
Results: Patients had higher levels of pre-treatment versus post-treatment anxiety (HADS-Anxiety mean, 7.41 versus 6.69), whereas depression scores were higher post-treatment versus pre-treatment (HADS-Depression mean, 3.14 versus 3.89). After medical treatment, patients were more fatigued, with lower performance status (Karnofsky Index), less social support and less quality of life, but no differences in coping styles were found. Women had higher levels of anxiety than men. Patients with psychiatric antecedents had higher levels of distress, but these differences were only observed after diagnosis and not after the treatment. In general, head and neck cancer patients had higher levels of distress, worse coping and worse social functioning.
http://onlinelibrary.wiley.com/doi/10.1002/smi.2445/pdf
Conclusions: Cancer patients require special consideration before and after treatment. Anxiety is the symptom that characterizes diagnosis, whereas depression is more common after medical treatment. The head and neck cancer patients were the group with the highest complexity.
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