Depression and Multimorbidity Link Among Breast Cancer Survivors

This is a surprise to absolutely no one: a recent study published in BMC Cancer found a strong link between depression and other medical problems among breast cancer survivors. The medical term is multimorbidity – which means living with two or more chronic illnesses. Since cancer is now considered to be a chronic illness and since the incidence of breast cancer is higher as women age, this seems apparent. If you already had diabetes, heart disease or arthritis and then were diagnosed and treated for breast cancer, one would suspect that life could feel hard.

The study concluded that more attention needs to be paid to cancer survivors with multimorbidities and their risk of depression.

We also know that depression is not uncommon among cancer survivors although I usually prefer to think about it as situational depression, an adjustment disorder or PTSD. There are highly variable reported rates of depression among cancer survivors, ranging from 15%-25% and even higher. As a contrast, the reported incidence of depression in the general population is 7%-8%. As far as I know, no one previously has studied the associations or links among multimorbidity, depression and breast cancer. The researchers in this study looked at data from almost 8,500 women in the UK. They found that about one third of the women had one other chronic medical problem in addition to breast cancer and that another third had two or more health issues. The most common were hypertension, asthma and various painful conditions like arthritis. They specifically reported that 5.3% of the women had been diagnosed with depression; most often, those women also had irritable bowel syndrome (IBS), diabetes or migraines.

The study concluded that more attention needs to be paid to cancer survivors with multimorbidities and their risk of depression. People who are depressed are likely to have less adherence to treatment, decreased cancer survival, and a generally greater risk of medical issues, time in hospitals or other medical facilities, and medical bills. Again, no one would want to dispute these findings, but it all seems pretty obvious.

As I write this, I have just concluded meeting with a support group of breast cancer survivors. They discussed their lives in general, cancer worries in specific, and a shared concern about access to the kind of medical care and attention they want and need. Several women complained of being unable to reach their doctors during the months of treatment, of leaving messages and writing emails that were never answered. Their sense of vulnerability and even abandonment persists into the period post-treatment and contributes to their anxiety and mood. When they feel physically unwell, they quickly become worried about cancer. Could that headache or shoulder pain mean that the cancer has spread? If they are uncertain about their ability to reach a doctor, their worries increase.

We talk in Cancer World about the two-week rule. This means that most aches and pains go away within two weeks. If they don’t, it is reasonable to call a doctor and report the problem. (Important note: clearly this rule does not apply to a concern about an acute event like a heart attack or a stroke!) If you despair of reaching your doctor for answers and reassurance, the anxiety is higher. This experience is surely more common and more distressing for people who are living with more than one chronic health condition and, therefore, have more physical symptoms to sort out or worry about.

Contending with medical worries certainly affects our moods. If you find that your worries are greatly interfering with your quality of life and make it hard to enjoy things, it is time to consider talking with someone. A good place to start is the Oncology Social Work Group. Someone in that group can talk with you about individual or group sessions and/or refer you to someone in the community with experience working with cancer patients and survivors.