Following the diagnosis of breast cancer, my sister has become very depressed and suicidal. How does cancer cause such deep depression?
Most Kenyans have now known that there is no health without mental health. To put this now popular mantra slightly differently, no aspect of healthcare can be considered complete without adding a comment on the mental health aspect.
It is true, for example, that all chronic medical conditions increase the likelihood of developing one or other mental health conditions. For example, people with diabetes are more likely to be diagnosed with depression than those without. The same is true for people with chronic cardiovascular disease, renal disease as well as chronic lung diseases and strokes. About 50 percent of people diagnosed with some types of cancer also have a depressive illness that sadly often goes undiagnosed.
The fact of diagnosis of a chronic condition in your sister is the first and most probable reason she is now depressed. That, however, is only the tip of a huge iceberg. The reality is that the diagnosis of any cancer sends most people into an emotional rollercoaster in part driven by the stigma and lack of information that often follows the diagnosis of cancer.
Part of the stigma is driven by the fact that until a few years ago, in the minds of many people in Kenya, a diagnosis of any type of cancer at whatever stage was associated with death within a short time. The feeling of helplessness and hopelessness following a diagnosis was often fuelled by the social and financial disruption that was anticipated following the diagnosis.
The reality today is rather different, and many are those who have realised that they are not mere bystanders in a situation of cancer of the breast and indeed of many other types of cancer.
Two things are changing this state of fear of cancer. The first is the knowledge that long before the diagnosis is made, there is a great deal that one can do to ensure early detection and hence better outcomes following treatment. The earlier the cancer is detected, the better the outcome. Self-examination and mammography are strategies for early detection of breast cancer.
Similarly, regular simple blood checkups for men are useful in the timely detection of cancer of the prostate. Many cancers of the gastrointestinal tract are detectable before spreading and although the diagnosis might lead to the kind of distress that your sister now finds herself in, the long-term survival rates in cancer are linked to early detection. This must be the message that continues to be passed to empower people long before the diagnosis is made.
The second fact that is changing cancer diagnosis and treatment is the fact that we now have effective and less toxic treatments, administered by a larger and better-trained cohort of doctors and nurses in many parts of Kenya. The availability of experts coupled with early detection means we have better survival rates.
The psychosocial aspects of cancer treatment are also important and might be part of what is driving your question about your sister. In this regard, it is now clear that following a diagnosis, of cancer, the patient is not the only interested party, and is most certainly not the only person entitled to accurate information on what is likely to happen after the diagnosis.
The spouse, children, parents and in some cases, siblings are legitimate stakeholders who play a supportive emotional role over and beyond raising funds. The extended family which might include the neighbors and the church support groups might be of some relevance depending on the circumstances one finds themselves in. Each case has its special circumstances which must be addressed.
Given all the foregoing, what about your sister and what is it about her that has led to the state of what you call suicidal depression? How much does she know about all the things that we have alluded to here? What is the level and extent of social and other support she has?
Concerning the cancer, at what stage was the diagnosis made, and has it spread to other parts of the body say the brain, or was it found early on a routine examination? Is she on treatment for cancer and is the treatment causing any untoward side effects?
Does she have a history of depression during periods of stress or indeed without specific stressors? What is the extent of social support available to her following the diagnosis?
All these questions must be addressed by the team looking after your sister, and for my part must congratulate the team looking after her for having made the diagnosis of depression, because proper treatment of depression will impact the prognosis of the cancer.
