Depression in cancer patients and survivors is becoming a growing concern.
After cancer diagnosis, a majority of patients focus on getting well and may not be concerned about the side-effects of chemotherapy or radiotherapy. But as loss of libido, involuntary diarrhoea or anal bleeding kick in, depression follows.
Dr Sayed Karar, a consultant palliative physician at the Aga Khan University Hospital says many cancer patients struggle with fear, worry and depression.
Others pre-empt problems and worry if the anal bleeding will ever stop after a prostate gland biopsy, how they will live without a breast, if they will lose their jobs or if the cancer will come back and if it does, how will they know in time.
Flora Wachira, an oncology nurse who was told she had cancer via phone said after the devastating news it was like being on an emotional rollercoster. She even started questioning God.
‘‘The information was too much for me to handle. I asked God questions. Why did He choose me? Why did He not go for the old people. I was told to terminate my pregnancy so as to receive chemotherapy, but I refused. Defiantly, I carried the pregnancy to term. I became paranoid. I couldn’t eat food that I hadn’t cooked myself because I thought my relatives wanted to kill my unborn baby to save my life,’’ she says.
To handle the pressure of confusing emotions, Dr Karar says patients with life-threatening illnesses such as cancer should talk to a palliative care specialists who can also help them deal with the pain, fatigue, loss of appetite or nausea.
‘‘We even counsel care-givers who in most cases are overburdened and in most cases neglect themselves as they focus on the sick. Infact, 60 per of care-givers suffer burnout,’’ he said.
Timothy Mukua, a counselling psychologist said when breaking the bad news, ask the patient how much he wants to know, but don’t withhold information.
‘‘Don’t lie. The more information a patient gets, the better he or she gets to manage the disease. And never tell them there is nothing you can do for them. There is always something, you can do,’’ he said.
You would expect cancer survivors to be overjoyed after recovery, but Prof Ronald Wasike, a consultant breast surgeon said after months or years of being emotionally and physically scarred, some plunge in constant worry and barely enjoy the new lease of life.
‘‘Some remain in limbo even after surviving the disease because they are not confident that they are cancer-free,” he said.
To calm the fears, talk to a doctor about the possible side-effects so that when they occur, you do not panic.
He said common side-effects after removal of the breast and lymph nodes in the armpit such as nerve injury and shoulder dysfunction may linger. Joint pains that occur after chemotherapy treatment may also persist.
What are the signs and symptoms that your doctor wants you to report if any occur?
‘‘Maybe a new lump in the breast or near the scar, an ache or pain that is new or which does not go away after three weeks,’’ said Prof Wasike.
The surgeon says a majority of breast cancer survivors worry most about having lymphedema (swelling of the arm), passing on the cancer gene to their families, losing their libido or vaginal dryness, being infertile and recurrence or getting a second cancer.
‘‘Some women feel that their bodies betrayed them and after months of treatment, they may feel disconnected from the pleasure that their bodies once provided them,’’ he said, adding that such women should seek counselling and openly communicate with their partners to regain intimacy.
Chemotherapy may trigger early menopause and to alleviate the fears of being childless, young women can store fertilised eggs, use surrogate mothers or opt for adoption.
‘‘For vaginal dryness or soreness, pain during intercourse, breast cancer survivors can use Astroglide or Replens which are moisturisers —similar to natural lubricants,’’ said Prof Wasike.