Many people facing cancer experience some degree of depression, anxiety and fear. These feelings are completely normal responses to a life-altering experience. In people with cancer, depression may arise because of a feeling that one’s ability to perform family or work roles has changed, or because of seeming loss of control over life events, or because of changes in body image. And anxiety may form because of fear of death, fear of suffering and pain or simple fear of the unknown. Whatever the reason, it’s important to recognize and understand the symptoms, and to seek help if necessary.

Cancer and Depression

It is normal to grieve over the changes that cancer brings to a person’s life. The future, which seemed so certain before, may feel uncertain. Some dreams and plans may seem permanently lost as a result of the cancer diagnosis. But when you are caring for a person who experiences long-lasting sadness or is having difficulty carrying out day-to-day activities, that person may have clinical depression. In fact, clinical depression occurs in about 25 percent of people with cancer, causing great distress, impaired functioning, and less ability to follow their treatment schedule. Clinical depression, however, is treatable. If you are caring for someone with the symptoms of clinical depression, you should encourage him or her to get help. There are a number of treatments for clinical depression including medication, counseling or a combination of both. These therapies can improve quality of life and reduce the suffering of people with cancer.

Symptoms of Clinical Depression

• Persistent sadness or "empty" mood for most of the day
• Loss of interest or pleasure in almost all activities
• Significant weight loss or weight gain
• Lethargy or restlessness and agitation nearly every day, enough for others to notice
• Fatigue or loss of energy
• Sleep irregularities – sleeping too much or too little
• Trouble concentrating, remembering, making decisions
• Feelings of guilt, worthlessness, helplessness
• Frequent thoughts of death or suicide, suicide plans or attempts

If five or more of these symptoms happen nearly every day for two weeks or longer, or are severe enough to interfere with normal activities, it will be helpful for you to encourage your loved one to see a qualified health or mental health professional.

What to Do When Caring for a Person with Clinical Depression

• Encourage the depressed person to continue treatment until symptoms improve, or to seek different treatment if there is no improvement after two or three weeks.
• Promote any form of physical activity, especially mild exercise such as daily walking.
• Help make appointments for mental health treatment, if necessary.
• Provide transportation for treatment, if necessary.
• Engage your loved one in conversation and other enjoyable activities.
• Realize that negative thinking is a symptom of depression and will disappear with treatment.
• Reassure your loved one that with time and treatment, he or she will begin to feel better.

Cancer, Anxiety, and Fear

It is also normal for people who have cancer to feel fear and anxiety at many critical times during their treatment. For most people, initial diagnosis and the possibility of recurrence create the most anxiety and fear. Fear of pain, doctor visits, tests, dying, what happens after death, and what may happen to loved ones may also produce apprehension. Despite symptoms, the person may deny his or her feelings. That, too, is common. That’s why, if you observe symptoms, it’s important to encourage a visit to a health or mental health professional.

Symptoms of Anxiety and Fear

• Uncontrolled worry
• Difficulty solving problems
• Difficulty focusing and concentrating  
• Extreme muscle tension
• Trembling or shaking
• Dry mouth
• Angry outbursts
• Irritability

What to Do When Caring for a Person with Anxiety and Fear

• Listen carefully to any expression of feelings.
• Provide reassurance and support.
• Talk about your own feelings and fears as well as your loved ones.
• Encourage, but do not force, the person to talk.
• Seek help through counseling and support groups.
• Use prayer or other types of spiritual support if it helps.
• Encourage some of the relaxation tips listed below.
• Talk with a doctor about using anti-anxiety or antidepressant medications.

Panic Attacks

Panic attacks are also a symptom of anxiety and fear, but they can be so alarming that they warrant this separate mention. Panic attacks happen very suddenly, grow rapidly and peak within about 10 minutes. Hallmarks of panic attacks include:

• Shortness of breath
• Racing heart
• Dizziness, unsteadiness, lightheadedness or faintness
• Chest pain or discomfort
• Feeling of choking
• Trembling or shaking
• Sweating
• Feeling of losing control or “going crazy”
• Urge to escape
• Numbness or tingling sensations
• Feeling "unreal" or "detached" from oneself
• Chills or hot flushes

What to Do if Your Loved One Has a Panic Attack

• Be sure that the symptoms are caused by panic rather than an illness.
• Stay calm, and speak softly during the attack.
• Sit with the person during panic attacks until he or she is feeling better.
• Call for help if needed.
• After the attack has subsided, encourage the person to seek treatment.
• Provide transportation for treatment because the person may fear that another attack will occur while driving.

As mentioned earlier, people may put on a false front, or a "happy face," even if he or she doesn't really feel that way. This may be a way to try to protect you, other loved ones, and possibly themselves, from painful feelings.

If you think that this is happening, gently tell the person that you want to hear about his or her feelings, no matter what they are. The message may be something like, "I care for you, and I am here for you whether you are happy, afraid, angry or sad."

Mild versions of any of the above symptoms may be helped simply by more social interaction. People with cancer and cancer survivors who have solid social support tend to have less anxiety and depression and a better quality of life. That’s why it’s good to encourage the person you are caring for to “let people into his or her life” to share what they are going through and to share conversation, laughter and camaraderie.

Finally, being able to talk with the doctor about medical fears, pain and other issues may help your loved one feel more comfortable. You may want to offer to go with - or take - him or her to the doctor. Your presence may be calming, and you may be able to help the person remember symptoms or problems that need to be addressed. The doctor or cancer care team can answer questions and explain conditions. They can also offer referrals to mental health professionals.

In General, Call the Doctor if You Observe Any of These Symptoms:

• Thoughts of suicide
• Inability to eat or sleep
• Lack of interest in usual activities for several days
• Inability to experience pleasure in anything
• Emotions that interfere with functioning and last more than a few days
• Confusion
• Difficulty breathing
• Sweating
• Severe restlessness
• New or unusual symptoms that cause concern

Emotional Coping Techniques to Suggest to Your Loved One:

Breathe:

• Get in a comfortable position, sitting or laying down
• Close your eyes or focus them on a distant object
• Breathe in and out slowly through your nose
• Establish a steady rhythm by saying to yourself: “In, one, two; Out one, two”
• Feel yourself relax and go limp each time you exhale
• Continue for just a few seconds or for up to 10 minutes

Tense and Release:

• Lie down in a quiet room
• Take a slow, deep breath in and as you do, tense a specific muscle or muscle group, For example, clench your teeth or stiffen your arms or legs
• Tense for a second or two while holding your breath
• Breathe out, releasing the tension and relaxing your body completely
• Repeat with another muscle or muscle group

Visualize:

• Close your eyes; breathe slowly and feel yourself relax
• Create an inner picture that represents your fight against cancer such as knights in armor capable of battling cancer cells or rockets capable of blasting the cells
• Breathe in and as you do, visualize your cancer fighter going to any part of your body where you feel discomfort, pain or tension
• Breathe out and visualize your “weapon” attacking and eliminating the bad cells
• Continue to visualize in this manner as you breathe in and out