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Cancer Survivors Face Tough Road Long After Treatment Ends

Study shows they're at increased risk of psychological distress years later

THURSDAY, July 30 (HealthDay News) -- Cancer survivors are more likely than their healthy peers to suffer serious psychological distress such as anxiety and depression, even a decade after treatment ends, new research shows.

Those who were relatively young at the time of diagnosis, unmarried, had less than a high school education, were uninsured, had other illnesses or had difficulty doing the activities of daily living were at the highest risk of psychological problems.

The study appears in the July 27 issue of the Archives of Internal Medicine.

The United States is home to 12 million cancer survivors, or 4 percent of the population, numbers that are expected to rise as cancer screening improves and Baby Boomers age, according to the researchers, from Brigham and Women's Hospital and Dana-Farber Cancer Institute in Boston.

To gauge the long-term psychological impact of the disease, they analyzed mental health and medical data on 4,636 adults who'd survived cancer and 122,220 who had never had cancer. The data was collected between 2002 and 2006 by the National Health Interview Survey, which is conducted yearly by the U.S. Census Bureau.

During a follow-up period of at least five years and an average of 12 years, about 5.6 percent of cancer survivors were found to have experienced severe psychological distress within the previous month, compared with 3 percent of those without cancer.

Dr. James Zabora, a former associate professor of oncology at Johns Hopkins School of Medicine who has researched cancer and mental health issues, said the study was well done but that the measure of mental health has not been scientifically validated for use in cancer survivors.

In fact, he said, he suspected the incidence of mental health issues among cancer survivors may be higher.

"It's a well-designed study, and the investigators document a significant issue, that is, survivors of cancer continue to struggle well after their treatment and recovery," said Zabora, now dean of the National Catholic School of Social Service. "But you could argue maybe this instrument under-diagnosed psychological distress."

Those who are younger, single, have less education and no insurance may suffer more because they have fewer resources to draw from to get through it, he noted.

"When you are faced with a serious stressor, in order for you to respond to it, you have to define what it means for you," Zabora said. "That process depends on how many resources you have to manage that stressor. The younger you are, the less experience you have dealing with stressors. The lower your education, the more difficult it is to understand the complex nature of the disease. If you're unmarried, you may have less support."

Getting a diagnosis of cancer and going through chemotherapy can be among life's most trying experiences, said Kevin Stein, the American Cancer Society's director of quality-of-life research.

The physical and emotional fallout of cancer treatment, including fatigue, pain, nausea and vomiting, mouth sores and hair loss, can contribute to feelings of anxiety and depression.

While many of these symptoms may subside or disappear after treatment ends, some, including fatigue, can linger for months or years.

Chemotherapy can also cause delayed problems that aren't apparent until months or years later, including peripheral neuropathy (nerve pain or numbness), infertility, organ dysfunction, hearing loss, muscle atrophy and cardiovascular disease.

"Chemotherapy is an effective treatment because it's toxic to the cancer cells, but sometimes it does collateral damage," Stein said.

Cancer can also bring about job loss and changes to relationships, including family roles and sexual intimacy. Survivors also may fear the cancer will recur, worries that may contribute to psychological distress.

In the study, 9 percent of long-term cancer survivors and 6 percent of individuals without cancer reported seeing or talking to a mental health professional within the previous year. One-third of cancer survivors with serious psychological distress reported using mental health services, while 18 percent said they could not afford mental health care.

Screening for psychological distress in cancer survivors by primary-care physicians and oncologists may help direct people to services that can help them cope, Stein said.

Some may find benefit from anti-anxiety medications, cognitive behavioral psychotherapy and stress management techniques, such as deep breathing and progressive muscle relaxation.

And don't underestimate the power of eating a proper diet, maintaining a healthy weight and staying physically active, Stein said.

"All of those things impact mood in a positive way and can help manage distress," Stein said. "And always stay in touch with your doctor. When you recognize signs of emotional distress, discuss it."

More information

The American Cancer Society has resources to help cancer survivors cope.

SOURCES: Kevin Stein, Ph.D, director, quality of life research, American Cancer Society; James Zabora, D.Sc., dean, National Catholic School of Social Service, Washington, D.C.; July 27, 2009, Archives of Internal Medicine

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