By: Jimin Kim, Human Biology, Health, and Society ‘25
The sounds of beeping machines, running footsteps, and anxious voices. In the middle of this chaos sits one patient, with all sorts of machines hooked up to her arm. Her face shows deep sorrow, interpreted by her parents as anxiety for tomorrow’s big surgery: she is fighting a battle with cancer.
Cancer treatment has developed significantly over the years, becoming a complex and dynamic system across oncological, surgical, and radio-therapeutic fields. Despite knowing her surgeon is skilled and mortality rates have been slimmed thanks to technological advancements, this girl about to undergo surgery still feels sadness in her heart.
Research has shown that the “prevalence of depression and anxiety among cancer patients is up to 20% and 10% respectively, regardless of the treatment phase or point in the disease trajectory” [1]. Psychologists predict that the reason for these statistics is due to the intense treatment regime and a long time of uncertainty over quality of life. Many cancer patients go through treatments uncertain about the future: when they will be fully healed, or whether they’ll be healed at all. Moreover, there are several limitations to how a patient can respond to their mental disorders, such as how they perform daily activities, dietary restrictions, and the constant presence of stress [2]. Cancer patients are also more likely to under diagnose the symptoms such as fatigue, insomnia, and anorexia, as they easily overlap with the conditions of cancer [3].
After the girl has recovered from the surgery, she begins radiotherapy. Her doctor notices her anxiety and orders psychotherapy. She is soon diagnosed with severe depression, but is hesitant about starting pharmacotherapy to treat it. The multitude of drugs that she is already taking was already a big burden.
When pharmacotherapy is needed, choosing the right antidepressant for cancer treatment patients is fundamental to preventing drug-drug interactions and adverse side effects [4]. The patient’s medical history, cancer type, and the severity of the disease should all be factors in how proper antidepressants are chosen. Some include selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). SSRIs are typically similar to TCAs in terms of efficiency, and have a wider margin of safety [4]. It is advised that these drugs are started at a low dosage and titrated to the minimum amount effective enough for treatment in order to prevent adverse side effects (headaches, nausea, insomnia) [5]. SSRI is a good treatment option for cancer patients since the agents do not inhibit cytochrome P450, a key enzyme in cancer treatment that mediates metabolic activation of procarcinogens and participates in the activation and inactivation of anticancer drugs [6]. In addition, SSRIs are well tolerated and pose few drug-drug interactions. It is clear that proper pharmacotherapy must be used to improve the quality of life for cancer patients.
Raising awareness about mental health issues for cancer patients is key to supporting the long journey of treatments they go through. They endure not only the physical battle against disease, but also the mental and emotional challenges along the way. As advancements in cancer treatment continue to improve the outcomes of cancer patients, it is crucial to address the significant prevalence of depression and anxiety among patients. Recognizing the psychological well-being of cancer patients should be integrated into the care plan. This includes medical interventions and pharmacotherapy tailored to each patient’s medical needs.
References
[1] Fernando, A., Tokell, M., Ishak, Y., Love, J., Klammer, M., & Koh, M. (2023). Mental health needs in cancer – a call for change. Future Healthcare Journal, 10(2), 112–116. https://doi.org/10.7861/fhj.2023-0059
[2] Vucic, V., Radovanovic, S., Radevic, S., Zorica Savkovic, Mihailovic, N., Mihaljevic, O., Ivana Zivanović Macuzic, Djordjic, M., Gavrilovic, A., & Tatjana Boskovic Matic. (2021). Mental Health Assessment of Cancer Patients: Prevalence and Predictive Factors of Depression and Anxiety. Iranian Journal of Public Health. https://doi.org/10.18502/ijph.v50i10.7502
[3] Harvey Max Chochinov, Wilson, K. G., Enns, M., & Lander, S. (1997). “Are you depressed?” Screening for depression in the terminally ill. American Journal of Psychiatry, 154(5), 674–676. https://doi.org/10.1176/ajp.154.5.674
[4] Ahmed, E. (2019). Antidepressants in Patients With Advanced Cancer: When They’re Warranted and How to Choose Therapy. Cancer Network, 33. https://www.cancernetwork.com/view/antidepressants-patients-advanced-cancer-when-theyre-warranted-and-how-choose-therapy
[5] Kennedy, G. J., & Marcus, P. (2005). Use of Antidepressants in Older Patients with Co-Morbid Medical Conditions. Drugs & Aging, 22(4), 273–287. https://doi.org/10.2165/00002512-200522040-00001
[6] C Rodriguez-Antona, & M Ingelman-Sundberg. (2006). Cytochrome P450 pharmacogenetics and cancer. Oncogene, 25(11), 1679–1691. https://doi.org/10.1038/sj.onc.1209377
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