Anxiety’s toll on cancer survivors, spouses

AS cancer survival rates increase, the long-term effects of depression and particularly anxiety on survivors and their spouses need to be better addressed, says Australia’s leading cancer patient advocate.

Professor Ian Olver, chief executive officer of Cancer Council Australia, told MJA InSight that the latest research published in The Lancet on long-term emotional impacts of cancer survivorship was “helpful” in the Australian context. (1)

“I think it is helpful to know how long anxiety lasts and that depression doesn’t”, Professor Olver, speaking from New York, said.

The British research team conducted a systematic review of 43 studies to find the prevalence of mood disorders in patients diagnosed with cancer at least two years previously.

They reported the prevalence of depression was 11.6% in 51 381 cancer survivors and 10.2% in 217 630 healthy controls. The prevalence of anxiety was 17.9% in 48 964 cancer survivors and 13.9% in 226 467 healthy controls. Additionally they found that the prevalence of both depression (26.7% v 26.3%) and anxiety (28.0% v 40.1%) differed little between cancer patients and their spouses.

“Our findings suggest that anxiety, rather than depression, is most likely to be a problem in long-term cancer survivors and spouses compared with healthy controls”, the authors wrote. “Efforts should be made to improve recognition and treatment of anxiety in long-term cancer survivors and their spouses.”

An editorial in the same issue of The Lancet said the impact of anxiety and depression on cancer survivors and their families should not be ignored or underestimated. (2)

“Psychological morbidity is associated with reduced quality of life, poor adherence to treatment and self-care, impaired physical, social, and family functioning, worse symptoms, and diminished will to live”, the author wrote.

Professor Olver agreed, saying: “Everyone studies the patient and nobody studies the spouse of the patient. Cancer is an experience the whole family goes through.

“We’ve been doing a study on survivors of testicular cancer, because they are usually young and have very long survivorship, and we have found a similar sort of thing to this research”, he told MJA InSight.

“In Australia we’re becoming increasingly aware of these issues and there is lots of survivorship research being done and we’re starting to address the issues of the family’s experience as well.

“Clinical practitioners are starting to take notice as well”, he said.

Professor Olver said there was often a disconnect between how cancer survivors felt and how they were expected to feel.

“Cancer survivors often feel that they’re being told ‘you should have a smile from ear-to-ear’ but the patient doesn’t feel that way, and they feel like they’re being ungrateful”, he said.

“The realities are that cancer survivors often don’t fit back into their old lives very easily.

“Cancer is a life-changing experience.

“Survivors prioritise things in a different way afterwards and it can translate into a dramatic change in their lifestyle.

“People who haven’t been through it can’t understand that.”

Professor Olver said the biggest source of anxiety for both patients and spouses was the possibility of recurrence.

“We can take steps to make sure to address the anxiety and ensure the survivor and their spouse and family have adequate support.”

The British researchers said improvements in survival rates over the past 20 years had had a dramatic effect on post-cancer care.

“Cancer is increasingly thought of as a chronic disease ― about 70% of patients live for at least 5 years after diagnosis”, they wrote.

1.    The Lancet 2013; 5 June (online)
2.    The Lancet 2013; 5 June (online)