Many cancer survivors battle depression
Many survivors experience PTSD, including ongoing anxiety and depression,
I’d been cancer-free for nine months when I found myself weeping over poorly made eggs over easy. The yolks were hard, instead of dripping and lovely and orange. I’d had cancer, for God’s sakes, and I was crying over eggs? I was supposed to be a survivor.
We cancer survivors are everywhere these days. When I was young, in the late 1960s, cancer seemed to always win. If you heard your friend’s grandma had cancer, you understood she would die, probably soon. Thanks to early detection and sophisticated medicine, more and more cancer patients enter treatment with the very real possibility that their lives will continue, and will continue well. They will enter the cancertreatment system as a sick person and come out having earned the “survivor” label.
We survivors are supposed to be happy and grateful, to embrace our second chance at life. But that’s not how the story ends for some of us.
My breast-cancer diagnosis led to a lumpectomy and six weeks of radiation, followed by five years of taking tamoxifen, an estrogenblocking drug that inhibits some types of tumours. Nine years ago, this was the standard treatment for my type of cancer. I didn’t need chemotherapy, and my radiation treatments ended with an excellent prognosis.
For a while, I celebrated that outcome. As months passed, though, a moody broodiness draped over my thoughts and actions. I slept a lot. I smiled little. I wept often. My husband raised concern. I said: “One more week. Give me one more week. I promise I can pull myself out of this.” I was wrong.
Many cancer survivors get clinical depression and/or anxiety. Studies as far back as the mid-1990s were reporting depression and anxiety issues in breast-cancer survivors. The National Cancer Institute’s Annual Plan and Budget Proposal for 2019 lists the challenges that cancer survivors face, including risk of recurrence, increased risk of second primary cancer, reduced quality of life, economic burden and treatment side effects. But also on the list: “emotional distress (depression, anxiety, uncertainty, altered body image, survivor’s guilt).”
Many survivors experience some form of Post-Traumatic Stress Disorder (PTSD). One study found that nearly one in four newly diagnosed breast-cancer patients experienced PTSD, which includes the possibility of ongoing anxiety and depression. An Australian study in 2011 found higher rates of anxiety and depression among cancer survivors six months after diagnosis than those in the general population, prompting calls to screen patients throughout their cancer treatment. A German study found that 40 per cent of survivors ages 25 to 55 at the time of diagnosis had moderate or high levels of anxiety. That same study also noted that survivors in countries without socialized medicine may well have different numbers due to “other stressors” — code for “huge medical bills.”
Some cancer survivors, like me, had a propensity for psychological fallout. I’d had depressive tendencies and had put myself in therapy for a while. It helped. I moved on.
But previous depressive bouts did not compare with the dark curtain that fell within my first year of survivorhood. Fatigue drowned any desire to move. Energy vanished. My concentration disappeared. Tired, brain-addled, sad, I felt worthless and guilty.
How did I have the right to feel sadness? People died of cancer, and I didn’t.
Survivor’s guilt is real, as the National Cancer Institute acknowledges, and common to soldiers and those of us who live through cancer. In my case, the guilt fed my brewing depression.
At my doctor’s office, I started, with tears, to explain my sadness. I should probably see a psychiatrist, I said. He leaned forward, and his dark eyes looked almost angry. I braced myself for an incoming lecture about how lucky I was, how I had no right to my sadness.
Instead, he was kind. “Didn’t anyone tell you how common this is for cancer survivors?” And I breathed easier. He wasn’t angry with me, but with my caregivers. In his mind, someone should have told me to be watchful for depression as a possible after-effect.
Cancer did have positive effects on my life. My diagnosis changed my attitude about my writing. Before, I was afraid to submit my work. I created stories and essays but couldn’t muster the courage to put them out in the world. I was afraid of rejection. Cancer slapped me in the face — “You were afraid of a rejection letter from an editor?! Fear something worth fearing!”
Less than a year after finishing treatment, I had started publishing in literary journals. I have my cancer experience to thank for that. Oh, and earrings. Before cancer, when my husband and I would travel, I would often want to buy a pair of earrings. But I would always talk myself out of it. I didn’t get them; they cost too much money. Post-cancer Pam always buys the earrings. Has too many earrings. And loves them. They make me smile.
But sometimes I need help with smiling. Yes, I’m lucky and blessed, and I know it. But the teams and the support systems nearly vanish once you hear “Your cancer is gone.” Cancer patients need to know that there are treatments and medications to fight cancer. And survivors need to know that there are also treatments and medications to fight depression. There are ways to be as happy as everyone thinks you already are. I’m living proof.