The words stopped me in my tracks. Depression “significantly affects” breast cancer survival, read a medical journal headline.
It was an article about research, published last week, that found that breast cancer patients with depression are up to twice as likely to die from the disease as women with good mental health.
As a former breast surgeon who has had breast cancer three times (I’m currently undergoing treatment), I noticed right away.
You see, I too have felt overwhelmed by depression since I was diagnosed with my first cancer in 2015, when I was 40 years old. And I’m not alone.
Up to a quarter of people with cancer develop clinically significant depression – two to three times more than the general population.
The words stopped me in my tracks. Depression ‘significantly affects’ breast cancer survival, medical journal headline said
Are we unfortunate people really doomed? Well, the short answer is: I don’t think so.
When I saw the study, I immediately examined the data. I found that, despite the worrying claims, the real picture is unlikely to be so bleak.
The Russian researchers analyzed a number of existing studies to draw their conclusions. Some of these date back to 1977 and the most recent was from 2018, which in terms of breast cancer treatment is a long time ago.
Since then there have been a number of new treatments to address the most difficult to treat forms of the disease, and many of them have had notable success.
I’m taking one myself right now: palbociclib, which was described by the Institute of Cancer Research in London as one of the “most important advances” in decades. My treatment seems to be working and I am optimistic.
But as a patient, I cannot deny the truth. It’s no surprise to me that, if left untreated, depression can shorten our lives. When we are depressed, we are less likely to eat well and exercise, drink and smoke, and take the medications we need.
All of these things increase the risk of recurrence. Both cancer and depression make work difficult. We are struggling financially, which makes our mental health even worse. It can be a vicious circle.
But my message, believe it or not, is one of hope. If you are a breast cancer patient suffering from depression, I want you to know that getting the right treatment is transformative. There are specific psychological support services for people with cancer and they saved my life.
As a cancer surgeon, I didn’t realize that depression, anxiety, and other mental health issues were common after a diagnosis.
It sounds ridiculous, but it’s true. You see, I focused on the physical side effects, until I got cancer myself.
Chemotherapy was hard. I spent mornings sitting in the shower feeling sorry for myself, waiting for the pain and nausea to go away. Combine that with the pain of everything he was losing. My hair. My chest. My fertility. Potentially my job. What about my relationship?
Then, when I finished treatment (chemo, surgery, and radiation), I was told my doctor wouldn’t see me again for five years. I felt an overwhelming sense of panic and despair. Was that all? How would you deal with it?
For the next five years, I woke up every day thinking, ‘Will this be the day my breast cancer comes back?’
I was suffering from something minor, like a pain in my hip, and I was panicking. My GP sent me for tests, which only made my anxiety worse. The same thing happened with my annual mammogram. ‘What if it’s not right?’ He asked me. Would I break down if I had to go through all this again?
When my cancer first came back in 2018 (a nodule of scar tissue near my armpit), I lost my job.
I was left with chronic pain and stiffness in my shoulder and my life as I knew it was over. I defined myself as a surgeon and suddenly I had no idea who I was or how to fill my days. And how many days did I have left to fill?
That’s when my oncology nurse told me there was counseling available through Macmillan Cancer Support. I met an amazing therapist named Diane who told me it was normal to feel depressed and anxious.
As a former breast surgeon who has had breast cancer three times (I’m currently undergoing treatment), I noticed right away.
During six sessions of cognitive behavioral therapy (CBT), a type of psychotherapy, she helped me develop coping strategies and little things I could focus on, like celebrating a “win” every day.
But the most important thing was to have someone to talk to. I didn’t want to burden my friends and family with my morbid thoughts; I wasn’t sure they would understand or know what to say. But in Diane I found someone I could be honest with. I could admit that I wasn’t okay and vent all my irrational feelings and fears. And once I said them out loud, it was like a weight had been lifted off my shoulders.
When my mother died in December 2022, I spiraled into depression again. I contacted the local hospice, which offers eight free CBT sessions to anyone who needs it. Having that space to cry, scream, and scream was very important to me. I would never have had the courage to be so vulnerable in front of my family.
My therapist asked me to draw how I was feeling. As I pulled out the crayons, I thought: This is ridiculous. But soon I found myself staring at an angry, black squiggle and was able to explain how my pain was holding me back.
She encouraged me to write poems and silly letters as a way to express my feelings, and I still reread them when I’m reeling.
When I had my second breast cancer recurrence in 2023, I had CBT sessions again. I will be forever grateful to everyone who funds it through donations to Macmillan.
Referrals for therapy on the NHS take months, if not years, and private sessions with a specialist cancer therapist can be even harder to find.
Depression and anxiety can appear weeks, months, or even years after a cancer diagnosis. Something you read might trigger it (a celebrity being diagnosed with cancer, for example) or a friend from a support group might die, and you’re consumed with guilt: ‘Why am I still alive?’
Knowing what I know now, I think everyone diagnosed with cancer should be told that their mental health can be affected just as much as their physical health.
But depression doesn’t have to be the end of us: there is help available.