Cancer and mental health: the public health challenge

1 September 2017

Multimorbidity (having two or more health conditions) is a growing public health concern and is now one of the most significant challenges facing health services.1 Cancer and common mental health conditions (such as anxiety and depression) contribute to a significant proportion of multimorbidity.

Having both cancer and a mental health condition is related to poorer quality of life, increased risk of death (including by suicide), poorer treatment adherence and outcomes, and higher healthcare costs.

Therefore, preventing depression and anxiety amongst those living with cancer and other physical health conditions must be a priority. 

Why might cancer impact on mental health?

As many people will know only too well, cancer, and the associated symptoms, treatment and aftermath, can have a significant emotional impact on patients, their relatives and carers. The experience of being diagnosed, feelings of hopelessness and uncertainty around survival and death, can all have a detrimental impact on patients' wellbeing.

In addition, the stigma surrounding both mental and physical health conditions, such as lung cancer, can exacerbate feelings of guilt and shame. The physical symptoms of specific cancers can also impact mental health (such as incontinence and sexual dysfunction). These are some of the factors that together place people living with cancer at heightened risk of developing common mental health conditions. Despite this, the combination of cancer and poor mental health has generally received little research attention.

How common is mental ill health in people with cancer?

Estimates vary when it comes to the prevalence of common mental health conditions amongst those with cancer, between approximately 4 and 49%.2, 3 

Taking one example, ovarian cancer, we see that anxiety tends to be higher following treatment (27%) and during treatment (26%) and is lowest before treatment (19%). Whereas, depression is highest before treatment (25%), reduces slightly during treatment (23%), and again following treatment (13%). This is in the context of a lifetime prevalence rate for clinical depression and anxiety of around 10 and 8%, respectively, amongst women.4

The prevalence of mental health conditions that coexist alongside cancer varies depending on the cancer type. Here in Scotland, the prevalence of depression is highest in patients with lung cancer (13.1%), followed by gynaecological cancer (11%), breast cancer (9%), colorectal cancer (7%), and genito-urinary cancer (6%).5

Multimorbidity in Scotland is also an issue related to socioeconomic inequality. Cancer and comorbid depression is significantly higher in the least advantaged groups, compared to the most advantaged. Cancer and comorbid anxiety is also unequally distributed - again with the most disadvantaged significantly more affected than the most advantaged.6

What is the Mental Health Foundation doing?

As part of our research work in Scotland, we are carrying out a review on cancer and mental health that will investigate the scale and nature of the mental health needs of those affected by cancer in Scotland and the policies and practices required to help address any unmet needs.

Preventing mental health conditions amongst those living with cancer, as well as ensuring adequate management of conditions should they occur, are important public health and clinical concerns, which are likely to grow as people are living longer. If addressed, significant gains in patient quality of life and survival may be achieved, in addition to savings in health care costs.

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References 

  1. Salisbury, C., 2012. Multimorbidity: redesigning health care for people who use it. The Lancet 380:7-9.
  2. Krebber, A.M.H., Buffart, L.M., Kleijn, G., Riepma, I.C., de Bree, R., Leemans, C.R., Becker, A., Brug, J., van Straten, A., et al., 2014. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psycho-Oncology 23:121-30.
  3. Walker, J., Holm Hansen, C., Martin, P., Sawhney, A., Thekkumpurath, P., Beale, C., Symeonides, S., Wall, L., Murray, G., et al., 2013. Prevalence of depression in adults with cancer: a systematic review. Annals of Oncology 24:895-900.
  4. Watts, S., Prescott, P., Mason, J., McLeod, N., Lewith, G., 2015. Depression and anxiety in ovarian cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open 5:e007618-e18.
  5. Walker, J., Hansen, C.H., Martin, P., Symeonides, S., Ramessur, R., Murray, G., Sharpe, M., 2014. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: A cross-sectional analysis of routinely collected clinical data. The Lancet Psychiatry 1:343-50.
  6. Barnett, K., Mercer, S.W., Norbury, M., Watt, G., Wyke, S., Guthrie, B., 2012. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet 380:37-43.