Mental and emotional problems
Confusion, Delirium
Confusion, or delirium, is a temporary or permanent state of brain dysfunction. It can present with sudden personality changes, impaired thinking, unconsciousness, agitation or lethargy. Confusion may range from mild difficulty in recalling information and ability to focus attention to severe changes in person’s behavior. It should not be confused with occasional forgetfulness or inability to focus. Confusion can be a challenging side effect for patients and family members to cope with.
Delirium caused by cancer treatment is usually due to metabolic changes or damage to nerve cells. Confusion may also be caused by conditions more related to the cancer than to its treatment. These conditions include:
Advanced cancer Endocrine problems and (such as extremely high or low blood sugars), low sodium, high calcium) Severe anemia Dehydration Cancer that has spread to the brain Imbalances in electrolytes, such as low sodium and high calcium Fever or infection Organ failure Medications (pain, sedative or psychotropic medications) Alcohol use or withdrawal Changes in behavior and thinking need to be evaluated by your physician immediately. It might indicate an underlying serious problem which has to be corrected.
Anxiety and depression
Anxiety and depression are not uncommon problems in persons diagnosed with cancer and undergoing cancer treatment. Hearing the word cancer is an overwhelming experience for most of us. Not knowing what the future holds, loss of control over our bodies, changes in our societal roles, financial worries, all increase our levels of stress and anxiety and can lead to depression.
These feelings are normal but if allowed to dominate our every waking moment they can develop into a debilitating disorder affecting our quality of life and our relationships with family and friends and even effectiveness of cancer therapy.
Anxiety
Anxiety can be mild, moderate or severe and is generally described as having feelings of distress, fear or uneasiness. Patients with existing anxiety disorders such as panic disorder, obsessive-compulsive disorder, phobias, generalized anxiety disorder or posttraumatic stress disorder are higher risk for anxiety and depression while going through treatment. It is important that you speak with your physician at the start of treatment if you have been diagnosed with any of these disorders.
Symptoms to look for are:
- Excessive worry about events or activities
- Muscle aches and pains
- Changes in sleep patterns
- Restlessness
- Physical symptoms such as rapid heartbeat, sweating, palpitations, trembling, shortness of breath, dizziness, flushing, high blood pressure.
- Difficulty concentrating
- Irritability
Things that you can do to lower your risk of cancer-related anxiety are:
- Avoid using alcohol to relieve symptoms of anxiety.
- Find a relaxation technique that works for you like slow deep breaking, in & out 15 times.
- Follow your treatment plan and take any prescribed medications exactly as prescribed. No more, no less.
- Keep a diary of how you are feeling once treatment is started. Keep your physician or nurse informed if symptoms are getting better or worse.
- Learn and practice new ways to cope with the stress in your life.
- Make sure you are getting enough sleep.
- Start a mild – moderate daily exercise program. Exercise increases the release of endorphins and promotes a feeling of well-being.
- Consider cancer support groups.
- Communicate with your loved ones. They may also be experiencing anxiety over the “unknowns”.
Treatment for severe anxiety is often a combination of mediations and talk-therapy. If your anxiety is out of control and affecting your daily life talk to your physician or nurse. There are ways to help.
Depression
Depression is a condition that is characterized as persistent feelings of sadness, despair, loss of energy and difficulty dealing with normal everyday life. Symptoms of depression include:
- Feelings of worthlessness or hopelessness
- Loss of pleasure in activities
- Changes in sleeping and eating habits
- Frequent thoughts of suicide or death
- Feelings of guilt
Risks for developing depression can be a combination of cancer related factors and non-cancer related factors. Persons with pre-existing non-cancer related factors may be at a higher risk for developing depression after a diagnosis of cancer.
Cancer related factors include:
- Depression at the time of cancer diagnosis.
- Poorly controlled pain.
- Increased physical impairment.
- Advanced stage of cancer.
- Treatment with some cancer treatment drugs.
Non-Cancer related factors include:
- Lack of family support.
- Previous suicide attempts.
- History of depression.
- History of depression in your family.
- Having other illnesses at the same time that are strongly related to risk of depression (such as stroke or heart attack).
- History of alcohol or drug abuse
Treatment of depression most often consists of talk-therapy and anti-depressants.
Things that you can do to help yourself include:
- Make sure you get plenty of sleep - sleep deprivation can make it impossible to cope with even small everyday problems.
- Start an exercise program. 20-30 minutes a day of mild exercise such as walking releases endorphins and promotes a sense of well-being.
- Be willing to try relaxation techniques such as meditation or yoga.
- Consider support groups - they have been shown to improve quality of life.
If you have suicidal thoughts, such as wanting to “end it all” you need immediate help. Tell someone right away - depression should and can be treated.
Cognitive changes
Limited information suggests that cancer treatment, including chemotherapy and hormone therapy, can cause cognitive dysfunction, usually manifesting as changes in short-term memory and concentration. Much of the information we have regarding the cognitive effects of cancer therapy is antidotal. More research is necessary to determine what changes are related to therapy and what problems result from other factors, such as the stress of coping with cancer and its treatment and/or the onset of early menopause.
Currently, no treatments have been approved for cognitive changes and they appear to resolve on their own after completion of therapy. For now, the best way to manage changes in memory and concentration is to employ some type of memory prompt such as making lists in a notebook or using “stickies” to keep track of tasks.