SOURCES: Anja Mehnert, Ph.D., professor of psychosocial oncology, University of Leipzig, Germany; Kevin Stein, Ph.D., managing director, Behavioral Research Center, American Cancer Society; Oct. 6, 2014 Journal of Clinical Oncology online
MONDAY, Oct. 6, 2014 (HealthDay News) -- One out of three people diagnosed with cancer also wind up struggling with a mental health disorder such as anxiety or depression, a new study from Germany reports.
Many people seem to cope with the natural stress of a cancer diagnosis, but for about 32 percent of cancer patients, the diagnosis may prompt a full-blown psychological disorder, said study lead author Anja Mehnert, a professor of psychosocial oncology at the University of Leipzig in Germany.
That's much higher than the 20 percent mental disorder rate of the general population, she said. It's important to note that although the study strongly links cancer and a mental health disorders, it wasn't designed to prove that having cancer directly caused any mental health disorders.
"[Our] findings reinforce that, as doctors, we need to be very aware of signs and symptoms of mental and emotional distress," Mehnert said. "We must encourage patients to seek evaluation, support and treatment if necessary, as there are long-term risks often associated with more severe, untreated mental health disorders."
In an interesting twist, Mehnert and her colleagues found that breast cancer patients were twice as likely to experience a mental disorder than people with more typically fatal forms of cancer, such as stomach or pancreatic cancer.
"It kind of surprised us, because breast cancer is one of the most treatable cancers and most of the women have a very positive prognosis," she said.
Researchers in the study held face-to-face interviews with more than 2,100 Germans with cancer. They were between 18 and 75 years old. The researchers used standardized questions to determine if the cancer patients had mental health problems classified under the Diagnostic and Statistical Manual of Mental Disorders, or DSM-V, the standard diagnostic tool used by mental health professionals.
They found that slightly more than 40 percent of patients with breast cancer, head and neck cancer, and malignant melanoma also had at least one mental disorder, the study found. The lowest rates of mental disorder, around 20 percent, occurred among patients with pancreatic, prostate or stomach or esophageal cancers, according to the study.
The most common mental disorders affecting cancer patients were anxiety disorders and adjustment disorders, according to the study. Adjustment disorders occur when a person cannot cope with a life crisis, and are unable to function on a daily basis or maintain relationships with those around them, Mehnert said.
Mehnert said adjustment disorders are probably driving the overall increased rate of mental disorders for cancer patients, since the rate of anxiety disorders among these patients is close to that of the general population.
There are a number of potential reasons why breast cancer patients are more apt to have a diagnosable mental disorder, according to Mehnert and Kevin Stein, managing director of the American Cancer Society's Behavioral Research Center. Stein was not involved in the current research, but reviewed the study's findings.
Both said gender might play a role. "Women tend to express their emotional distress more openly than men do," Stein said. Mehnert added that the physical effects of cancer treatment -- including mastectomy -- could be a "very high threat to the identity of a woman."
The highly active and involved nature of the breast cancer community also might encourage patients to be more open with their feelings, Stein said. The women also might be more worried about recurrence of their cancer, even if initial treatment is successful.
Mehnert and Stein differed on whether the German findings might apply to American patients. Mehnert said it's likely, given the cultural similarities between Germany and the United States. But Stein cautioned that the findings probably don't apply outside of Germany.
Both experts agreed that oncologists and other physicians need to keep an eye out for signs of psychological distress and refer patients to a mental health professional if it looks as if a patient is having trouble coping.
Mehnert also urged cancer patients to seek help if they feel they need it.
"It is normal to feel distress if you have cancer. It's not unusual to develop a mental disorder," she said. "You don't have to feel ashamed. Many people still think that if they see a mental health professional, they are weak or are not able to cope well with their disease. That's just not so."
The findings were published online Oct. 6 in the Journal of Clinical Oncology.
For more information on psychological stress and cancer, visit the National Cancer Institute.