Dealing with depression after a cancer diagnosis —The MUHC takes a personalized and team approach

Depression is not always easily detected in patients with cancer. Feelings of anger, sadness, guilt and anxiety can be considered a normal response to this disease. But lurking behind the mask of cancer can be a deeper mental health challenge. At the McGill University Health Centre (MUHC), we offer adapted psychological and psychiatric resources to help patients who need it, cope through their cancer diagnosis.

According to Dr. Marc Hamel, clinical director at the MUHC Psychological Oncology Program, the prevalence of emotional distress in oncology patients is around 35 to 45 per cent. From that percentage, a certain amount of patients will also need a more specialized treatment, depending on the history of their mental health condition.

“Throughout the patient’s journey, there are different milestones: time of diagnosis, before treatment, during treatment and after treatment,” says Dr. Hamel. “We really have to adapt our approach to treatment at every step to help patients best cope with their particular circumstance.” 

To provide patients with these personalized services, a multidisciplinary team consisting of psychologists, a clinical nurse specialist, a couple and family therapist and a psychiatrist come together to determine their needs. “There’s no magical recipe that applies to all people,” says Dr. Hamel. “Each patient requires a unique approach adapted to his/her reality. For example, some will only need psychotherapy, while others will require medication as well.”

Once a patient has been assessed as experiencing difficulty coping, psychiatrists are sometimes brought into the loop to include psychotherapeutic medications to the treatment plan. 

Dr. Lawrence Hoffman, a psychiatrist at the MUHC who works with oncology patients, says a patient’s reaction to the disease is connected to their personal and medical history. “We have to understand how that person has dealt with challenges or illnesses in the past,” he says. “This helps flag patients who could be at risk of developing depression or other mental health illness even before we start treatment for the cancer.” 

The situation gets complex when patients who have never suffered from mental health issues start cancer treatment. “The treatment itself can put them at risk of developing psychiatric and psychological side effects such as anxiety and depression,” explains Dr. Hoffman. In fact, for patients in remission, the possible recurrence of their illness or even the return to a ‘normal life’ can be charged with a strong psychological impact. Dr. Hoffman believes that “although they are not biologically at risk, they are in a process of high-anxiety and depression can kick in.”

In these cases, patients are not only harder to flag as having a mental illness, prescribing can be more difficult as it is their first time taking psychotherapeutic medication.

Dr. Hoffman always works closely with the treating medical team to get a clear idea of the patient’s needs and challenges. 

“We have to have an ability to listen and be present for the patient,” says Dr. Hoffman. “Being able to be empathetic is part of learning the patient’s needs. This combined with a team approach helps provide our patients with the best care possible as they journey through their cancer diagnosis.”