The Battle After Remission: Cancer Survivors and Suicide

The risk of committing suicide among cancer survivors is high even many years after diagnosis, according to a study published in the Journal of Clinical Oncology. Christopher John Recklitis, PhD, MPH, of the Dana-Farber Cancer Institute, also spoke on the matter at the 2015 World Congress of Psycho-Oncology, where he said that suicidal thoughts can occur even when there are no physical signs of depression. Therefore, friends and family members are usually unaware of a cancer survivor’s internal struggles.

In a survey of 693 prostate cancer survivors, Recklitis and his colleagues found that 12 percent of respondents experienced suicidal ideation in the previous year. The contributing factors were physical health, emotional well-being, pain, employment status, and finances. Depressed mood and a previous mental health condition were also associated with suicidal ideation.

The Unexpected Hardships of Life After Cancer

After your last cancer treatment, everyone may seem eager to celebrate your triumph—except for you.

Actress and author Jacey Powers was diagnosed with Stage II Invasive Ductal Carcinoma at the age of 25, and again at the age of 28. Today, “I’m happy and healthy,” she told Healthline. “But there have been many bumps in the road.” Life after “you’re cured” is not the relief you expect it to be, said the two-time cancer survivor. 

“The second time I was diagnosed, I was shocked,” Powers told Huffpost. “That shock quickly turned to anger. I had treated my previous breast cancer very aggressively. So, to be told that my cancer had returned felt very unfair.” Still, she believes it’s normal for survivors to feel depressed and to question why and how they’re alive.

During her initial diagnosis, the former child star revealed that “after a year of fighting, and to some extent defining myself as a person fighting this illness, where do I go now? What’s the next fight? The questions can feel overwhelming.” Regardless, Powers is grateful to everyone who was kind and wise enough to lend support beyond her initial treatment.

Cancer and Mental Health

People tend to focus on the body when thinking of cancer. The psychological effects are usually an afterthought.

“Cancer survivors, as well as survivors of cardiac events or other major medical diagnosis, often spend time and energy on medical treatment for the physical illness, and not on the mental health component associated with this life changing event,” said therapist Cara Maksimow, LCSW, CPC.

“Identifying mental health needs related to stress, anxiety, and depression around any medical illness is important to recognize,” Maksimow stressed. “Treating the stress and depression can affect all aspects of health.”

Overlooking the Signs of Suicidal Ideation

Cancer can have traumatic or long-lasting emotional effects, according to Lekeisha A. Sumner, PhD, ABPP, assistant clinical professor at the Department of Psychiatry and Biobehavioral Sciences, University of California. Furthermore, “cancer may involve stressful events that repeat or continue over time,” said the National Cancer Institute. “The patient may suffer symptoms of post-traumatic stress anytime from diagnosis through completion of treatment and possible cancer recurrence.” Parents of childhood cancer survivors may also suffer from post-traumatic stress.

Sumner has treated many cancer survivors and conducted psycho-oncology research involving them. However, signs of depression leading to suicidal thoughts are still difficult to detect. The board-certified clinical psychologist added that the symptoms of depression might overlap with other aspects of cancer and/or its treatments. These indicators include fatigue, pain, and sleep deprivation.

“Also overlooked are the symptoms of anxiety (usually about recurrence and role functioning) and cognitive impairments (difficulties with thinking clearly, concentration and/or memory),” she told Healthline.

A cancer survivor may also have some residual grief from the cancer experience, as well as feel overwhelmed by the expectations people have about how a survivor’s lifestyle should be after treatment. “This exacerbates symptoms of depression, anxiety, and adjustment that if left untreated may result in suicidal ideation,” said Sumner.

After the last treatment, survivors should continue to have regular doctor visits and talk openly about any emotional distress they are experiencing. “Openness to working with a mental health professional with expertise in psycho-oncology has been shown to be an effective intervention,” explained Sumner. “It can facilitate stress management, adjustment, effective coping, and process the grief commonly experienced.”

Signs of Suicidal Thinking

Ben Michaelis, PhD, clinical psychologist and author, also spoke about the warning signs of suicide in cancer survivors.

“If someone you know talks about killing themselves, having no reason to live, feeling like things would be better if they weren’t there, feels trapped, or says that they feel like a burden to other people,” enumerated Michaelis, “those are clear warning signs.”

Others are socially distant, giving away possessions, or reaching out—only to say goodbye.

“Try to connect them with either a mental health professional,” advised Michaelis.

When people develop cancer, the main focus is on physical survival. However, when treatment ends, the psychological effects of enduring and surviving cancer can intensify.

Crisis Hotlines

Suicide prevention hotlines help millions of people every year by providing the option to speak with professional counselors and trained volunteers, either through phone or text message.

If you or someone you know is thinking about suicide, contact the following organizations:

  • National Suicide Prevention Lifeline. This national network of more than 150 local crisis centers offers free emotional support 24/7 to those experiencing a suicidal crisis.
  • Crisis Text Line. Aiming to bring people “from a hot moment to a cool calm,” this free text messaging resource offers around-the-clock support. They have exchanged over 79 million text messages since August 2013.
  • The Trevor Project. This organization offers crisis intervention and suicide prevention to LGBTQ youth.

Survivors often feel immense pressure to be grateful for having a “second chance” at life. Guilt and fear of seeming ungrateful may prevent them from seeking the help they need. “If you are a cancer survivor thinking about suicide, you are not alone and there is help out there. Lots of it. It is just a matter of letting someone know what you are going through,” Michaelis assured.

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