Bowel cancer, commonly known as colon cancer, is among the most common types of cancer worldwide, particularly in Western countries. While the physical consequences of bowel cancer are widely understood, its impact on mental health is frequently underestimated. The majority of reviews and research reports in the biomedical field start by mentioning the high rate of occurrence, death, or morbidity of the condition under question.
However, small bowel cancer stands out for a different reason. Even though it lies between two of the most common cancer sites—the stomach and large bowel—cancer in the small bowel is extremely rare.1 If you or your loved ones have been diagnosed with bowel cancer, you may already be familiar with its physical challenges; however, its impact on mental health is often overlooked and less understood.
People with bowel cancer may experience significant emotional challenges throughout their diagnosis and treatment. Therefore, it is important to understand the mental health problems that people with bowel cancer face, as these may have a big effect on their general health and quality of life.
Bowel cancer symptoms can vary but frequently include changes in bowel habits (such as diarrhoea or constipation), blood in the stool, abdominal pain, unexplained weight loss, and fatigue. These symptoms are frequently misdiagnosed as those of less serious gastrointestinal diseases, causing diagnostic and treatment delays. Early identification is critical for improving survival possibilities, as bowel cancer is more curable in its early stages.2
Bowel cancer risk factors include age (the majority of occurrences occur in people over 50), a family history of the disease, a diet high in red or processed meats, poor fibre intake, obesity, smoking, and excessive alcohol consumption. Chronic inflammatory disorders of the colon, such as Crohn's disease or ulcerative colitis, raise the risk of developing bowel cancer.3
Implementing population-wide bowel cancer screening programs significantly reduces mortality and illness burden. As an example, in the Australian National Bowel Cancer Screening Program (NBCSP), residents aged 50-74 years are mailed a faecal occult blood test (FOBT). Every two years, they will receive a screening kit to complete at home. The NBCSP's implementation has increased survival rates, reduced cancer-related health problems, and allowed for earlier diagnoses.4
A colon cancer diagnosis might have severe psychological consequences. Discovering that one has a potentially fatal illness often sets off a chain reaction of emotional responses, including shock, anxiety, fear, and depression. These emotions are both a natural reaction to the diagnosis and a reflection of the disease's uncertainty and fear.
Research has shown that common challenges to screening participation include forgetting or misplacing the kit, worrying about hygiene, and the psychological discomfort that comes with a positive test result.5 Increased psychological distress (a subjective, worldwide, non-specific negative affect state that can include stress, worry, or depression) may make a person more vulnerable to various obstacles that impede their participation in colon cancer screenings.6
For instance, feeling more sadness might result in gloomy outcome expectancies and decreased self-efficacy which can raise screening barriers like avoidance or the belief that home bowel cancer screening is physically burdensome.7,8,9 Similar to this, when anxiety is elevated, people tend to avoid circumstances that make them feel disgusted or afraid.10
Higher anxiety levels may make a person more likely to stress about screening-related hygienic issues or to be nervous about a positive outcome. Stress and its many competing priorities might cause neglect of one's health. Stress may cause people to feel overwhelmed by screening, which lowers their likelihood of devoting the necessary time and mental capacity to complete the kit.
Mental health plays a critical role in the overall treatment and recovery process for bowel cancer patients. Research has shown that patients who maintain good mental health are more likely to adhere to their treatment regimens, engage in health-promoting behaviours, and have better overall outcomes. Mental health significantly influences a patient’s ability to follow through with prescribed treatments.
Depression, for instance, can lead to a lack of motivation, which may result in missed appointments, incomplete courses of chemotherapy, or neglect of self-care practices like nutrition and physical activity. Anxiety can similarly interfere with treatment adherence if patients avoid medical appointments due to fear or panic about their condition or treatment side effects.11
Chronic stress and poor mental health can negatively impact the immune system, which is crucial for fighting cancer. Stress hormones like cortisol can suppress immune function, increase inflammation, and potentially contribute to cancer progression. Therefore, managing stress and improving mental health can have a direct positive effect on the physical health of bowel cancer patients.12
The quality of life for bowel cancer patients is closely linked to their mental health. Patients who receive psychological support often report better overall well-being, even in the face of a challenging diagnosis. They are more likely to remain socially active, maintain relationships, and continue engaging in activities they enjoy, which can enhance their sense of purpose and reduce feelings of isolation.13
Given the significant mental health challenges faced by bowel cancer patients, it is essential to integrate psychological care into their overall treatment plan. This can be achieved through a multidisciplinary approach that includes oncologists, psychologists, psychiatrists, social workers, and support groups.
Cognitive-behavioural therapy (CBT) is particularly effective for bowel cancer patients. CBT helps individuals identify negative thought patterns, develop coping strategies, and build resilience against the emotional challenges of cancer. Techniques such as relaxation training, mindfulness, and stress management can also be beneficial in reducing anxiety and improving overall mental well-being.14
Joining support groups, either in person or online, can provide patients with a sense of community and understanding. Sharing experiences with others who are facing similar challenges can reduce feelings of loneliness, offer practical advice, and provide emotional support. Support groups can also help patients and their families cope with the psychosocial aspects of cancer, fostering a network of care and encouragement.15
Mental health screening is an essential component of comprehensive cancer care, particularly for patients with bowel cancer who are at a heightened risk for psychological distress due to the nature of their diagnosis and treatment. Regular mental health screening involves systematically assessing patients for symptoms of anxiety, depression, stress, and other mental health issues throughout their cancer journey.
The primary purpose of regular mental health screening is to identify psychological distress early. This early detection is crucial because mental health issues if left unaddressed, can escalate and significantly impair a patient's ability to cope with their illness, adhere to treatment protocols, and maintain their overall quality of life. Early identification allows healthcare providers to intervene with appropriate psychological support, counselling, or referral to mental health specialists, thereby preventing the worsening of symptoms.
Caregivers, often family members or close friends, play a vital role in the support system of bowel cancer patients. They provide emotional support, assist with daily activities, help manage medical appointments and treatments, and often serve as the primary source of comfort and care for the patient. Given the intense demands of caregiving, these individuals are at significant risk of experiencing psychological distress, including stress, anxiety, depression, and burnout.
Caregivers frequently experience high levels of emotional and physical strain as they navigate the challenges of supporting a loved one through cancer treatment. The constant worry about the patient’s health, coupled with the practical demands of caregiving, can lead to chronic stress. Many caregivers may also feel isolated, overwhelmed by their responsibilities, and uncertain about how best to support the patient. These pressures can take a toll on their mental health, potentially affecting their ability to provide effective care.
Supporting the mental health of caregivers is crucial not only for their well-being but also for the well-being of the patient. Caregivers who are emotionally healthy and supported are better equipped to provide consistent, compassionate care. On the other hand, a caregiver who is struggling with depression, anxiety, or burnout may have difficulty managing the patient’s needs, leading to gaps in care or increased stress for the patient. Respite care is another important resource that allows caregivers to take a break from their responsibilities, reducing the risk of burnout and giving them time to recharge. Educational resources can help caregivers understand the patient’s condition and treatment, manage side effects, and learn effective caregiving techniques.16
Bowel cancer has far-reaching effects beyond its physical manifestations, profoundly impacting the mental health of those affected. The psychological challenges faced by bowel cancer patients, including anxiety, depression, body image issues, and cognitive impairments, can significantly influence their treatment and recovery outcomes. Addressing these mental health concerns through integrated care approaches is essential for improving the overall well-being and quality of life for bowel cancer patients.
By recognising the intricate connection between bowel cancer and mental health, healthcare providers can offer more comprehensive care that addresses both the physical and emotional needs of patients. This holistic approach not only supports better mental health outcomes but also enhances the effectiveness of cancer treatments, ultimately leading to better survival rates and improved quality of life for patients.
