Cancer and Mental Health

The personal fight against cancer is an existential, life-altering struggle that is not only physical, but also mental. It may sound trite, but without winning the mental battle, the physical battle becomes all the more difficult. The experience of cancer is very painful for both patients and those around them.

One in three people with cancer will experience a mental health issue before, during or after treatment, compared with the global figure of one in four people. Suicide rates among those with cancer are significantly higher (about twice as common) as in the general population. In those with cancer types with higher rates of morbidity (i.e., with a high level of debilitating symptoms), such as head, neck, lung and pancreatic cancers, the rates are significantly higher than that. Despite this, the links between cancer and mental health have received little attention over the years.

According to the Mental Health Foundation, a cancer diagnosis has a significant emotional impact because it robs people of their independence, isolates and frightens them, and affects their self-esteem. They have shown that these problems commonly arise at the end of cancer treatment, often with little or no emotional health support available. In fact, the lack of mental wellbeing support for cancer survivors is widespread. Many speak of feeling as though they had “fallen off the edge of a cliff” and of feeling lost, isolated, and abandoned when the support of cancer specialist services suddenly stops with the end of treatment. Of those asked, 60% said that one-to-one counselling and 30% said peer support groups would have improved their mental wellbeing during and after treatment.

The psychological impact of cancer

According to MacMillan, it is common to experience a wide range of emotional responses when diagnosed with cancer. These are perfectly normal but may turn into more serious issues over time if not addressed. A cancer patient may experience:

  • Shock and denial: you may find it hard to believe that you have cancer when you are first diagnosed.
  • Fear: it is very common and perfectly normal to experience fear or even terror when you have cancer. You should not be ashamed of feeling this way.  
  • Sadness: a natural reaction to change or loss. You may feel you have been robbed of the future you thought you would have as your life changes.
  • Avoidance: you may cope by trying not to find out much about the cancer or not talking about it. You should seek help from the healthcare team for this, but don’t give up your boundaries. If you don’t want to talk right away, you don’t have to.
  • Anger: anger is a common emotion in people with cancer, ranging from feelings of “why me?” to resentment of others who don’t have cancer.
  • Guilt and blame: you may feel guilty or blame yourself for the cancer, perhaps because of high-risk behaviours. You may look for something or someone to blame for your diagnosis.
  • Feelings of extreme isolation and loneliness: you might feel isolated by your diagnosis as a result of fatigue (going out less) or by the feeling that nobody understands what you’re going through. There is also a common reluctance to ‘burden’ others. If you live alone, this can add extra stress to an already difficult situation and further increase feelings of isolation and fear.

Other sources of stress might include money worries, especially if you are unable to work or are paying directly for your treatment. According to MacMillan, on average, 80% of people feel the financial impact of cancer and are, on average, £570 a month worse off because of their cancer diagnosis. 

Cancer patients must have an outlet to share their feelings. This might include family members or caregivers, but it can be extremely hard to talk about such difficult feelings. With this in mind, there are also specialised support services that can help with this (see below). It’s often easier to open up to a non-judgemental stranger or professional counsellor, who are specially trained for such situations.

What mental health issues are common in those with cancer?

These are natural feelings but may lead to depression, anxiety, or distress, the most common mental health issues for people with cancer (American Cancer Society). Miovic and Block catalogued the various psychiatric disorders that occurred in a large sample of patients with advanced or terminal cancer.1 They found that between 10.6% and 34.7% experienced adjustment disorder (an excessive and unhealthy emotional or behavioural reaction to a stressful event or change in a person's life). One or more anxiety disorders, such as GAD or PTSD, were seen in 6-13.9%, while 14.1-31% experienced some form of depressive disorder. Interestingly, 4.5-8% of caregivers experienced anxiety or depression.

Distress is an unpleasant emotional state that can affect the way you think and act and can make it hard to cope with your cancer and treatment. It is completely normal to feel distressed when you have cancer. Signs of distress can include:

  • Sadness
  • Fear
  • Anger
  • Hopelessness
  • Feelings of lack of control
  • Questioning of faith, purpose, or meaning in life
  • Wanting to pull away from people
  • Concern about illness
  • Concern about home or social role (as a father, mother, friend, caregiver, etc.)
  • Depression, anxiety, or feeling panic


Anxiety means feeling uncomfortable, worried, or scared about a real or possible situation. Sometimes, the cause can’t be easily recognised. If left unchecked, it may grow worse and worse.  The signs of anxiety include:

  • aching muscles
  • feeling sick
  • butterflies in your tummy
  • sweating
  • feeling your heart thumping in your chest (palpitations)
  • finding it harder to breathe
  • panic attacks


Depression means having a persistent low mood over a significant period of time, often with no obvious immediate cause. It can be mild and temporary; it may involve periods of sadness or feelings of emptiness (no emotions). Long-lasting depression may be classed as major depression or clinical depression, affecting 1 in 4 cancer patients, and requiring treatment with antidepressants or therapy. The signs of depression you might notice include:

  • continuous low mood or sadness (dysthymia)
  • feeling hopeless and helpless
  • having low self-esteem
  • feeling tearful
  • feeling guilt-ridden
  • feeling irritable and intolerant of others
  • having no motivation or interest in things (apathy)
  • finding it difficult to make decisions
  • not getting any enjoyment out of life (anhedonia)
  • feeling anxious or worried
  • having suicidal thoughts or thoughts of harming yourself

These psychological conditions can manifest as physical symptoms such as pain, fatigue, sleep difficulties, loss of interest in sex, and changes in appetite. Of course, some of these are also symptoms caused by cancer, so you should try to look out for multiple changes to your mood, demeanour, or wellbeing as clues to your psychological state. It is often easier for others to spot these in you, rather than trying to notice them yourself. Use the checklists above as a guide.  Three-quarters of cancer patients with severe depression in the UK are not currently receiving treatment for it, mostly because they have not sought help. People assigned male at birth (AMAB) are far less likely to seek help than people assigned female at birth (AFAB). Other related conditions can occur; for example, PTSD, relationship and body image issues are regularly seen in cancer patients.  

In addition to anxiety, depression, and distress, there may be other psychological problems that are direct complications of the cancer. Brain cancer may cause symptoms that resemble psychosis or schizophrenia. This is relatively rare, although it is more common in the elderly.2 Psychosis has also occasionally been reported in other types of cancers but it is vanishingly rare and may not be directly linked to the cancer itself but may be an underlying condition.

Patients, especially those with advanced cancer, may experience a type of confused mental state called delirium. There are three types of delirium, the symptoms of which can resemble depression or dementia: hypoactive, where the patient is inactive and seems sleepy or depressed; hyperactive, where the patient is restless or agitated; and mixed, where they cycle back and forth between hypoactive and hyperactive. Delirium usually comes on rapidly and suddenly and can be caused by cancer, cancer treatment, or other medical conditions, including:

  • Organ failure: e.g., liver or kidney failure
  • Electrolyte imbalances: electrolytes are important minerals, like sodium and potassium, in blood and body fluids that help keep the heart, kidneys, nerves, and muscles working properly
  • Infection.
  • Paraneoplastic syndromes: these occur when cancer-fighting antibodies or white blood cells attack non-cancerous cells in the nervous system by mistake
  • Side effects of medicines and treatments: the effects usually go away after the medicine is stopped
  • Withdrawal from medicines that slow down the central nervous system

Treatments vary and range from simple ideas like filling the patient’s room with familiar objects to sedatives and tranquillisers like haloperidol and midazolam. A fuller discussion of delirium can be found here.

Coping and getting help with mental health issues

To help you cope psychologically with cancer, there is help available, and there are also things that you can do to help yourself. One of the most important things that you can do to mitigate the psychological impact of cancer is to try to care for your physical health. 

Regular moderate exercise will help boost general wellbeing and can help fight depression. Moderate exercise is when your heart rate is up, but you can still hold a conversation comfortably.

A healthy diet will improve your resilience to side effects and help you fight off infections. You may feel “off your food” or have an impaired sense of taste and smell sometimes because of the cancer or the treatment, but try to make up for it when you feel better. MacMillan has an excellent booklet of tempting recipes for people affected by cancer. 

Sleep is vital to our wellbeing, and a lack of it will affect your health, mood, and ability to recover from treatment side effects. If you have trouble sleeping, try this bedtime routine suggested by BUPA. In addition, seek medical advice on sleep if you are still having problems.

Relaxation and mindfulness can boost mood, combat depression and anxiety, help with sleep, and ease pain. There are numerous relaxation guides and apps available. For example, try the excellent Headspace™ or any free alternatives, and your GP or care team might be able to help.

Lastly, it is important to keep talking. Talk to your doctor, talk to your family or friends, seek out a support group local to you. There are also online and telephone resources for when things get difficult (this information is for users in the UK).

For general cancer support, there is the MacMillan help and support page. This is an excellent resource and offers advice as well as one-to-one support and an online community. If your concern is about your mental health, try talking to your GP. There is also the facility to talk to someone on the telephone, just dial 111 and select option 2. In addition, charities like Mind have excellent online resources about all kinds of mental health problems, and will signpost support for you.

Other Resources

Here are some other useful links to further information and support.  This is far from being an exhaustive list:

The Samaritans

MacMillan Cancer Support

National Cancer Institute



  1. Miovic M, Block S. Psychiatric disorders in advanced cancer. Cancer 2007;110:1665–76.
  2. Lisanby S.H, C Kohler, C, Swanson C.L, Gur R.E. Psychosis Secondary to Brain Tumor.  Semin Clin Neuropsychiatry. 1998;3(1):12-22.

Dr. Richard Stephens

Doctor of Philosophy (PhD), Physiology/Child Health
St George's, University of London

Richard has an extensive background in bioscience and bioinformatics with a PhD in membrane transport physiology and 28 years of experience in scientific publishing, bioscience research and computational biology.
On moving to Cambridge, UK, in 2015, Richard took the opportunity to broaden the application of his scientific background as well as to explore new avenues of interest. Among other things he mentored students at the Disability Resource Centre at the University of Cambridge and is currently working as an educator, pro bono for the Illuminate charity whilst further developing his writing and presentation skills. presents all health information in line with our terms and conditions. It is essential to understand that the medical information available on our platform is not intended to substitute the relationship between a patient and their physician or doctor, as well as any medical guidance they offer. Always consult with a healthcare professional before making any decisions based on the information found on our website.
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