Introduction

Lung cancer is the most common cancer in the world, and more than 2 million individuals receive new diagnoses every year.¹ Lung cancer is classified into two main categories according to their treatment approaches: Non-Small Cell Lung Cancer(NSCLC) which includes adenocarcinoma, squamous cell carcinoma, large cell carcinoma, and; Small Cell Lung Cancer (SCLC).²

NSCLC accounts for about 80-85% of these cases and is the main cause of death due to lung cancer. Advanced lung cancer is generally considered an incurable disease. For NSCLC patients, treatment depends on the occurrence of specific mutations, such as EGFR mutations of the Epidermal Growth Factor Receptor (EGFR), which occur in 10-20% of cases. In other patients, the first-line treatment remains platinum-based chemotherapy with a 15-30% response rate.¹

Small-cell lung cancer (SCLC), accounting for 10-15% of cases, is largely linked to smoking, showing a high initial response to chemotherapy but a high relapse rate.

This article explores the interrelation between lung cancer and mental health and details the implications of lung cancer on a patient's mental health, as well as quality of life.¹

Emotional impact of lung cancer

The majority of patients with lung cancer have a large number of symptoms. Among these, emotional distress and mood-related issues are relevant, yet not well explored. These emotional challenges might contribute to worsening the physical condition and daily life activities. 

A few symptoms, such as fatigue, anxiety, and depression, help the physicians to assess patients Quality of Life (QoL). In a study conducted by researchers at Mayo Clinic,

patients were asked to rate six specific symptoms— frequency and severity of pain, dryness, and production of phlegm with coughing, shortness of breath, and fatigue—on a scale from 0 (worst) to 10 (best), where higher ratings represented fewer symptoms. Findings indicated that more emotional problems were associated with having more frequent pain, greater pain severity, more dry coughing, more shortness of breath, and greater fatigue.

This symptom rating scale has been validated for patients with cancer and correlates well with other assessments of physical and mental function, mood, and quality of life. It has been successfully used with patients who have lung cancer as well as those with advanced or high-grade cancer.³

Prevalence of mental health disorders in lung cancer patients

Another studyt examined cancer-specific mortality in lung cancer patients with and without Severe Mental Illness (SMI), using data from Finnish health registries between 1990 and 2013. Of the 37,852 lung cancer cases, 12% had a history of SMI. Even after considering factors like stage and treatment, the researchers have found greater mortality in SMI patients, mainly with psychosis and squamous cell carcinoma in men, women with psychosis, particularly for small-cell and squamous cell carcinoma, and women with mood disorders, namely adenocarcinoma. None of these categories showed appreciable improvements in their rates of mortality over time. Their study draws attention to the importance of coordination between mental health and oncology professionals to minimise this gap in mortality.⁴

Social stigma and its role in mental health challenges

The social stigma surrounding lung cancer could also intensify mental health conditions and worsen quality of life. Indeed, in a t study evaluating the role of health-related stigma, close to half of the participants had anxiety and depression symptoms at significant levels. A greater number of patients showed more distress and less life satisfaction if their stigma perceptions were higher due to significantly more restricted social support, as well as a significantly more negative attitude about the disease. The findings from this study point towards a need for measures that help to reduce stigma and improve the well-being of patients with lung cancer.⁵

Importance of mental health in physical outcomes

There have been several studies indicating that the psychological status of cancer patients can determine their physical outcomes. Scientific research has revealed that:

• Sychological management of depression and anxiety disorders can promote better survival in patients as well as their quality of life
• Better adherence to treatment causes improved immune responses in patients
• Better lifestyle behaviours such as exercise and diet can be encouraged with proper mental health support

The integration of mental health care and psychosocial support into cancer treatment plans has been shown to help patients cope better and adapt to life after a diagnosis by reducing stress and improving resilience.^6,7

Integrating mental health support in lung cancer care

Need for a multidisciplinary approach

Lung cancer management requires a multidisciplinary team because of the advancement in diagnostic or therapeutic tools and the complexity of the disease. As classical multidisciplinary teams primarily focus on the diagnosis and treatment of lung cancer, they often fail to consider the patient's functional status and psychological well-being.

Providing supportive care

The supportive care team's role is to provide support for patients undergoing cancer therapy to provide physical and psychological support during treatment.

Key areas for supportive care

• Exercise promotes physical fitness and enhances psychosocial resilience
• Nutrition assists in building strength, promoting recovery and it influences both the physical and psychological well-being
• Smoking cessation enhances the cure rate and survival chances
• Psychological well-being creates socio-psychological benefits, which facilitate the fight from cancer and improve the quality of life

Current gaps

Study findings indicate that the need for supportive care is typically not mentioned in multidisciplinary meetings. A specific discussion on supportive care during team consultation is necessary.⁸

Expert opinion

To provide better care for lung cancer patients, routine multidisciplinary lung cancer management must involve supportive care. This could be done with the assistance of more specialists like kinesiologists, dietitians, and psycho-oncologists to formulate plans for individualised care. This aligns well with the principles of precision medicine, which is of high importance for the betterment of outcomes in lung cancer patients.⁸

Enhancing access to mental health resources for lung cancer patients

These are several ways to enhance access to mental health resources for lung cancer patients. These include:

High prevalence of mental health concerns

• Mental health problems such as depression and anxiety among patients were noticed to increase, with 20% experiencing depression and 10% experiencing anxiety 
• These result in reduced quality of life and decreased survival due to the disruptions in treatment^9,10

Benefits of providing mental health services

• Integrating mental health professionals, such as psychologists or onco-psychiatrists, into oncology treatment settings can provide patients with early access to care 
• This enables often become better able to handle the diagnosis, make more decisions about their participation in therapy, and deal more effectively with some of the symptoms, for example, fatigue and pain⁹

Impact on survival and treatment adherence

• Mental health interventions can enhance survival rates 
• Some studies show that improvement in psychological distress can influence lifestyle choices, such as nutritional diet and increased physical activities, which can help improve the immune response toward overall resilience 
• A treatment approach including social intervention and mental health support promotes better survival outcomes​⁹

Telemedicine and remote mental health resources

• Telemedicine and mobile health apps help patients who cannot reach out to in-person services with much-needed mental health care 
• It is possible to access therapy and counselling through telemedicine and mobile health apps, especially for those patients living in rural or underserved areas 
• The apps focused on mindfulness and cognitive behavioral strategies may alleviate symptoms of anxiety and depression¹⁰

Training for oncologists and care providers

• With this, education on mental health screening for oncologists and other healthcare providers will enable them to make referrals early and treat patients 
• In that case, the understanding of the psychiatric symptoms associated with the treatment and mental health services available would also enable oncologists to look after their patients better from the beginning to the end of cancer treatment¹⁰

Raising awareness to reduce stigma

• Effective programs include educating both patients and providers about fighting stigma, which has always accompanied seeking help for mental illness 
• When there is less stigma, more patients can pursue mental health care as an integral part of cancer care⁹

Summary

Lung cancer can significantly impact mental health, leading to anxiety, depression, and emotional distress. Patients may struggle with uncertainty, physical limitations, and social isolation, all of which compound psychological strain. Early mental health support, including counselling and peer support, can improve emotional resilience and quality of life, helping patients manage psychological challenges alongside physical treatment.