Pancreatic cancer is the 12th most common cancer type worldwide, with 510,992 people diagnosed with pancreatic cancer in 2022. Pancreatic cancer is the 6th most common cause of death due to cancer, with 467,409 deaths in 2022, and Asia still bore the highest burden with 45.4% of all deaths due to pancreatic cancer. There are different types of pancreatic cancer, but pancreatic adenocarcinoma is the most common type, making up about 95% of pancreatic cancers. Other less common types of pancreatic cancer include adenosquamous carcinomas, squamous cell carcinomas, signet ring cell carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with giant cells.1,2
The diagnosis of pancreatic cancer in a patient is often associated with a lot of emotional stress and mental health issues. These mental health issues persist through treatment and may even progressively worsen throughout treatment and palliative care. These patients have the side effects of medications to contend with, and their families also witness a decline in their quality of life, while experiencing huge financial and economic burden, just to mention a few.3,4
Studies have shown that depression and anxiety are common among patients with pancreatic cancer.4,5,6 Additionally, the prognosis for this type of cancer is one of the least favourable. This is because by the time people present symptoms, such as jaundice or loss of appetite, the cancer is already in the advanced stage and has spread to other parts of the body.1,2 This article will explore the relationship between pancreatic cancer and mental health.
Studies have reported high rates of depression and anxiety among patients with pancreatic cancer, with prevalences ranging from 33% to 50%.4,6 High rates of depression were reported among pancreatic cancer patients, in different stages of the disease, in independent studies conducted.7,8,9
Evidence suggests that the presence of anxiety and depression among patients with advanced cancer can worsen physical symptoms, such as pain, fatigue and weakness, ultimately leading to a lower quality of life. These mental health conditions also lead to the use of more aggressive treatments, such as chemotherapy, having a longer stay in hospital, and at other times having to be admitted to the intensive care unit. All these further worsen the quality of life of the patient. Studies have also reported that other physical symptoms brought on by pancreatic cancer can be worsened by depression and anxiety.9,10,11,12
In a study by Subramaniam et al, patients diagnosed with either anxiety alone or depression alone had lower chances of being treated with pharmacotherapy or receiving mental health services compared to patients who were diagnosed with both anxiety and depression. This finding suggests that patients with both anxiety and depression may have more severe symptoms and, therefore, are more likely to receive treatment compared to patients who have either anxiety or depression.13
Fear, confusion and denial are the usual initial reactions of the patient on receiving a diagnosis of pancreatic cancer. There are even cases where patients refuse to inform either a spouse or family member of the diagnosis, for fear of not wanting to place an emotional burden on their families, or be a burden themselves. Worry and anxiety about the extent of the disease or the effectiveness of treatment are also emotional effects expressed by the patient. The patient also worries about how the cancer diagnosis would affect their life and future, as well as that of their families. A constant worry is the financial implications of treating and coping with the disease. Feelings of hopelessness, helplessness, depression, fear of the disease recurring and death are also experienced.14
The caregivers, especially the spouse if the patient is married, and close family members, also experience anxiety about the disease and how it could affect the family, fear of the unknown, fear of the future and fear of not being able to cater to the financial aspect. Families begin to struggle with the changes to family dynamics concerning reprioritising family needs. It could also mean a disruption in the family hierarchy, or a restructuring, or redesign of the home to accommodate the needs of the family member who is now a patient. The patient can become aggressive towards family members, which can lead to conflicts and quarrels in the family. Caregivers, especially spouses, bear the brunt of taking care of the patient, and being a recipient of the patient’s change in mood and possibly aggression, which could lead to stress and burnout.14
This includes the use of antidepressant medications, selective serotonin reuptake inhibitors (SSRIs), psychostimulants or benzodiazepines. Tricyclic antidepressants are the most commonly used medication.10
This requires the inclusion of a mental health specialist on the team to cater to the psychological needs associated with pain, fatigue, anxiety, depression, nutrition, as well as the emotional needs of the caregiver and family.7,10
Cognitive behavioural therapy (CBT) has been found to improve the quality of life of pancreatic cancer patients. It is an intervention that combines behavioural stimulation, exposure treatment, emotion regulation and relaxation training. CBT can provide better outcomes when used together with medications.15
Pain is a common problem in patients with advanced pancreatic cancer, and chronic pain is reported by over 50% of patients. Pain management is a critical part of improving the quality of life of patients.16
Rest and relaxation are useful coping strategies. Taking a nap, going to the beach or finding a quiet place to rest are helpful strategies. Visiting the spa or having body massages at home by family members or a masseuse, listening to music, watching a movie, reading books, going on the internet and making use of social media have been documented to be helpful.
Practising mindfulness techniques, yoga and meditation, is a useful coping strategy. These techniques can be helpful to reduce the stress associated with pancreatic cancer treatment.
Provision of social support by family members, such as a spouse and children, and friends, including persons going through similar health conditions, has helped with feelings of depression and worry. Support groups are not only physical, they can also be online.
Religious activities, such as praying (either alone or as a group, online or physically), listening to religious music, depending on your religious inclination, reading religious texts or going to places of worship can build faith.
A balanced diet provides the required nutrients to promote physical and psychological well-being.
Keeping one’s mind and time occupied by carrying out household chores or volunteering, for activities in the community, or a religious setting, prevents one from spending too much time thinking about the disease and it can reduce time spent worrying.
The usually late diagnosis of pancreatic cancer and its close association with anxiety and depression require an interdisciplinary approach to mental health, to provide a wholesome form of care and support for pancreatic cancer patients. The American College of Surgeons recommends the inclusion of mental health professionals as part of the team for routine screening in clinical oncology.13
Integrating mental health care treatment as part of pancreatic care treatment, cannot be overemphasised due to the evidence that exists where anxiety and depression present as the initial clue to pancreatic cancer in some patients before other symptoms, such as jaundice, loss of appetite and weight loss appear.3,17
Pancreatic cancer significantly affects mental health, leading to anxiety, depression, and emotional and financial strain. Integrating mental health support into pancreatic cancer care and treatment, practising mindfulness, providing avenues for peer and family support, as well as encouraging patients and families to seek help, will go a long way in ensuring pancreatic cancer patients have a better quality of life from diagnosis through treatment and while living with the condition.
