Cancer survivors more likely to suffer depression from disability than diagnosis

A new study has found that health-related disability has a much larger impact on psychological distress than a diagnosis of cancer by itself.

Scientific Director of the 45 and Up Study, Professor Emily Banks of the National Centre for Epidemiology and Population Health at the Australian National University says people who have been treated for cancer in the previous month are 50 per cent more likely to have high psychological distress than those who have never had cancer.

She says that the risk of high psychological distress is 600 to 800 per cent greater in people with cancer if they need help with daily tasks.

However, long term survivors without disability have levels of depression and anxiety only slightly higher than people without cancer.

"Disability is clearly a really important factor influencing mental wellbeing," said Professor Banks.

"A significant number of Australians experience physical disability to the point where they need help with day to day tasks – like doing the shopping or walking 200 metres – as a result of their cancer, its treatment, or some other comorbid condition."

The study, which involved 89,574 people who filled out questionnaires, suggests people are able to adapt psychologically to a previous diagnosis of cancer, especially if they are still functioning well physically.

"The good news is that cancer survivors can be reassured that they should, in general, be able to reestablish their emotional equilibrium once they have been through the period of diagnosis and treatment, especially if they remain able-bodied" said Professor Banks.

The study report suggests that, following the initial diagnosis, people with cancer and a significant disability are a group that is likely to benefit from targeted psychological and other forms of support. The study is published in the Medical Journal of Australia.

The 45 and Up Study is managed by the Sax Institute in collaboration with major partner Cancer Council New South Wales; and partners the National Heart Foundation of Australia (NSW Division); NSW Health; beyondblue: the national depression initiative; Ageing, Disability and Home Care, Department of Human Services NSW; and UnitingCare Ageing. The study was also supported by the National Health and Medical Research Council.

Main findings

The study 'Is psychological distress in people living with cancer related to the fact of diagnosis, current treatment or level of disability? Findings from a large Australian study' aimed to investigate the separate and combined associations of cancer diagnosis, current treatment and functional impairment with psychological distress in a large cohort of Australian adults.

The risk of psychological distress was around 600 to 800% higher in those reporting significant disability compared with those without disability.
Among those without disability, the level of psychological distress among those with cancer was around 14% higher than those without cancer.
The excess risk of psychological distress attributable to disability is about 40 times greater on average than that attributable to cancer diagnosis, in the absence of disability, among long-term survivors.
There is a lack of reliable evidence on the joint contributions of the diagnosis of cancer, current treatment and functional impairment to psychological distress.
It is widely accepted that people living with a diagnosis of cancer experience higher levels of psychological distress than the general population. However, recent evidence suggests that although high levels of psychological distress are seen at the time of diagnosis and treatment and with advanced disease, long-term survivors may have similar rates of anxiety and depression to the general population.

(Source: Australian National University: Medical Journal of Australia)