Psychosocial Concerns

The majority of the evidence suggests that cancer survivors have good emotional functioning after cancer,68 although rates of some diagnoses, such as depression, are higher among cancer survivors than in the general population.69,70 Fear of recurrence and death understandably dominate adjustment disorders, and may reach the extent where they interfere with vocational and personal pursuits.71

Cancer survivors with preexisting anxiety or affective disorders appear to be at greatest risk for ongoing distress.25 Changes to body image from cancer therapy, such as that resulting from mastectomy or colostomy, can be a source of problems with psychological adjustment.72 Distress appears to dissipate with time, however. There are a small proportion of patients who experience ongoing effects characteristic of posttraumatic stress disorder.73 Having a spouse or partner decreases the risk of psychological sequelae,74 although these caregivers may also themselves be adversely

affected.75 Social networks76 and support groups77 have been found to improve mental health in breast and prostate cancer survivors.

Cancer appears to cause a greater detriment to the quality of life of younger patients than the elderly,78,79 likely due to the greater disconnect between their expectations for health, physical functioning, and roles at that stage oflife than when older. A small proportion of cancer survivors report persistent fatigue at levels above population norms. Depression and chronic pain are commonly associated with these cases.80 Recurrence of cancer and late effects such as hypothyroidism must be ruled out. Exercise may help. Tools like the "Distress Thermometer" in NCCN guidelines, are available to assist providers in screening for symptoms of distress.

Some positive psychological effects of having been a cancer survivor have also been observed.81,82 Sense of well-being has been reported to be better among cancer survivors than respondents without a history of cancer56 and marital relationships may be strengthened.70 These findings speak to the resilience of cancer survivors. Survivors can find themselves with a greater appreciation for life and a better ability to prioritize things, resulting in an overall positive impact on their lives.

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