The words stopped me in my tracks. Depression ‘significantly impacts’ breast cancer survival, ran the headline in a medical journal.
It was an article about research, published last week, that found breast cancer patients with depression are up to twice as likely to die of the disease as women with good mental health.
As a former breast surgeon who’s had breast cancer three times – I am undergoing treatment at the moment – I immediately took notice.
You see, I have also been floored by depression since my first cancer diagnosis in 2015, aged 40. And I’m not alone.
Up to a quarter of people with cancer develop a clinically significant depression – two to three times the number found among the general population.
The words stopped me in my tracks. Depression ‘significantly impacts’ breast cancer survival, ran the headline in a medical journal
Are we unlucky ones truly doomed? Well, the short answer is, I don’t think so.
When I saw the study, I immediately pored over the data. I discovered that, despite the worrying claims, the real picture is unlikely to be as bleak.
The Russian researchers analysed a number of existing studies to draw their conclusions. Some of these dated back to 1977 and the most recent was in 2018, which in terms of breast cancer treatment is a long time ago.
Since then there has been a raft of new treatments to tackle harder-to-treat forms of the disease, and many are remarkably successful.
I’m on one myself right now – palbociclib – which was described by the Institute of Cancer Research in London as among ‘the most important breakthroughs’ in decades. My treatment seems to be working, and I am optimistic.
But as a patient, I can’t deny the truth. It is no surprise to me that, untreated, depression can shorten our lives. When we’re depressed we’re less likely to eat well and exercise, more likely to drink and smoke, and less likely to take the medication we need.
All these things increase the risk of recurrence. Both cancer and depression make it harder to work. We struggle financially, which makes our mental health even worse. It can be a vicious cycle.
But my message, believe it or not, is one of hope. If you’re a breast cancer patient who’s suffering with depression, I want you to know that getting the right treatment is transformative. There are specific psychological support services for people with cancer, and they saved my life.
As a cancer surgeon, I didn’t realise that depression, anxiety and other mental health issues were common after a diagnosis.
It sounds ridiculous, but it’s true. You see, I was focused on the physical side effects – until I got cancer myself.
Chemotherapy was tough. Mornings spent sat in the shower feeling sorry for myself, waiting for the pain and nausea to go away. Couple that with the grief of everything I was losing. My hair. My breast. My fertility. Potentially my job. What about my relationship?
Then, when I finished treatment – chemo, surgery and radiotherapy – I was told I wouldn’t be seen again by my doctor for five years. I felt an overwhelming sense of panic and despair. Was that it? How would I cope?
For the next five years, I woke up every day thinking: ‘Is this the day my breast cancer comes back?’
I’d suffer something minor, like a pain in my hip, and go into a blind panic. My GP would send me for investigations, which only made my anxiety worse. It was the same with my annual mammogram screening. ‘What if it’s not OK?’ I wondered. Would I fall to pieces if I had to go through it all again?
When in 2018 my cancer did come back for the first time – a nodule of scar tissue near my armpit – I did lose my job.
I was left with chronic pain and a stiff shoulder and my life as I knew it was over. I defined myself as a surgeon and suddenly had no idea who I was or how to fill my days. And how many days did I have left to fill?
It was then that my oncology nurse told me there was counselling available through Macmillan Cancer Support. I met an incredible therapist called Diane who told me it was normal to feel depressed and anxious.
As a former breast surgeon who’s had breast cancer three times – I am undergoing treatment at the moment – I immediately took notice
During six sessions of cognitive behavioural therapy (CBT) – a type of psychotherapy – she helped me develop coping strategies and little things I could focus on, such as celebrating a ‘win’ every day.
But more important was just having someone to talk to. I didn’t want to burden my friends and family with my morbid thinking – I wasn’t sure they would understand or know what to say. But in Diane, I found someone I could be honest with. I could admit that I wasn’t fine, and vent all my irrational feelings and fears. And once I’d said them out loud, it was like a weight had been lifted.
When my mum died in December 2022, I spiralled into depression again. I reached out to the local hospice, which provides eight free CBT sessions to anyone who needs it. Having that space to cry, scream and shout was so important to me. I would never have had the courage to be that vulnerable in front of my family.
My therapist asked me to draw how I was feeling. As she pulled out the crayons, I thought, this is ridiculous. But soon I was staring at a black angry scrawl, and was able to explain how my grief was holding me back.
She encouraged me to write silly poems and letters as a way of expressing my feelings, and I still re-read them now when I’m having a wobble.
When I had my second breast cancer recurrence in 2023, I had CBT sessions again. I’m forever grateful to everyone who funds it through donations to Macmillan.
Referrals for therapy on the NHS take months, if not years, and private sessions with a therapist who specialises in cancer patients can be even harder to find.
Depression and anxiety can hit weeks, months or even years after a cancer diagnosis. Something you read can trigger it – a celebrity being diagnosed with cancer, for instance – or a friend in a support group might die, and you become consumed with guilt: ‘Why am I still alive?’
Knowing what I now know, I believe that everyone diagnosed with cancer needs to be told that their mental health can be affected just as much as their physical health.
But depression doesn’t have to be the end of us – there is help out there.