Maria Fernanda Garcia, a therapist with the Cancer Support Community Greater Miami, readily remembers a breast cancer survivor who attended one of her groups. She often “forgot” to go to her medical appointments. It was her way of coping with her fear about what the doctor might find. It was also a sign of her depression. 

A new study suggests that Garcia’s patient’s experience is all too common. The study, published in the October 2016 issue of Cancer Epidemiology, found depression is linked to the amount of care cancer survivors receive. The study also found that depression was more common among cancer patients with financial concerns.

Depression is marked by feelings of sadness, loss of interest in formerly pleasurable activities, difficulty sleeping and low energy. Past reports have found that nine in 100 people in the general population experience depression, compared with about 27 in 100 cancer survivors.

Finding The Right Therapist

Ask questions to determine a good fit.

Talk therapy and antidepressants can be used individually or together by people managing depression. For treatment to be most beneficial, it’s important to find the right therapist. When you meet a therapist for the first time, here are some questions you can ask to see if you two are a good fit:

  • What training and experience do you have in treating cancer patients with depression?
  • How often and for how long would you anticipate seeing me?
  • How long do you expect it to take before I begin feeling better?
  • Will you coordinate my care with other treatment providers, and if so, how?
  • How can I be in touch with you between sessions if I have questions?
  • What are your credentials?
  • Can you prescribe medications or work with a prescribing physician if medications are needed?
  • What do you charge for your services?
  • Do you accept my insurance? If not, do you have low-fee or sliding-scale options?

Adapted from materi​​​als developed by the Anxiety and Depression Association of America.

The new study used data colle​​cted from 3,964 cancer survivors who took part in the 2010 Behavioral Risk Factor Surveillance System telephone survey. The researchers found that 13 percent of the cancer survivors reported experiencing depression. Those with depression were more likely to be female, unmarried, unemployed and to have other chronic health problems.

About 8 percent of the survivors with depression reported not having a primary care physician, compared with 4 percent of the survivors who were not dealing with depression. In addition, 36 percent of the patients managing depression reported cost was a barrier to care, compared with 7 percent of those who did not have depression. These numbers suggest depression coupled with financial worries results in fewer doctor visits and inadequate follow-up care.

Peggy Rios, program director of the Cancer Support Community Greater Miami, says social isolation can result from many aspects of cancer survivorship, including financial problems. Social isolation coupled with financial hardship may compound feelings of depression. “If people can no longer work, they become separated from their support system,” she says. “They’re also not generating the income they need to sustain themselves, so they become anxious about paying their bills. It’s a vicious cycle that can culminate in full-blown depression.”

There are ways to reach out to cancer survivors who are depressed. “Screening, ideally at the time of diagnosis, is the necessary first step,” says Vinay K. Cheruvu, a biostatistician at Kent State University in Kent, Ohio, who led the study. The problem is “physicians often don’t conduct these screenings.” In addition, he says, “both patients and providers are reluctant to bring it up.” Yet it is only by identifying those patients and helping them get more information “that they are more likely to seek out mental health services.”

Cheruvu says he hopes his study will lead to more research. “Well-designed studies can shed light on what the barriers are to seeking mental health care and how they can be overcome, to improve the overall well-being and survival of these patients,” he says.​