A cancer diagnosis can affect far more than physical health. It may bring uncertainty, changes to daily life and difficult emotions for the person diagnosed, as well as their family and loved ones. Feelings such as shock, fear, sadness and anger can be understandable responses to cancer. For some people, however, emotional distress becomes persistent or begins to significantly affect sleep, relationships, decision-making or day-to-day functioning. Psychological concerns may also evolve throughout diagnosis, treatment, recovery and survivorship.
Psych-oncology recognises that effective cancer care must address both physical and mental wellbeing. Research suggests that psychiatric concerns are common among people with cancer. A 2024 review reported that psychiatric concerns are common among people with cancer, with some studies reporting that they affect a substantial proportion of patients. Adjustment disorders have been reported in up to 32% of patients, whilst Major Depressive Disorders have been reported in approximately 14-25% of people with cancer. These figures do not mean that every person with cancer will develop a mental health condition. Rather, they highlight why emotional wellbeing should be integrated into cancer care, rather than treated as separate from physical treatment.
What Is Psych-Oncology?
Psych-oncology is an interdisciplinary field concerned with the psychiatric, social and behavioural aspects of cancer. It developed as a form of cancer care that not only focused on treating the disease and extending survival, but also on improving quality of life. Today, psych-oncology may involve collaboration between oncologists, psychiatrists, GPs, nurses, palliative care clinicians and other members of a person’s healthcare team.
Support can address anxiety, depression, adjustment to illness, sleep difficulties, pain, fatigue, changes in relationships, treatment-related concerns and fear of cancer progression or recurrence. It may also help patients and families manage practical changes involving work, finances, caring responsibilities and everyday independence.
The Emotional Impact of Cancer Can Change Over Time
There is no single or “correct” way to respond to cancer. Emotional reactions often vary according to the person, the type and stage of cancer, treatment experiences, previous mental health, available support and other circumstances.
Following A Diagnosis
The period following a diagnosis can involve shock, disbelief and uncertainty. Some people feel overwhelmed by medical information and treatment decisions, while others may initially feel numb. Concerns about the future, family members, work, finances and possible treatment side effects often arise at this time. Even when a treatment plan has been established, uncertainty can remain difficult to manage.
During Treatment
Cancer treatment can affect mood and well-being in several ways. Pain, nausea, sleep disruption, hormonal changes and reduced independence may contribute to emotional distress. Treatment can also affect body image, sexuality, cognitive functioning, relationships and a person’s usual roles at home or work. Repeated appointments, tests and periods of waiting can heighten anxiety. For people with existing mental health conditions, the physical and emotional demands of cancer may sometimes contribute to a recurrence or worsening of symptoms.
After Treatment
Finishing treatment is often viewed as a positive milestone but does not always mean that the emotional impact ends. Some people may feel relieved, while others find the transition away from frequent medical care unsettling. They may experience anxiety before follow-up appointments or become highly alert to physical sensations that could indicate the cancer has returned. Lingering fatigue, pain, cognitive changes or changes to identity and relationships can also make returning to everyday life more complicated than expected.
During Advanced Cancer and Palliative Care
People living with advanced cancer may experience grief, uncertainty, anxiety, depression or concerns about loss of independence and the effects of illness on their family. Questions about meaning, dignity, relationships and end-of-life decisions may become important. Psychiatric support can form part of palliative care alongside symptom management and other medical treatment.
When Does Distress Require Further Assessment
Experiencing difficult emotions after a cancer diagnosis does not necessarily mean that someone has a psychiatric condition. Distress exists on a spectrum and may fluctuate depending on treatment, physical symptoms and personal circumstances. However, anxiety, depression and other psychiatric conditions can occur alongside cancer and should not automatically be dismissed as an expected reaction.
Ongoing distress can also affect the body. Research suggests that chronic distress associated with cancer may be linked with changes, including changes in stress hormones, including cortisol, and immune system activity. These processes may interact with psychiatric symptoms and adversely affect sleep, fatigue, coping and treatment adherence. Importantly, this does not mean that a person’s emotional state caused their cancer or determines its course. Rather, it highlights why distress should be recognised and addressed as part of comprehensive cancer care.
Assessments can be complex because physical and psychiatric symptoms often overlap. For example, fatigue, sleep changes, reduced appetite, difficulty concentrating and low energy may be related to cancer treatment, medications, depression, anxiety or a combination of factors.
How Can Psycho-Oncological Support Help
Support should be tailored to the individual rather than based on a single approach for everyone. Some people may benefit from information and brief emotional support, while others may require structured psychotherapy or psychiatric treatment.
Depending on the person’s needs, support may involve:
- Education about common emotional responses to cancer
- Strategies for managing anxiety, uncertainty and treatment-related stress
- Specific talking therapies (psychotherapy) to address unhelpful thoughts and coping patterns
- Support with sleep, pain and fatigue
- Medication for the treatment of depression, anxiety or another psychiatric condition where clinically appropriate
- Support for partners, families and carers
- Coordination between psychiatric care and cancer care
A personalised approach also recognises that a person’s needs may change. Someone who copes well during treatment may experience difficulties afterwards, while another person may require more intensive support soon after diagnosis and less support later.
What Is the Role of a Psychiatrist for Cancer Care?
A psychiatrist may become involved when emotional or behavioural symptoms are persistent, severe, diagnostically complex or likely to benefit from medication or psychotherapy. Psychiatric assessments can help distinguish an understandable response to cancer from a psychiatric condition requiring treatment. They can also help determine whether symptoms may be related to cancer, another medical condition, medication side effects or cancer treatment.
When medication is being considered, the psychiatrist may review possible side effects and interactions with oncology treatments and other medicines. This makes communication between the psychiatrist, oncologist and GP particularly important. Psychiatrists may also assist people with pre-existing mental health conditions, significant anxiety and depression, cognitive or behavioural changes, delirium, difficulty adjusting to illness or psychiatric symptoms arising during palliative care.
When May It Be Helpful to Seek Psycho-Oncological Support?
It may be helpful to speak with a GP, oncologist or psychiatrist when experiencing emotional distress:
- Persists or becomes more intense over time
- Significantly affects sleep, appetite or everyday functioning
- Makes it difficult to attend appointments or follow treatment instructions
- Leads to ongoing withdrawal from relationships or usual activities
- Significantly affects body image, intimacy or sexual well-being
- Involves persistent anxiety, panic, low mood or hopelessness
- Contributes to difficulties in making treatment decisions
- Reflects a recurrence of a previous mental health condition
People do not need to wait until symptoms become severe before asking for support. Early conversations can help identify what type and level of care may be most appropriate.
Cancer affects every aspect of a person’s life, including physical health, emotional wellbeing, relationships, work and everyday functioning. Psycho-oncology offers evidence-based support to help individuals and their families throughout diagnosis, treatment, recovery and survivorship. Seeking help is a sign of strength, not weakness, and effective support is available at every stage of the cancer journey.
To enquire about a psycho-oncology consultation, click here
To learn more about our Sydney psychiatrists with a special interest in psycho-oncology, visit Dr Stephen Freiberg and Dr Ben Bravery profile.