Navigating emotional challenges: A journey with patients undergoing chemotherapy

Abstract

A recent article reported that cancer patients with subthreshold depression are more likely to develop major depression within a year. Multivariate regression analysis revealed that regular exercise was a protective factor against cancer-related fatigue, whereas advanced age, radiotherapy, pain, and low hemoglobin were risk factors for cancer-related fatigue. A limitation of this study was the lack of methodological details about leukemia patients receiving depressive treatment at a specific hospital. Professional assessment, behavioral modification plans, communication, destressing techniques, and educational plans may help chemotherapy patients manage emotional issues and reduce anxiety. Furthermore, these strategies can inspire patients to create, facilitate their treatment, and help them to remain healthy.

Key Words: Leukemia patients; Cancer patients; Emotional distress; Subthreshold depression; Chemotherapy

Core Tip: Cancer patients with subthreshold depression are more likely to develop major depression within a year, with factors such as advanced age, radiotherapy, pain, and low hemoglobin increasing the risk of subsequent major depression. Professional assessment, behavioral modification plans, communication, destressing techniques, and educational plans can help patients to manage treatment and stay healthy.

INTRODUCTION

Recently, we read an article[1] that provided evidence that cancer patients with subthreshold depression are more likely to develop major depression within the next year. Subthreshold depression (also known as subsyndromal or subclinical depression) refers to the presence depressive symptoms that do not meet the criteria for any described depressive disorder diagnosis. These symptoms may emerge even before the diagnosis of any noncommunicable serious illness, including leukemia, in diagnosed cases. These conditions are harmful to patients.

APPRAISAL OF THE ARTICLE

This study[1] compared the basic clinical characteristics between two groups of leukemia patients (97 individuals with subthreshold depression and 100 individuals without depression) and found that they were comparable. However, there was a statistically significant difference between the groups in terms of combined radiotherapy and regular treatment. The study revealed statistically significant differences in pain, scores on the Piper Fatigue Scale, hemoglobin levels, and c-reactive protein levels between the groups. No significant differences were found in the albumin levels or Pittsburgh Sleep Quality Index scores. The study also reveals that subthreshold depression was positively correlated with age, regular exercise, and c-reactive protein levels; negatively correlated with hemoglobin levels; and not correlated with pain. Aging, concurrent radiotherapy, pain, and lower hemoglobin levels are risk factors for cancer-related fatigue, but regular exercise is a protective factor against cancer-related fatigue.

THE LIMITATIONS

There are no thorough methodological details in this article, which focuses on leukemia patients receiving treatment for depressive symptoms at a particular hospital. Therefore, the findings may not be applicable to other populations or patients with other types of cancer. Additionally, there were no details on the statistical analysis methods used for analyzing the data, which makes it challenging to assess the robustness of the study's findings. Furthermore, the article does not explicitly discuss any limitations or potential sources of bias in the study, thereby inhibiting an evaluation of the study's reliability and generalizability. However, the article showed that subthreshold depression increases the risk of major depression within a year, especially among cancer patients.

THE RECOMMENDED PLAN OF ACTION

The efforts of the authors seem commendable in the current scenario. After reading the article, we felt compelled to share some of our own strategies for addressing the emotional challenges faced by cancer patients receiving chemotherapy (CT). Patients with almost all cancer types, especially those in advanced stages, typically receive CT. CT is an effective cancer treatment because it blocks or delays the spread of cancer cells, which are known to divide and continue to increase rapidly. To date, CT remains a cornerstone in the treatment of many cancers (including breast cancer), particularly in advanced and metastatic cases. The aim of CT is to prolong survival and improve quality of life even among inactive patients[2]. However, CT does not always work because some tumors are resistant to it, and it can cause side effects such as nausea, vomiting, diarrhea, fever, heart damage, a low white blood cell count, and a weak immune system[3,4]. The side effects of this treatment can be significant, resulting in symptoms such as tiredness, nausea, and nerve damage. It is important to carefully consider the beneficial properties of the treatment and its potential harmful effects, as it may result in a range of emotional problems[5,6]. Patients receiving CT also face the risk of experiencing distress in all aspects of their everyday lives, including emotional distress such as anxiety and despair[7]. The following strategies can help minimize this risk.

Assess and evaluate the patient's status

Professional psychologists and counselors may be helpful in assessing and evaluating a patient’s status. Additionally, connecting patients with other individuals going through similar experiences is highly beneficial. Patient support groups lead to reduced loneliness. We also recommend family love and affection for emotional rehabilitation.

Behavior modification blueprints

Patients should receive guidance on healthy eating habits to maintain their health and vitality. Professional dieticians may assist patients in managing their diets. With the assistance of physiotherapists, therapists can encourage patients to engage in gentle exercise as needed, thereby boosting mood and reducing weariness. Patients should be encouraged to maintain a healthy routine and prioritize proper sleep hygiene to aid in their recovery.

Creative communication

To reduce the risk of emotional issues, medical staff should discuss emotional well-being with patients. Maintaining a record of mental and physical sensations can help manage anxious symptoms. Encouraging patients to indulge in creative activities for emotional comfort can be helpful.

De-stressing techniques

Based on patients' needs, it is necessary to offer a variety of strategies to reduce anxiety and handle emotional disorders. We teach people to regulate their emotions through breathing, relaxation, and mindful meditation. Therefore, patients practice deep breathing, muscle relaxation, and visualization to facilitate their breathing.

Educational plans

Psychoeducation for patients and caregivers is essential for creating a peaceful and pleasant environment. This type of education helps people understand diseases and treatments. Patients and caregivers plan for side effects and agree on how to handle the potential occurrence of anxiety, depression, and despair. Patients who receive psychoeducation learn to seek focused care from psychiatrists, psychologists, and social workers.

Patients receiving CT benefit from being the main focus when there is any kind of emotional disturbance, regardless of when it starts or ends. Strategies offer beneficial effects in navigating these challenges. However, it is crucial to undergo training and judiciously implement a combination of approaches.

CONCLUSION

This article the individuals with subthreshold depression–especially leukemia patients–are more likely to develop major depression within one year. Further, authors shares their experiences and describe that to manage emotional issues among patients receiving CT, strategies such as acquiring professional help for assessment and management, developing blueprints for behavioral modification practices, connecting with communication, developing destressing techniques, and providing educational plans may be beneficial. These strategies can help patients reduce anxiety and address emotional issues while also promoting their engagement in artistic and creative pursuits. By implementing these strategies, health care professionals can help patients navigate the challenges of cancer treatment and maintain a healthy lifestyle.