Health of the Whole
Why treating the psychological, as well as physical, aspects of cancer matters
Restaurateur Dennis Serras looks back on his life before esophageal cancer and realizes: Most of the low periods he experienced were more likely the result of a really bad day than depression. Even after undergoing chemotherapy, radiation, an unexpected emergency colon surgery and having a large portion of his esophagus removed, Serras felt like he was sailing through cancer and treatment pretty well.
Everything changed -- for Serras and his family -- when his surgeon Mark Orringer, M.D., came into his hospital room with news that, despite his successful surgery, cancer cells were discovered on the outside of his esophagus. This meant another round of chemo and radiation.
"This really sent me into a tailspin," Serras said. "After two days of chemotherapy, I couldn't take it. The depression was awful. It encompasses you 100 percent and you can't do anything about it."
Social Worker Donna Murphy, L.M.S.W., C.C.L.S., from the PsychOncology Clinic at the University of Michigan Comprehensive Cancer Center explains that, just as in normal life, cancer patients experience ups and downs. With cancer, people are forced to deal with the unknown in a way most people never know.
— Michelle Riba, M.D.
"No two experiences with cancer are ever the same," Murphy says. "The many-changing circumstances of an illness and the time frames and predictions for prognosis add to the worry and concern. Combined with other life changes, people can feel overwhelmed and helpless, which can impact the complicated decision-making that lies ahead."
As a self-employed partner of 17 restaurants in five states, Serras was able to put work aside and into the capable hands of others when necessary. Yet, he knew his cancer was taking its toll on his wife, Ellie, their two daughters, and his brothers and sisters.
"I was always looked at as a leader in my family, someone who can't be sick," Serras said. "Your whole family gets sucked into it. They want to do what they can. My wife was with me. My girls were with me every day, at the house or at the hospital. Ellie says I was on my back more than I was standing after that second round of chemo and the depression."
Serras ended up in the care of Michelle Riba, M.D., who leads a team of mental health professionals with a thorough understanding of cancer treatments and the emotional aspects surrounding cancer.
"Many of the traditional symptoms of depression overlap with the symptoms of cancer, such as fatigue, weight changes, sleep problems, lack of concentration, lack of energy and guilt," Dr. Riba says. "Each patient must be evaluated properly, in the context of the cancer itself, as part of fully integrated care that links physical treatment and the psychological needs of the individual."
Ellie says getting connected with Dr. Riba, who treats patients at the U-M Depression Center, was the key to her family's ability to recover emotionally.
"Every patient in the hospital needs to be told about the Depression Center, she says. "When your body is betraying your whole sense of self, it is normal to go through confusion. Depression takes away your reasoning and logical thinking. We found that mental health leads the path to physical health."
Serras overcame his depression through a combination of talk therapy and medication, and is still adjusting to his life's new normal as a cancer survivor. His esophagus surgery resulted in his only being able to eat about a cup and a half of food at a time, which has been the biggest change in his daily life.
Serras continues to have follow-up visits with Dr. Riba. He is now cancer-free and has recently learned he is doing well enough to get his next screening in six months instead of three.
- Everyone with cancer becomes depressed.
- Men do not get depressed.
- My emotions aren't severe enough to need help.
- Depression and anxiety come hand in hand.
- Having a good prognosis means you won't get depressed.
- Support groups are for everyone.
- Being anxious means you have a psychiatric problem.
- Depression lasts forever.
- Depression makes you incompetent.
- People with depression want to be alone.
Another patient's perspective -- by Carol Hollenshead
"When I was diagnosed with breast cancer, I worked as director for the Center of Education of Women at the University of Michigan. It was very much a job I loved, but a job that took more than 100 percent. When my cancer metastasized, I had to really think about what I wanted to do with my time.
Talking to Dr. Riba was incredibly helpful as I struggled to make the decision to retire. Since then, my husband and I have traveled extensively and I have never looked back.
For those of us living with advanced cancer, it requires continual adjustment to changing circumstances and treatments. Anyone coping with cancer as a chronic disease would be well-served to see a physician like Dr. Riba, who understands both the treatment and psychological issues involved.
For example, when my cancer moved to the spine and was causing me a great deal of pain and misery, Dr. Riba said to me, "You really should consult a pain specialist."
It wasn't just pain that was the problem. My pain drugs were making me fuzzy in the head and unable to do such things as drive a car safely. I consulted with Dr. Carmen Green. Two days after I switched medication, I was a completely different -- and much happier -- person."