This is the second of the sentinel events that frequently occur for cancer survivors that I identified in a review of the cancer survivorship literature.

When treatment is over, many cancer survivors find themselves feeling a little lost and with hours in the day to fill that were previously taken up by chemotherapy and radiation sessions. In addition, when treatment ends, most people are at their lowest both physically and emotionally after the challenges of the various treatments. Often survivors assume that the day of their last treatment they will go back to their former level of functioning and activity; in fact, it can take weeks or months for the person to fully recover their energy and abilities. All of these can lead to depression.

The classical signs of depression include sadness, lack of pleasure in life (anhedonia), hopelessness and helplessness, low self-esteem and self-worth, feelings of guilt, and suicidal thoughts. Difficulty sleeping is another important sign of depression. Some studies estimate that up to 25% of people with cancer experience depression. Age, gender, type and stage of cancer, and the presence of social support all affect how often depression occurs and depression can be experienced anywhere in the cancer journey, from diagnosis to the end of life. Depression can also happen when treatment ends.

It can be very difficult for the cancer survivor to ask for help or accept it when it is offered. Some survivors are helped by taking anti-depressants; like all drugs these can have side effects and may take up to 3 works to begin working. Other survivors are more interested in non-pharmaceutical treatments. Cognitive behavioral therapy (CBT) can be very effective in mild to moderate depression and exercise may help too.

It is important for health care providers to assess for depression with all our patients each and every time we interact with them along the disease trajectory. Identification and treatment of depression is an important and at times neglected part of the care we provide.