As the global incidence of cancer continues to rise, increasing attention is being paid to the burden of psychiatric and psychosocial consequences associated with the disease. Psychiatric disorders affect at least 30–35% of patients with cancer at different stages of the disease and vary depending on disease stage and clinical course. In today’s article, we will discuss the epidemiology of several psychosocial disorders affecting patients, as important contributors to distress and disease burden that should be addressed through evidence-based interventions as part of comprehensive cancer care.
Receiving a cancer diagnosis is one of the most significant and transformative moments in a person’s life. The everyday life that existed before the diagnosis may suddenly change. Regardless of disease stage, cancer represents a psychological, physical, and financial burden for both patients and their families. Despite decades of fighting the disease, cancer remains a major malignant condition that has not yet been completely overcome. According to GLOBOCAN 2024 data, the global cancer burden has increased to 20.6 million new cases worldwide.
In clinical practice, a patient’s overall condition is assessed using objective indicators such as tumor size, response to treatment, laboratory findings, and imaging results. However, beyond these parameters lies the patient’s everyday life, which is not always reflected in medical records. Following a diagnosis, a person’s priorities in life, relationships with family and friends, perception of their own body, professional and social roles, ability to plan for the future, and sense of meaning in life may all change.
Advances in oncology have significantly improved survival rates. Early detection, improved surgical approaches, systemic therapies, targeted treatments, and immunotherapy allow an increasing number of people to live fulfilling lives after a cancer diagnosis. As a result, the goal of oncology is no longer limited to disease control or prolonging survival. An increasingly important question has emerged:
What is life like after a person has overcome the disease?
The impact on mental health may begin from the moment an individual notices changes in their body, such as discovering a lump, bleeding, pain, or numbness. This period continues until the exact cause of the physical changes is diagnosed and may be considered a recognition phase. The timing of a medical consultation depends on several factors. For example, people with a previous history of cancer are more likely to seek medical attention immediately. However, because of fear of receiving a cancer diagnosis, possible financial stress, and concerns about society’s attitudes, some individuals delay seeking medical advice.
From the moment of diagnosis, patients must cope with uncertainty, treatment-related demands, changes in physical functioning, and emotional distress. Cancer diagnosis and treatment are not only biomedical events but also significant psychological and social experiences that require substantial adaptation. Alongside appropriate medical treatment, emotional well-being and psychological resilience can become important tools in the fight against cancer.
This state can be described as the “new normal.” It does not necessarily imply a deterioration in quality of life. Rather, the new normal may represent a combination of adaptation, loss, fear, hope, and personal transformation. For some individuals, a diagnosis may become a source of limitations in life; for others, it may lead to a reassessment of priorities, deeper relationships, or a new understanding of themselves and their future.
Particular importance should therefore be placed on acceptance of the diagnosis, the reassessment of personal values, personal growth, changes in social relationships, attitudes toward the future, and trust in treatment. Together, these factors may determine how a person’s “new normal” develops following an oncology diagnosis.
In this context, the concept of the “new normal” provides a useful framework for planning life after cancer. Rather than viewing adaptation as a simple return to the pre-diagnosis state, the new normal can be understood as an evolving process through which individuals reconstruct their everyday lives around the physical, psychological, social, and existential consequences of cancer. The Cancer Survivorship Adaptation Model similarly conceptualizes adaptation as an ongoing process involving changes in personal context, cognitive appraisal, goals, assumptions, and self-perception, with quality of life emerging from the interaction of these domains.
The European School of Oncology (ESO) explicitly integrates survivorship and quality of life into modern oncology education and emphasizes the need to address the physical, psychological, and social burdens associated with surviving cancer. This shift is particularly important because clinical outcomes do not fully capture the cancer experience. A patient may have a favorable radiological response or enter remission while simultaneously experiencing fear of recurrence, changes in body image, emotional distress, altered social roles, or uncertainty about the future.
Although every cancer experience is different, anxiety is very common among cancer survivors. Unlike depression, which according to studies often decreases after completion of treatment, anxiety levels tend to remain stable or may even increase.
A study published in JAMA Oncology suggests that the risk of psychiatric comorbidity may increase almost one year before an official cancer diagnosis. These findings were based on a nationwide Swedish analysis involving more than 300,000 patients with cancer and more than 3 million cancer-free individuals selected as controls. Led by a research group from the Karolinska Institute, the investigators compared rates of five disorders between the groups: depression, anxiety, substance use disorders, somatic/conversion disorders, and stress/adjustment disorders.
The study’s author, Fang Fang, MD, Assistant Professor at the Department of Medical Epidemiology and Biostatistics at Karolinska University, noted that the period between referral to a cancer specialist and diagnostic evaluation may range from several weeks to several months. Therefore, the initial signs of psychiatric problems may overlap with the early manifestations of cancer-related symptoms.
A cancer diagnosis significantly increases the risk of developing new mental health disorders, particularly during the first days and months following diagnosis. Although the risk gradually decreases over time, some degree of increased risk may persist in the long term. These findings highlight the importance of early psychological assessment and psychosocial support for patients following a cancer diagnosis.
While working on this article, I became interested in the situation in Georgia and contacted Ms. Tamar Kakhniashvili, President of the Georgian Psycho-Oncology Society. She provided me with relevant materials and answered several questions.
- Ms. Tamar, first of all, I would like to ask about the current situation in Georgia. What does the available evidence tell us about the mental health of oncology patients?
Under the initiative of the Georgian Psycho-Oncology Society, a study was conducted between October 2019 and January 2023, involving 207 patients receiving active treatment for breast cancer. The participants had a mean age of 53 years, ranging from 31 to 77 years.
Women with lower financial income (47.6%) experienced more pronounced depressive symptoms than those with adequate financial support (8.8%). Unemployed women (28.6%) were almost three times more likely to experience moderate or severe depressive symptoms compared with employed patients (8.7%).
A significant difference in depressive symptoms was also observed according to educational level. Participants with higher education reported fewer depressive symptoms (10%) compared with those with secondary education (20.4%).
The study demonstrated significant associations between depression and factors such as financial status, educational level, and employment. Low household income and lower educational attainment were identified as predictors of clinical depression among patients with breast cancer.
More information can be found in the published article:
https://pubmed.ncbi.nlm.nih.gov/40078466/
- What are the most common problems that psycho-oncologists have to help patients cope with?
The main problems include depression or mixed anxiety-depressive states, difficulty accepting the disease, fear of treatment because of potential side effects, fear of changes in everyday routines, financial difficulties associated with expensive diagnostic investigations, and fear of disease recurrence at a later stage.
Early identification and timely referral to mental health professionals can play a crucial role in the effective management of depression.
- Is there sufficient integration between oncology and mental health services in Georgia?
Of course, integration is not yet sufficient. Ideally, every oncology clinic should have a properly trained psycho-oncologist. Nevertheless, within the scope of our activities and despite the lack of dedicated funding, I believe we have achieved a great deal. We continue to work toward the development of psycho-oncology in Georgia and to support patients.
Thank you to Ms. Tamar for the interview.
After speaking with her, I became interested in understanding what patients themselves think about the involvement of psychologists in the treatment process. To explore this question, I developed a questionnaire and surveyed approximately 50 oncology patients at the Krystyna Kiel Oncology Center.
The majority of respondents (70%) were women, and their ages ranged from 50 to 80 years. The way in which the disease was initially detected varied according to diagnosis. In most cases, the disease was identified because of symptoms such as pain or bleeding (60%), through primary healthcare services (20%), by self-examination (10%), or through other circumstances (10%).
When asked how long it took them to consult an oncologist after noticing symptoms, the responses were distributed as follows: 70% sought medical attention immediately, while 30% delayed consultation for the reasons discussed above.
For most respondents, the anxiety and fear associated with their disease were alleviated by support from family members, trust in their physician, and confidence in the treatment process.
Regarding the involvement of a psychologist in cancer care, opinions were divided. Most older patients did not consider psychological support to be necessary as part of their treatment, whereas younger patients welcomed the idea of integrating psychological support into cancer care.
In conclusion, cancer diagnosis can be considered not only a physical, but also a significant psychological challenge, with its impact being particularly profound during the early period following diagnosis and requiring timely psycho-oncological support. Early identification of psychosocial needs and appropriate support can contribute to improving patients’ quality of life, emotional well-being, and engagement in the treatment process.
Author: Nino Bregadze, MD, Clinical Oncology Resident
