Depression and anxiety

Depression

Depression is strong feelings of sadness that do not go away. This can last for weeks or months. It is normal to feel sad about a cancer diagnosis. You may feel sadness because of how your life has changed. If your sadness does not get better that might be a sign of depression.

Symptoms of depression might include:

• feeling tired and having low energy
• feeling slow or restless
• changes in sleeping or eating habits
• feeling hopeless and/or guilty
• crying without a clear reason
• not enjoying things that you used to enjoy
• having trouble thinking, focusing and remembering things
• worrying too much about your treatment or cancer returning
• reduced sex drive
• thinking a lot about death and wanting to die

If you are have any of these symptoms for 2 weeks or longer, please speak to your health care provider.

Depression can be caused by your:

• diagnosis and its effect on your life
• tumour(s)
• treatment(s)

Tumours, surgery, radiation and drugs can change the chemicals in your brain that keep you happy. Depression does not mean you are not trying to be happy. Depression is not a sign of weakness or not trying. Asking for help is the first step to feeling better.

Talk to someone if you think you might be depressed. Please see Find Support – Hospital Resources for more information.

Anxiety

Anxiety is a feeling of being worried, nervous, fearful or uneasy. When you learn you have cancer a lot is unknown. It is normal to have some anxiety, but too much anxiety can be a problem. If you are always anxious it can affect your life.

Symptoms of anxiety might include:

• a feeling of panic, fear, or discomfort
• cold or sweaty hands or feet
• trouble breathing
• fast heart beat
• a feeling of not being able to sit still
• dry mouth
• nausea (feeling like you are going to throw up)
• muscle tension
• dizziness
• trouble sleeping

These feelings can occur on their own, or with depression. These feelings can also be caused by:

• learning you have cancer
• your tumour
• certain types of medicine

If you are worried that these feelings are affecting your life you can ask for help. Please see Find Support – Hospital Resources for more information.

Find Support for Depression and Anxiety

At UHN

Social Work

Social workers can help you and your family with the emotional and practical aspects of coping with the diagnosis and treatment of cancer. They can help with:

• emotional matters: dealing with fear, anxiety, sadness, anger and a sense of loss
• financial matters: income support, drug costs and disability pensions
• practical matters: transportation, home support and referrals to community resources

You or a family member can make an appointment with a social worker at any time before, during or after treatment. Contact social work directly or ask a member of your healthcare team to arrange for you to see a social worker.

Princess Margaret Cancer Centre
Phone: 416 946 4501 extension 3666

Psychiatry and Psychology

Psychiatrists are trained to help people facing cancer. They can help you and your family learn how to cope with the emotional distress of a cancer diagnosis and treatment. The Psychosocial Oncology Clinic can offer consultations (a first meeting with a psychiatrist), counselling and medicine if needed for patients and family members.

Psychologists are experts in how people think, feel and behave. They diagnose and treat mental health conditions such as problems with thinking, memory and emotional distress. Talk to your healthcare team if you would like to be referred to the Psychosocial Oncology Clinic.

Psychosocial Oncology Clinic

The Psychosocial Oncology Clinic is a team of social workers, psychologists and psychiatrists. They are there to help you and your family:

• Cope with the diagnosis of cancer,
• Reduce stress and
• Improve your emotional well-being.

This clinic can also support you after your treatment. There is no fee for this service.

Princess Margaret Cancer Centre, 16th Floor
Phone: 416 946 4525
Hours: Monday to Friday, 9:00 am – 5:00 pm

Cancer Rehabilitation and Survivorship Program

The Cancer Rehabilitation and Survivorship (CRS) Program offers many programs and services to help you and your family throughout your cancer journey. When you are referred to the CRS Program, you will meet different health care professionals. They will help you:

• Prepare a plan to manage your cancer experience
• help you reduce and manage any late or long-term effects of cancer and its treatment
• help you find services and programs that best meet your needs

Cancer Survivorship Centre
Princes Margaret Cancer Centre, 2nd floor
Phone: 416 946 4501 extension 2363
Hours: Monday to Friday, 9:00 am – 5:00 pm

ELLICSR: Health, Wellness and Cancer Survivorship Centre
Toronto General Hospital (TGH) (Basement)
Phone: 416 581 8620
Hours: Monday to Friday, 8:30 am – 4:30 pm

Relaxation Therapy Sessions

Many people have anxiety and stress when they are undergoing cancer treatment. Sometimes, this stress can interfere with your daily activities. If you are having trouble with stress you may benefit from relaxation therapy.

Princes Margaret Cancer Centre
Phone: 416 946 2240 (group sessions)
Phone: 416 946 4501 extension 5580 (one-on-one sessions)

To register, ask your doctor for a referral to Occupational Therapy.

The Healing Journey Program: Coping with Cancer Stress

This program helps cancer patients and family members cope with the stress of cancer and its treatments. It includes techniques such as relaxation, thought control, mental imaging, emotional expression and goal setting.

There is no fee for this service.

Princess Margaret Cancer Centre and Wellspring Cancer Centre
Phone: 416 946 2062
Website: The Healing Journey Program: Coping with Stress

Mindfulness-Based Stress Reduction Program

This 8-week program helps patients reduce stress and anxiety caused by their cancer. This includes stress from diagnosis and treatment. It uses meditation and a method called “mindfulness”. Mindfulness is a type of mental training that helps you manage stress in a healthy way. Please call for more information or to sign up.

There is no fee for this service.

Toronto General Hospital (TGH)
200 Elizabeth Street
Toronto, ON M5G 2C4
Phone: 416 340 4452 (leave a message)

Community Resources

Canadian Cancer Society Peer Support Service

This is a telephone support program that connects patients and caregivers with fully screened and trained volunteers who have had cancer, or who have cared for someone with cancer. Peer volunteers:

• listen
• provide hope
• offer support
• share ideas for coping

There is no fee for this service.

Phone 1 800 263 6750
Hours: Monday to Friday, 9:00 am – 5:00 pm
Website: Cancer Connection for online help

How to cope

This section will give you some ideas of what you can do to manage stress.

Exercise

Your treatments might make you tired. Exercise can help to improve your mood and increase energy levels. It important to rest after treatments, but resting too much can make your muscles weak and lower your mood.

Exercise can help you:

• build muscle
• improve blood flow
• feel less tired
• improve your mood and self-esteem

It is important to start slowly. Choose activities that fit your level of health and fitness. Stop and rest if you feel sore, stiff, or out of breath. Good exercises include walking, swimming, or yoga. If you like the exercise you are more likely to keep doing it.

Talk to your doctor before you start an exercise program. Your doctor can help you stay safe when you are active.

ELLICSR Healthy Steps

The ELLICSR Healthy Steps involves stretches and dancing set to music in a healing exercise program. This is a 10-week exercise series made for patients at Princess Margaret. Please call ahead to register.

ELLICSR: Health, Wellness & Cancer Survivorship Centre
Toronto General Hospital (TGH), Basement level, B PMB 130
Mondays and Wednesdays, 12:00 – 1:00 pm
Phone: 416 505 5578
Website: ELLICSR

Eat well

Eating well can help you feel better. It is important to have a balanced diet. Avoid foods that are unhealthy or make your symptoms worse. When you eat well, your body feels better which can improve your mood.

Some treatments cause nausea, vomiting, diarrhea and loss of appetite. This can make it hard to eat well during treatment. Talk to your doctor about ways to manage your side effects so you can eat well. You can also ask your doctor for a referral to a dietitian. A dietitian can help you find foods that you can eat while being treated.

Here are tips to eat well and improve your mood:

• do not skip meals
• eat every 3 to 4 hours
• eat foods rich in omega 3 fats (for example, fish, flax seeds and walnuts)
• avoid foods that are high in fat, sugar, or salt (for example, processed foods, desserts, sugary drinks, fast foods)
• avoid foods and drinks high in caffeine (for example, coffee, soda and chocolate)
• prepare healthy food and snacks in advance

ELLICSR Kitchen

The ELLICSR Kitchen program is designed to support people touched by cancer. The program gives you skills and information to manage your diet. It hosts a series of dynamic healthy cooking classes that include:

• healthy, simple and yummy recipes
• special guest visits
• tasty samples

ELLICSR: Health, Wellness & Cancer Survivorship Centre
Toronto General Hospital (TGH), Basement level, B PMB 130
Third Thursday of every month, 12:15 – 1:15 pm
Phone: 416 581 8620
Website: ELLICSR

Sleep

Get enough sleep so you feel less tired during the day. Sleeping well can also improve your mood. Medicine (drugs), treatments and stress can affect how you sleep.

To help you sleep better:

• go to bed at the same time every night
• do something relaxing before bed
• do not use devices such as phones or computers before sleep
• use ear plugs or eye shades if you are a light sleeper and wake up easily
• exercise during the day to help you sleep
  at night

If you can’t fall asleep within 20 to 30 minutes after going to bed, get out of bed and do a light activity (for example, go for a walk, read a book). This may help you feel tired enough to fall asleep.

Relaxing activities

Doing things that you like can help you feel better and less worried. You may feel like you don’t enjoy the things that you used to. You may want to try new things to see what helps you relax.

To help you relax, try the following:

• watch your favourite show or movie
• go for a walk
• finish tasks you need to do, including:
  • chores or appointments. Sometimes it feels good to know that you are in control and that you can get things done
• yoga
• keep a journal
• music or art therapy
• meditation
• deep breathing exercises
• visiting a spiritual centre or place of worship

Gilda’s Club

Gilda’s Club offers support groups, education classes, art programs and children and teen programs. It is also a place where all cancer patients (adults, teens and children), families and friends can connect socially and emotionally. The building is wheelchair accessible. Contact for more information.

There is no fee for this service.

24 Cecil Street
Toronto, ON M5T 1N2
Phone: 416 214 9898
Hours: Monday to Friday, 9:00 am – 9:00 pm
Website: Gilda's Club of Greater Toronto

Wellspring

Wellspring has community centres across Canada that provides support, education and coping skills to people with cancer and their families. Visit the website and click on “Contact Us” or call for more information.

There is no fee for this service.

Relaxation Therapy class

The Relaxation Therapy drop-in class helps people living with a brain tumour who are feeling worried, sad or stressed at various stages of their cancer journey. Relaxation exercises may help you cope with both everyday stress and stress that you may be feeling about your health. No registration required.

There is no fee for this service.

Gerry & Nancy Pencer Brain Tumour Centre
Princess Margaret Cancer Centre, 18th floor
Wednesdays at 1:15 pm
Phone: 416 946 4501 extension 3995

Talk about how you feel

You may be facing a lot of changes. It can be hard to deal with change by yourself. Talking to someone about it can be scary. You may worry that you are being a burden when you share your thoughts. You may also feel like others do not understand what you are going through. It is important to find the right person to talk to. If you do not feel you can talk to your family, you may want to talk to a professional. Talking to someone can help you understand your feelings and reduce stress.

Try talking to:

• your family
• your partner
• your friends
• support groups

A professional can give you advice on how to cope. They can also listen to you without judgement. Some of these professionals include:

• a psychiatrist
• a psychologist
• a psychotherapist
• a social worker

These professionals all have a different approach. Talk to your doctor about which one might be the best approach for you. Your doctor can give you a referral.

Medications

You may want to try medications to help your mood. Your cancer doctor, family doctor, or a psychiatrist can prescribe medicine to help you. Talk to your doctor about drugs to help your mood.

Sex and intimacy

Sex can be hard to talk about with your doctor. Sex and intimacy (physical or emotional closeness shared with another person) are important parts of life. Changes in sex and intimacy with cancer can affect your life and relationships. At the start of your cancer journey, sex may not be the first thing you think about. It is important to try to accept changes you are going through. It may be helpful to talk to your partner.

Dealing with symptoms

Sickness, pain and feelings can make it difficult to have sex. The side effects of your treatment and your mood can also affect sex and your desire to have sex.

Try some of these tips:

• To reduce fatigue, you can plan to take a nap before having sex.
• If you are taking medicine to help with sickness or pain, take it 1 hour before having sex so the medicine has time to start working.
• If you notice changes in sexual function (your body is not responding as it usually does), you can try the therapies below. Talk to your doctor to make sure they will not react with your cancer treatments.
  • hormonal therapy
  • pills for erections
  • lubricants (substances to help make sex less dry and painful)

Connect with your partner

With all of the changes in your body, you might fear that your partner finds you less attractive. Talk to your partner about how you are feeling.

Learning you have cancer can have a big effect on your feelings. You might feel worried or sad more often. During this time, you may want to try other ways of being intimate. Some examples are cuddling, kissing, touching and massages.

Talk about how you feel

• Talk to your partner if you feel unsure, worried or different. Your partner might feel the same way. Talking about it can help you find a way to move forward.
• If you are worried about physical problems with your sexual health, talk to your doctor or nurse.
• Talk to support groups. Others may have advice for you. Hearing from people who have dealt with cancer and sex can help you feel like you are not alone.
• You might be concerned about when to tell future partners about your cancer. Your doctor, social worker or a support group can help you with this.
• Talk to your doctor about concerns you may have about sexual function. You might be scared to talk about this, but your doctor is there to help. You and your doctor can make a plan to manage these problems.

ELLICSR Sex and Intimacy Class

The Sex and Intimacy Class is led by a sex therapist who will help answer questions about:

• short and long term effects of treatment
• how to cope with changes
• how to talk to your partner
• how to talk to your health care team

Call the number below to register for the class.

ELLICSR: Health, Wellness & Cancer Survivorship Centre
Toronto General Hospital (TGH), Basement level, B PMB 130
Phone: 416 581 8620
Website: ELLICSR