Depression in Cancer

Cancer can bring about many different emotions.

The American Society of Clinical Oncology recommends that every patient with cancer be screened for depression when the diagnosis of cancer is first made. They also recommend screening intermittently on an ongoing basis, and especially when there are changes in the cancer or its treatment status -- such as when the cancer is no longer responding to anti-cancer drug therapy -- and when there is a transition to palliative care.

When it comes to actual percentages of people with cancer who become clinically depressed, estimates ranging from about 1 to 40 percent have been reported. Experts say this wide range occurs for a variety of reasons.

Treatment side effects or symptoms of the cancer can mimic the symptoms of depression, including  fatigue, weight loss, depressed mood, disturbed sleep, low energy, and difficulty concentrating.

Another factor – and one that cancer patients have the power to control – is that sometimes patients and families, for a variety of reasons, are reluctant to talk about psychological things with their doctor, so the depression goes unrecognized.

A Few Statistics on Emotions in Cancer

When you step back and away from the diagnosis of pure depression to take a look at what is going on in each case, it helps to give a better picture of some of the psychological challenges that can occur in cancer.

Diagnostic Label -- Cancer Patients Affected:

Emotional Difficulties -- 50 percent

Non-specific distress -- 15 to 42 percent

Adjustment disorder -- 20 to 30 percent

Depression -- 6 to 13 percent

I Have Cancer. Shouldn’t I be Sad?

Yes. Absolutely. Sadness is a normal reaction to a life-threatening disease, and you don’t need a doctor to tell you that.

You get to be sad and to grieve. According to experts in diagnosing depression in cancer patients, sadness isn’t all that useful of a symptom. They point to other potential clues:

  • Lack of ability to experience ANY pleasure or anhedonia
  • Hopelessness
  • Worthlessness
  • Excessive guilt
  • Loss of self-esteem
  • Wishes to die

Feeling like you are a burden to others is a common thought that sometimes responds to counseling. It doesn’t always mean you are depressed, but feeling excessively guilty about it might be a sign of depression.

Feeling hopeless about the prospect of a cure when you are near death is normal, but having no hope at all in other areas – no hope that you might be kept comfortable, no hope that you might just live a little bit longer, can be a sign of depression.

Bottom Line

Identifying depression is tricky business. If your fatigue is from anemia, rather than depression, it won’t necessarily respond to antidepressants. Insomnia due to pain at night is due to the pain, not depression -- but having pain that’s not controlled does increase your risk for depression. It’s this back-and-forth between the mind and the body--and its importance--that should give you all the more reason to talk to your doctor about your feelings, and see what else can be done to feel better.


Andersen BL, DeRubeis RJ, Berman BS, et al. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol 2014; 32:1605.

Vachon ML. Psychosocial needs of patients and families. J Palliat Care. 1998; 14:49.

Strong V, Waters R, Hibberd C, et al. Emotional distress in cancer patients: the Edinburgh Cancer Centre symptom study. Br J Cancer 2007; 96:868.

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