Distress and Depression in Children with Cancer

Most kids with cancer experience some level of distress associated with their diagnosis and treatment. Distress is defined as any unpleasant feeling, emotion, or experience that affects your quality of life, and your ability to cope with your cancer diagnosis and treatment. Distress is a normal and expected side effect of cancer diagnosis, treatment, and survivorship.

Distress can be experienced in many different ways and can impact different parts of our lives. Distress includes:

• Practical issues/challenges (housing, insurance, transportation, disability).
• Family issues (talking with family and siblings, family support systems).
• Emotional challenges (depression, fears, nervousness, sadness, worry, loss of interest in usual activities).
• Spiritual or religious concerns.
• Physical problems (appearance, fatigue, pain, eating, getting around, sexual function, sleep).

This distress can impact your child’s functioning (physically, emotionally, and psychologically). Children with cancer also experience worry, sadness, anger, and hopelessness at various times in their cancer experiences. However, most children are resilient and possess strategies for managing these feelings, harnessing social support, accessing assistance, and processing emotions. But, distress can develop into depression as a result of the stress of the diagnosis, treatment, and even survivorship.

There are other factors that may increase the risk of depression in children. These include:

• Having a family history of depression.
• Being a girl.
• Being in puberty and experiencing hormonal changes.
• Experiencing other challenges, like anxiety and learning disorders.
• Having a history of emotional, behavioral, or developmental issues.
• Being an adolescent.
• Experiencing prolonged absence from school and peer support, which leads to social isolation.

Depression symptoms can also put additional stress on relationships with family and friends. Depression symptoms can overlap with cancer-related distress, but depression is different. Depression can interfere with education, school, and recreational activities. It is important for parents to be aware of the symptoms of depression. Check in with your children (including siblings) regularly about their feelings of distress, stress, and coping with cancer on a regular basis. Some symptoms of depression are:

• Feeling sad, down, and/or hopeless.
• Loss of enjoyment in activities.
• Changes in eating and sleeping habits.
• Irritability.
• Anger.
• Hypersensitivity (taking things too personally).
• Social withdrawal.
• Behavior changes characterized by vocal outbursts, crying, temper tantrums, or “melt-downs.”
• Inability to concentrate.
• Recurrent thoughts of death or suicide.

In children with cancer, the diagnosis of depression can be very difficult, as some of the symptoms (like fatigue, changes in weight, appetite, and sleep problems) can also all be related to the cancer and its treatment.

Treating Depression in Children with Cancer

Treatment of depression in children with cancer can consist of psychotherapy (talk therapy, behavior modification, cognitive behavioral therapy), teaching life skills and coping strategies, medication, or a combination of these methods. Family therapy may also be helpful. Treatment for depression can last six months or longer. Treatment may also be necessary later in life if depression symptoms recur.

When to Contact your Child’s Care Team

If your child is experiencing these symptoms for two weeks or more, contact your healthcare team for a full depression screening and assessment. Your child will also be assessed for risk of self-harm and suicide as part of this screening, as there is a higher prevalence of suicidal thinking and action in children with depression.