What does grief have to do with having cancer? Many people with cancer experience grief related to losses or changes brought about by cancer. Grief, which can be expressed as sadness, is a natural response to changes such as the loss of health, a clouded future, and shifts in identity.  

Grief is a collection of emotions that includes sadness and anger. Adapting to cancer can bring out different aspects of grief such as full or partial denial, longing for the situation to be different, guilt or shame about the past (I could/should have...), and for some people, trying to find meaning in this unwanted situation.  

There are similarities and differences among feelings of sadness, grief, and depression. Similarities may include feelings of sorrow, pain, and experiencing disruptions in your daily life. Generally, grief brings waves of emotions, and the experience is not one of persistently low mood, while depression does not always have a direct cause, it may have an event that triggers it, and it is persistent with episodes lasting weeks to months. You may experience both grief and depression simultaneously, but you can also feel each one separately.  

Due to societal stigma, depression might be harder to talk about than cancer. While sadness may come and go, depression is a clinical condition lasting at least two weeks and can require treatment. Symptoms include low mood, loss of interest in usual activities, changes in appetite and/or sleep changes, decreased energy, feelings of worthlessness or guilt, difficulty concentrating, and even thoughts of not wanting to be alive.

Many factors contribute to the development of depression, but it is not your fault or something you caused. The prevalence of major depressive disorder (MDD) in patients with cancer has ranged from 8% to 24% and the number of people living with symptoms but not diagnosed with MDD is even greater.

Depression is one of the most common forms of psychological distress. It is a burden for the person living with cancer and impacts the quality of life and sometimes adherence to treatment. While cancer is a risk factor for depression, individuals with a history of depression are particularly vulnerable to another episode of depression during cancer treatment. 

A range of biological, psychological, or social factors may play a role in the emergence of depressive symptoms.***

• Physical burden of cancer 

• Meaning of the cancer 

• Treatment for cancer 

• Losses related to cancer 

• Secondary impact of side effects from treatment (less able to engage in usual and meaningful activities due to fatigue or other side effects)  

• Medications or cancers that impact the brain 

Often sadness (and mood in general) can be tracked closely with physical symptoms and side effects. Many people feel emotionally down following a chemo treatment when they may be experiencing fatigue or nausea and can't participate in usual activities. Often your mood will improve when your physical symptoms get better.   

Many symptoms of cancer and its treatment overlap with depressive symptoms. Medications can cause sleep difficulties, fatigue, and appetite loss but these are also symptoms of depression. You may need to work with your healthcare provider to understand what factors are contributing to your mood and how best to treat it.  

Grief versus depression

• Have hope. Most often depression gets better with treatment. 

• Voice your concerns. Discussing your sadness and depression is crucial to getting support. You know yourself best, and it may require persistence in sharing concerns. Speak up and get the help and support you need. Getting treatment is a sign of strength.  

• Choose an effective treatment. Evidence shows that the most effective treatment for depression is a combination of medication and counseling. 

  • Medication: Talk with your medical team about your concerns and available medications. 

  • Psychological interventions (psychotherapy or counseling): A mental health therapist can partner with you to help identify thought patterns and behaviors contributing to your depression. Re-balancing your thinking and learning new behaviors can help. Schedule an appointment with an Iris mental health therapist today to explore feelings of sadness.  

• Keep moving. Exercising at least three times per week has been shown to help with depression.  

• Keep a routine. A routine can help keep you engaged in activities and provide a sense of control. 

• Seek social support. If you feel like self-isolating, social support is essential to helping depression. Who could you ask to help you to be aware of changes in your mood that might mean you are depressed? Give a caregiver permission to point this out to you.

Grief and its expression as sadness is a natural response to loss and change. Cancer often brings losses and a need to grieve and express sadness around unwelcome changes.  Allowing yourself to express your grief can help you move through it. Depression can surprise people by appearing at any time in cancer treatment. When considering depressive symptoms, separate normal and adaptive sadness and grief from more severe and persistent symptoms that interfere with social functioning, relationships, and adherence to cancer care.