Any type of cancer can be tough on your mental health, but relapsed or refractory diffuse large B-cell lymphoma (DLBCL) comes with some unique challenges.
If you have relapsed DLBCL, this blood cancer, which affects your lymphatic system, has come back, sometimes years after your last treatment.
"While we have recurrent treatment options available, it's emotionally very tough for patients," says David Greenberg, MD, chief of hematology and oncology at Hackensack Meridian Jersey Shore University Medical Center in Neptune, New Jersey. "Many of them have thought they've beaten their lymphoma, now they're faced with it again, and all those feelings come back."
Between 10% and 15% of DLBCL cases are refractory DLBCL. This means your treatments aren't working, and the cancer cells will keep spreading.
"It's normal for people to experience a wide range of emotions in response to a diagnosis of relapsed or refractory DLBCL," says Caroline Lange, LMSW, a clinical social worker at Memorial Sloan Kettering Cancer Center in New York City. "In addition to anxiety and depression, some of these might include anger, fear, social withdrawal, loneliness, uncertainty, and existential or spiritual distress."
Why Mental Health Matters
When you're dealing with cancer, paying attention to your mental health can fall off your to-do list.
But research shows that when your mental health isn't at its best, you're less likely to:
- Follow your cancer treatment plan
- Take steps to care for your health (like exercise)
- Get support from friends and family
- Manage health insurance challenges
- Have a meaningful relationship with your doctor
"For someone with relapsed or refractory DLBCL, depression and anxiety may be especially likely at the point of relapse; around scans, tests, and the start of a new treatment; and as symptoms appear," Lange says. "Ongoing physical symptoms that are challenging to manage can also bring on or intensify experiences of depression and anxiety."
Signs of Depression
One in every four people with cancer have depression. Some symptoms include:
- Having little interest in things you usually enjoy
- Feeling hopeless
- Changes in eating habits (like not eating or eating too much)
- Feeling like a failure or that you've let others down
- Not being able to concentrate
- Moving or talking slower than usual
- Having thoughts of hurting yourself
- Feeling like you would be better off dead
If you've been feeling sad for a while, you could also:
- Cry often and easily
- Be quick to anger
- Not want to spend time with friends or family
- Quit hobbies or activities you like
- Find it hard to remember things
- Use drugs or alcohol
If you've had depression before, it's more likely to come back when you're dealing with cancer.
Signs of Anxiety
Anxiety is another common response to cancer. Knowing that your health is under threat triggers your nervous system's "fight, flight, or freeze" mode. If it doesn't switch "off," you're stuck with a constant feeling of worry.
Anxiety can get in the way of your daily life. Some signs include:
- Feeling nervous or "on edge"
- Not being able to relax
- Finding it hard to sit still
- Being easily annoyed
- Having a sense that something bad is about to happen
You could worry about your DLBCL treatment. You could feel anxious about your family, job, or other responsibilities. It's common to also worry about not knowing what to expect.
When to Talk to Your Doctor About Your Mental Health
Doctors do their best to keep tabs on your mental health, but their main focus is on curing your cancer. That means "[we] sometimes don't remember to ask the questions like, 'How are you doing?' 'How do you feel?' 'How's your mental state?' A lot of times, patients will have to volunteer that information," says Greenberg.
But your care team wants to support you and can suggest many treatments that can make a positive difference. That could include:
- Talk therapy
- Medication
- Light therapy, in which you sit under a special light every day for 30 minutes
- Acupuncture
- Yoga
- Relaxation therapy
- Music therapy
- Hypnosis
- Massage therapy
- Meditation
"Feel empowered to share your mental health symptoms with your doctor early and often," Lange says. "Oncology teams are very interdisciplinary, and support is available."
How to Support Yourself
Taking care of your mental health may help you feel more in control.
Try to:
Make time for self-care. Any activity that helps care for your body and mind will help reduce your stress and recharge your energy. Self-care for you might mean cleaning out your kitchen drawers, listening to a podcast, or just crossing something off your to-do list.
Get moving. When you work out, your body releases "feel-good" chemicals that help improve your mood. Any amount of exercise can have benefits. If you're not sure what type of exercise is safe for you to try, ask your doctor.
Eat foods that support your mental health. Try to limit sweets, sugary drinks, and refined carbs like white bread and pasta. These can increase "stress" hormones. Better choices for your mood include:
- High-quality protein like eggs, salmon, tofu, and chicken
- High-fiber options, like fruits, veggies, beans, and whole grains
- Fermented foods, like Greek yogurt, kimchi, and sauerkraut
Do your best to get out. "I personally encourage all my oncology patients to try and stay active and engaged," Greenberg says. Spend time doing activities you enjoy and with family and friends. Sitting at home could make you feel more depressed and isolated.
How to Get Support From Others
Support from others can make it easier to manage your diagnosis of DLBCL. It could also improve your quality of life.
Try to:
Include people you trust in your treatment plan. That could mean asking them to come to doctor visits with you.
Ask friends and family to help out with your day-to-day needs. Accept help with child care, errands, and cooking.
Stay organized. Ask someone you trust to share updates about your health with family and friends. "There are also great resources to help coordinate care, like Lotsa Helping Hands," Lange says.
Tap into DLBCL resources. For instance, trusted nonprofits like Blood Cancer United and CancerCare offer free information and support services that may help ease your worries.
Join a DLBCL support group. It could be an online group or one that's offered through your medical center. "Hospital social workers can help you and your family explore what kinds of support might be most helpful," Lange says.
If you need help right away, call or text 988 to reach the 988 Suicide & Crisis Lifeline. You can reach someone 24/7, and it's confidential and free.
Opening up about your feelings may feel awkward at first, but it will help you get the support you need to feel better. You may not have control over your DLBCL diagnosis, but you can take control of your mental health.
Show Sources
Photo Credit: E+/Getty Images
SOURCES:
David Greenberg, MD, chief of hematology and oncology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey.
Caroline Lange, LMSW, clinical social worker, Memorial Sloan Kettering Cancer Center, New York City.
Cleveland Clinic: "Diffuse Large B-Cell Lymphoma."
Psychological Medicine: "Depression and cancer mortality: a meta-analysis."
Lymphoma Coalition: "Living With Diffuse Large B-Cell Lymphoma (DLBCL): A Toolkit for Patients, Loved Ones, and Caregivers."
American Cancer Society: "How Exercise Can Help Manage Depression During Cancer," "Supportive Care During Cancer," "Anxiety," "Depression."
988lifeline.org: "What to Expect."
CancerCare: "Diffuse Large B-Cell Lymphoma," "Anxiety and Cancer."
MD Anderson Cancer Center: "8 Foods That Impact Stress."
Blood Cancer United: "Resources for blood cancer patients."
Active Minds: "Self-Care."
