Psychological consequences Though often dismissed as “understandable,” distress is a treatable cause of reduced quality of life and poorer clinical outcome. Some patients delay seeking help because they fear or deny their symptoms of distress. Presentation can be obvious, as depressed or anxious mood can manifest as increased severity of somatic complaints such as breathlessness, pain, or fatigue. Adjustment disorder is the commonest psychiatric diagnosis, and neuropsychiatric complications may occur. The risk of suicide is increased in the early stages of coping with cancer. Depression Depression is a response to perceived loss. A diagnosis of cancer and awareness of associated losses may precipitate feelings similar to bereavement. The loss may be of parts of the body (such as a breast or hair), the role in family or society, or impending loss of life. Severe and persistent depressive disorder is up to four times more common in cancer patients than in the general population, occurring in 10-20% during the disease. “Distress is an unpleasant emotional experience of a psychological, social, or spiritual nature that may interfere with a patient's ability to cope with cancer and its treatment. Distress extends along a continuum, ranging from common normal feelings of vulnerability, sadness, and fear to problems that can become disabling, such as depression, anxiety, panic, social isolation, and spiritual crisis”US National Comprehensive Cancer Network Anxiety, fear, and panic Anxiety is the response to a perceived threat. It manifests as apprehension, uncontrollable worry, restlessness, panic attacks, and avoidance of people and of reminders of cancer, together with signs of autonomic arousal. Patients may overestimate the risks associated with treatment and the likelihood of a poor outcome. Anxiety may also exacerbate or heighten perceptions of physical symptoms (such as breathlessness in lung cancer), and post-traumatic stress symptoms (with intrusive thoughts and avoidance of reminders of cancer) occasionally follow diagnosis or treatment that has been particularly frightening. Challenges faced by people with cancer Maintaining activity and independence Coping with treatment side effects Accepting cancer and maintaining a positive outlook Seeking and understanding medical information Regulating the feelings associated with cancer experiences Seeking support Managing stress Certain cancers and treatments are associated with specific fears. Thus, patients with head and neck cancers may worry about being able to breathe and swallow. Patients may develop phobias and conditioned vomiting in relation to unpleasant treatments such as chemotherapy. Neuropsychiatric syndromes Delirium and dementia may arise from brain metastases, which usually originate from lung cancer but also from tumours of the breast and alimentary tract and melanomas. Brain metastases occasionally produce psychological symptoms before metastatic disease is discovered. Certain cancers (notably cancers of the lung, ovary, breast, or stomach and Hodgkin's lymphoma) sometimes produce neuropsychiatric problems in the absence of metastases (paraneoplastic syndromes). The aetiology is thought to be an autoimmune response to the tumour. Risk factors for psychiatric disorder Patient History of psychiatric disorder Social isolation Dissatisfaction with medical care Poor coping (such as not seeking information or talking to friends) Cancer Limitation of activities Disfiguring Poor prognosis Treatment Disfiguring Isolating (such as bone marrow transplant) Side effects