As “World Teen Mental Wellness Day” is upon us on March 2, there is no better time to bring attention to the unique mental health challenges of teens who battle cancer. Statistics show that teens have higher rates of mental disorders overall than adults. For example, the National Comorbidity Survey Adolescent Supplement reports an estimated 49.5% of US adolescents (13-18 years old) have had a mental disorder. This compares to 21% of adults who have a mental illness. Additionally, rates of various mental health disorders in teens have been increasing each year.

When World Mental Health Day originated in 1992, it took 20 years before World Teen Mental Wellness day was created, finally giving due attention to teens with mental health challenges. The fact that it took nearly two decades for teen mental health to get attention points to two significant problems. The first is that we haven’t been collecting data on teens for very long. The second is that teen mental health is getting worse.

This lack of attention to teens with mental health issues is exacerbated when that teen is or has battled cancer. There are many reasons why teens are more vulnerable to mental illness. Teens experience pivotal life changes with little control over their lives or bodies. Adolescence is the time to establish your own identity, something as scary as it is exciting. Add a life-or-death battle with cancer to these current teen development issues, and you have the perfect mental health storm!

MENTAL HEALTH IN TEENS WITH CANCER

At this stage in their lives, teens are looking for independence, and a cancer diagnosis means social, emotional, and financial change. Often it means they must be more reliant on their parents or guardians in ways they feel is unfair or detrimental to their development. They know their health limits them in ways they did not expect.

In addition, several studies have shown that young adult cancer patients report a higher symptom burden than older adults, including more significant cancer pain through treatment and afterward. Pain and depression are linked, so it’s likely that as cancer pain intensifies depression, depression exacerbates physical pain. Cancer survivors are often left with a fear of recurrence, a changed relationship with their bodies, and chronic health issues. Unfortunately, these are challenges their peers are most likely not facing. 

Emotional concerns of treatment can also have a lasting impact. Teens are already stressing about their bodies due to puberty; it’s not surprising that cancer-related changes like hair loss, weight gain, or scars from cancer treatment can increase these negative feelings. This can cause concerns about their future. Teens that are unhappy with changes in their bodies may worry about their ability to have romantic relationships or even friendships. That fear might be compounded by cancer or treatment’s effect on fertility.

No teen wants to feel isolated or alone. But teens going through cancer treatment often are. Teens undergoing chemo face friends treating them differently, or experience fears talking to their friends about what’s happening to them. Today teens are swayed by peer pressure and outside opinions and typically haven’t found enough security in their identity to ignore the views of their peers. Social media can be a great place to build community or a terrible site for bullying, where unrealistic ideas of lifestyles are always one click away. Teens may also face overwhelming academic pressures, especially when undergoing treatment that keeps them from the classroom or hours required to study and do homework. They want to maintain relationships intact and keep up in school to remain with their peers. Unfortunately, this is not always possible and leads to depression and mental health concerns.

PARENTS OF TEEN CANCER PATIENTS BEWARE OF…

Adolescents face a unique challenge in that health decisions often go through their parents. Sometimes parents delay treatment for mental health issues because they cannot believe that their child could be diagnosed with a mental illness. For example, parents of teen cancer patients often think these mental health issues will end when cancer treatments end. They, therefore, choose to focus on the cancer treatments over their teen’s mental health. Parents should know that if their teen is struggling with their mental health, it is not because the teen or parent has done anything wrong or that it is purely cancer treatment-related and will go away. They should also know that delaying mental health treatment can have severe repercussions on the teen’s wellbeing.

For the past few years, COVID has compounded the challenges of cancer treatment, recovery, and mental health concerns. Fear can be intensified in conjunction with cancer and Covid. Even healthy teens have faced new levels of isolation, depression, and unexpected change. Everyone with a teen in their lives should be knowledgeable about the mental health challenges they face and know how to help them.

The good news is that we’re more aware than ever of the declining state of teen mental health, and awareness leads to destigmatization and, hopefully, solutions. So while it’s terrible that this problem is growing, we can be hopeful that the response is growing along with it.

WHAT TO LOOK OUT FOR

Kids with cancer may have different indicators of mental illness, or usual indicators might be unreliable because they are also symptoms of cancer and treatment. Additionally, each mental illness has various indicators. Still, here are some signs to look out for.

• Loss of interest in activities that they used to enjoy
• Low energy
• Difficulty sleeping or excessively sleeping
• Spending more time alone and avoiding social activities
• Excessively exercising, dieting, and/or binge eating
• Self harm (e.g., burning or cutting their skin)
• Crying easily or being unable to cry
• Feeling hopeless; Thoughts of suicide
• Unwanted recall of painful aspects of cancer
• Feeling extremely fearful, upset, or angry when thinking about cancer
• Physical reactions (rapid heart rate, shortness of breath, nausea) when thinking about cancer
• Avoiding healthcare visits; white coat syndrome (increase in blood pressure)
• Refusing to talk about cancer

It’s also important to note that females, young adults with brain, spine cancer or requiring intrathecal chemo, and teens with prior trauma or other mental health issues are at higher risk. 

HOW TO HELP YOUR TEEN?

The most important thing you can do is not uphold the stigma against talking about mental health or against seeking professional care when needed. Teens in your life need to know that you are a safe person to talk to and that you will connect them to professionals if required.

Increasing your mental health literacy is a great way to start. Improved mental health literacy, defined as the “knowledge and beliefs about mental disorders which aid their recognition, management or prevention,” has de-stigmatized mental illness and made teens more able and likely to seek help. This can start with you.

DURING TREATMENT

Make sure your teen’s doctors are monitoring their mental health as well as their physical health. If accessible, mental health screenings or check-ins with therapists could be key to identifying mental health issues. Additionally, ensure communication between your teen and their oncologist is strong. Some doctors are more comfortable working with adults or young children than teens, and your teen may feel out of place in a doctor’s office where the patients are doing most of the talking and discussions about treatment. Teens can also be more resistant to treatment than other groups. They, rightfully, want to have the same lives and opportunities as their peers and thus may not take treatment as seriously as is necessary.

Mental health is just as important as physical health. In fact, mental health has a significant impact on physical health. Cancer patients with depressive disorders have documented more prolonged hospital admissions and are less likely to follow prescribed treatment regimens. The mental effect of cancer on teens is life-changing and needs to be treated with the same importance as physical care.

Encourage your teen to spend time talking with peers and friends. Having a connection with old friends or support from a group of teens experiencing similar things can be invaluable. Then, connect them with a professional when more help is needed.

POST-TREATMENT

Watch your teen post-treatment when they have time to slow down and process what they’ve been through. They are likely to experience intense sadness, guilt, and/or relief.

Consider getting therapy yourself – you have lived through trauma too! It could be vital in maintaining a healthy relationship with your teen. Over-protection after cancer treatment can lead to extraordinary tension between parent and child.

Remember that there may have also been positive growth through all the difficulties of cancer. Some survivors and their families experience beneficial changes in relationships, personal growth, and understanding of what they value. It can be powerful to remember the growth experienced during trauma.

One of the reasons teens are most affected by mental health issues is that teens can be resistant to seeking help. In this period between childhood and adulthood, teens want to establish themselves as individuals and prove that they can live independent lives. The best thing you can do as a fellow teen is to practice seeking help and show your friends that you are someone they can come to for non-judgmental discussion. Having a strong, trusted support system is invaluable when someone is struggling with mental illness.

HELP TEENS WITH CANCER ON A LARGER SCALE

If your teen is in cancer remission, remember that this is something to celebrate! But don’t forget that the diagnosis and treatment’s mental effects can last long after treatment ends. Often it can show up in sleep disorders. It is not just Covid that causes mental illness. Cancer treatment and survival is a big cause and sleep or lackthereof is a significant indicator. It can feel scary that so many teens, particularly those that have already survived cancer, are diagnosed with mental illnesses. We all want teens to have fun, enjoy this unique time of life, and figure out who they are. But as awareness builds and stigma slowly dissipates, we can continue to put up a united front to help teens everywhere.

For instance, many community colleges and universities have programs like “Students with Disabilities.” Teenagers can resist this help because of the name and the stigma they see that goes along with it. However, these programs are not publically administered and under the average student’s radar. They give the cancer survivor many much-needed benefits, like early class selection/registration, note-takers, longer times on tests that no other students are even aware of, help with study methods, and more. We need to remove barriers to treatment. Unfortunately, we don’t have enough data to identify the best ways to help because people are just now studying teen-specific and general mental health problems. Many of us can only solve these problems by supporting charities that make help and solutions more accessible.

You can help directly by donating to Here to Serve. This organization works to remove some of the stressors that can lead to long-term mental health issues and to provide tangible support to eliminate challenges that can become unmanageable when dealing with poor mental health. One of the most essential factors in maintaining positive mental health is support. Join Here to Serve on our mission to support families on their cancer journey.

Sources/Find additional info about teens with cancer at:

• CDC: https://www.cdc.gov/childrensmentalhealth/data.html
• NCBI/NLM/NIH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518700/
• US Department of Health and Human Services: https://opa.hhs.gov/adolescent-health/mental-health-adolescents#1
• NIH: https://www.nimh.nih.gov/health/statistics/mental-illness
• Science Direct: https://www.sciencedirect.com/science/article/pii/S1054139X20300331?casa_token=7oDXTrxCQIcAAAAA:GNzeRJMxl3kIbmzHAqHbKOVYTBFuEvCcyYC7R4BAamYZDKeb3ulH2zVswyEFAEl81Hn9XZrKrlE#bib12
• https://www.sciencedirect.com/science/article/pii/S1054139X20300331?casa_token=7oDXTrxCQIcAAAAA:GNzeRJMxl3kIbmzHAqHbKOVYTBFuEvCcyYC7R4BAamYZDKeb3ulH2zVswyEFAEl81Hn9XZrKrlE
• American Cancer Society: https://www.cancer.org/cancer/cancer-in-adolescents/special-issues.html
• Children’s Oncology Group: http://www.survivorshipguidelines.org/pdf/2018/English%20Health%20Links/15_emotional_issues%20(secured).pdf
• Penn Medicine: https://www.pennmedicine.org/updates/blogs/health-and-wellness/2017/may/teens-mental-health

By Kelly Markus

About The Author

Kelly Markus studied Film and Television and has spent time on sets in Los Angeles. Originally from the East Coast, she has moved back home. Since 2020, she has decided to refocus on writing. Having seen loved ones battle cancer, blogging for Here To Serve is close to her heart.

All information on this blog is for informational and educational purposes only. Always consult a medical provider in your particular area of need before making significant changes in your medical decisions or lifestyle.