McGill

Depression

Dr. Christine Maheu, RN, PhD

Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.

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Ms. Rosemary Cashman

Ms. Rosemary Cashman is a nurse practitioner at the BC Cancer Agency and an Adjunct Professor in the Faculty of Nursing at the University of British Columbia. Her professional experience includes the care of lymphoma, lung cancer and brain cancer patients. She co-chairs the Patient and Family Advisory Council, which guides the brain tumour care program at the BC Cancer Agency. She has authored book chapters and articles related to the care of brain tumour patients and their families. Ms. Cashman was involved in developing and implementing a rapid-access radiotherapy clinic for the palliative treatment of lung cancer and she continues to work in this clinic.

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Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C

Ms. Maureen Parkinson is the province-wide vocational rehabilitation counsellor at the BC Cancer Agency. She has also been vocational rehabilitation counsellor at a public rehabilitation hospital and vocational rehabilitation consultant to insurance companies and the court system. She has instructed and facilitated Service-Canada-funded programs on job searching and career exploration. Ms. Parkinson has a Masters in Counselling Psychology, is a Canadian Certified Rehabilitation Counsellor, and completed the Certified Return to Work Coordinator Program through the National Institute for Disability Management and Research. She has developed return-to-work and job-search seminars for cancer patients and created the guidebook “Cancer and Returning to Work: A Practical Guide for Cancer Patients” as well as on-line articles about returning to work and school. She also co-authored a paper commissioned by the Canadian Association of Psychosocial Oncology, “Cancer and Work: A Canadian Perspective”.

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Depression is a major cause of disability worldwide1, and is about 4 times more common in people with cancer than in the general population. One critical review of depression associated with cancer suggest that the rate of depression for solid tumours range from 20% to 50%2. However, pulled from multiple studies, the rate of depression among cancer patient can range from 3% to 38%1.

Cancer patients often experience emotional challenges in dealing with the cancer diagnosis, treatments and their side effects, and immediately after treatment ends. Those experiencing depression may struggle to maintain their quality of life, physical activities, relationships and sleep1. Common issues associated with depression include poor sleep, fatigue, lack of drive, difficulty focusing and slowed movements, anxiety about how your colleagues will relate to you and how to manage responsibilities at work.

It’s common for people who have recently been treated for cancer to experience painful emotions including times of sadness. These feelings may be associated with loss of function, loss of a role, change in appearance, sense of lack of support from others, and many other possible challenges. It’ is normal to have times of feeling sad about such things. However, if sadness is persistent over at least two weeks and not interrupted by better times where one can enjoy some things, professional support should be sought out. Without support, people with depression can begin to struggle with physical activities, work or school, relationships, and personal care.

Major depressive disorder or “Clinical depression” is characterized by:
– At least two weeks of sadness or depression that does not contain some “good days” and where it’s often hard to enjoy things that one usually finds enjoyable
– Other symptoms such as:
– Disrupted sleep, poor sleep, or too much sleep
– Poor or increased appetite
– Lack of focus or concentration
– Slowed movements
– Feelings of shame or guilt
– Low energy
– Feelings of hopelessness or worthlessness
– Thoughts about suicide

Vocational Implications

  • Depression can cause cognitive difficulties and fatigue that has the impact to affect work performance.  Please consult the Cognitive Challenges (changes in thinking) and the fatigue page from this website for more tips.  Those with depression may experience lower self-confidence and thus be more unsure in decision making and in interacting with others.

What you can do

Some symptoms of depression can be similar to cancer treatment side effects, making it harder to identify depression in cancer patients. Still, if you are experiencing one of the following symptoms, you may want to speak to your healthcare provider.

The main symptom of depression is a sad, despairing mood that:

  • lasts most of the day, every day
  • lasts for more than 2 weeks
  • affects performance at work or at school or affects relationships

Other symptoms of depression may be:

  • feeling useless, hopeless, helpless or negative
  • loss of interest or pleasure in work, hobbies, activities and relationships that you usually enjoy
  • less energy or extreme tiredness (fatigue)
  • trouble concentrating, remembering or making decisions
  • feeling nervous, restless or irritable
  • change in appetite and weight
  • change in sleep habits such as trouble sleeping (insomnia), early-morning waking or oversleeping
  • frequent thoughts of suicide (which should always be taken seriously)

Depression

Further reading: Tips to help you feel less sad or depressed (Canadian Cancer Society)

Depression can be treated successfully but the first step is identifying it. Here are resources that may help:

Job accommodations

Modify your work tasks and how you work:

Modify your work environment:

  • Increase natural lighting or add full spectrum lighting.
  • Practicing energy conservation:
    • Prioritizing:
      • Which duties are essential for your job to be done? Which could be delegated to someone else? Use your energy to accomplish the most important duties and help reduce stress by sharing tasks.
    • Planning:
      • Track your energy levels to recognize patterns of high and low energy points. Schedule more demanding tasks or those of higher priority during times of high energy.
      • Plan your day so that fatiguing tasks are spread out. Balance high and low energy tasks.
      • If possible, spread high energy tasks over several days in your work week.
      • Allow time to rest between tasks.
      • Do one thing at a time—ensure that you finish every task prior to starting a new one. Things will be accomplished quicker and with less mistakes which reduces your stress!
      • Gather all necessary materials for a task prior to beginning it.
    • Pacing:
      • Anticipate that things may take longer; make sure that you take this into account when scheduling your day. Do not expect to be working at the same speed as you were before. Be sure to communicate with your manager and team members the need for more time and less pressure to complete tasks.
      • Implement regular rest breaks. Schedule these rest periods and stick to your schedule. Taking the time to recharge is fundamental. Change tasks before you become fatigued. Take two minutes every hour to stretch

    Job Accommodation Ideas

     Other resources: