In 2022, it was estimated that 18.1 million US adults were cancer survivors. By 2032, this number is projected to increase to 22.5 million. All patients with cancer experience some degree of psychological distress associated with the diagnosis. This can include mental health conditions, most commonly anxiety and depression. Management of such conditions in cancer survivors begins with detection via screening. Commonly used screening tools include the National Comprehensive Cancer Network (NCCN) Distress Thermometer, the 7-item Generalized Anxiety Disorder (GAD-7) scale, and the Patient Health Questionnaire-9 (PHQ-9). Initial management involves patient education and psychotherapy. If needed, pharmacotherapy is similar to that for patients in the general population. Of note, several commonly prescribed antidepressants have been shown to decrease the effects of tamoxifen, which breast cancer survivors may be taking as adjuvant endocrine therapy. Integrative medicine therapies, such as music interventions, yoga, mindfulness meditation, and exercise, have shown benefit. Patients undergoing treatment should have outcomes assessed. Thoughts of self-harm or suicidal ideation are common among cancer survivors with mental health conditions. Clinicians should regularly ask patients about suicidal ideation. If present, this indicates the need for more intensive or altered treatment.

Case 1. PG is a 47-year-old premenopausal patient who comes to you because she is feeling depressed. She has a history of stage I breast cancer for which she underwent lumpectomy and adjuvant radiation therapy. This is year 4 of 5 planned years of tamoxifen therapy. PG describes feeling depressed for several months and scores 17 points on the Patient Health Questionnaire-9 (PHQ-9). However, she says she is reluctant to agree to psychotherapy because of time constraints. She says she would consider drugs but only if they will not cause weight gain.