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Remy’s woes befall many after cancer

Depression can hit as survivors adjust

Jerry Remy waved from the Fenway broadcast booth Wednesday. He says it is important to talk publicly about dealing with depression. Jerry Remy waved from the Fenway broadcast booth Wednesday. He says it is important to talk publicly about dealing with depression. (Elise Amendola/Associated press)
By Stephen Smith
Globe Staff / August 14, 2009

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When the bodacious voice of the Red Sox, Jerry Remy, disclosed this week that a wave of depression had swallowed him up in the months after lung cancer surgery, it was a story that rang with sad familiarity to psychologists like Karen Fasciano.

To an outsider, such despair in a cancer survivor would seem surprising: Surely the patient must be triumphal, having won a victory over a potentially lethal disease. But that is not what Fasciano witnesses in her office at Dana-Farber Cancer Institute.

There, she sees patients who are bereft and bewildered. During the months of chemotherapy and radiation, their lives had structure, support, and a singular, energizing focus: defeating cancer. But with treatment finished, some patients suddenly find themselves alone, exhausted, and fixated on how cancer has transformed their lives. And they are consumed by the potential that it could return.

“When you have cancer, often the most essential element is saving your life,’’ said Fasciano, who devotes a substantial amount of her time to helping patients who have finished cancer treatment. “But when people are done with their medical treatment, they experience the existential and emotional adjustment issues related to having had a life-threatening illness.

“Life is uncertain for all of us,’’ she said, “but people who’ve just gone through cancer treatment have a new awareness of that uncertainty.’’

On Wednesday night, from the familiar terrain of Fenway Park, Remy first spoke about his descent into depression. In a telephone interview last night, he described days and nights spent in a state of forlorn emptiness.

“You didn’t want to get out of bed,’’ Remy said, his voice strong, his words plainspoken. “The first thing you thought when you woke up was ‘another lousy day is ahead of me.’ I had no desire to do anything.’’

In November, he underwent surgery to remove a lung tumor, avoiding the chemotherapy and radiation that is so often the regimen of lung cancer patients. A ferocious infection in January weakened him, but otherwise, his recovery went well until the Red Sox made their first foray to the West Coast in April. That is when his mood plunged and he could not drag himself to the ballpark.

“I was a guy who always took pride in being there every day, whether I was sick or not,’’ Remy said. “I couldn’t answer the bell that one night. I really think that’s what triggered it.’’

Mary K. Hughes, a clinical nurse specialist in the psychiatry department at M.D. Anderson Cancer Center in Houston, said recent cancer survivors can easily become overwhelmed if they return to work and life’s other routines too soon.

“They can’t do what they used to do,’’ she said. “That starts them thinking: ‘What if this is forever? What if I’m never going to be able to work?’ And then all those fears start rising.’’

There’s debate among mental health specialists about just how many cancer patients and cancer survivors experience that crash.

Dr. William Pirl of the Massachusetts General Hospital Cancer Center said doctors used to believe that up to 25 percent of cancer patients experienced major depressive disorder, the sort of depression that is far more than a passing bout of the blues. More recent reviews, he said, suggest that a truer figure is 10 percent.

Still, that rate fails to capture patients who have milder forms of the condition, particularly those stricken with something called an adjustment disorder. As the name implies, those patients experience transient depression as they adjust to being diagnosed with cancer.

Patients are also vulnerable to depression midway through treatment, when the deleterious effects of chemotherapy and radiation become more apparent, said Pirl, who studies the treatment of depression in lung cancer patients.

“They’re feeling poorly, and they don’t know whether the treatment is working or not,’’ said Pirl, clinical director of Mass. General’s psychiatric oncology service. “They’re left in this ambiguous zone of not knowing whether their investment is going to pay off and thinking that maybe they’re going through treatment for nothing.’’

There’s also reason to suspect that the powerful treatments used to vanquish cancer may light the fuse of depression, specialists said. The drugs can start a cascade of metabolic and hormonal changes and cause inflammation thought to contribute to the condition.

The Institute of Medicine, an independent body that advises Congress on health affairs, issued a report in 2007 calling on cancer specialists to do a better job recognizing the psychological impacts of the disease and its treatment. Pirl conducted a national survey of oncologists a few years back and found that only two-thirds asked patients how they were coping.

When depression is identified, doctors sometimes prescribe antidepressants and refer patients to counseling.

Remy said last night that his doctors have tweaked his medication so that “they’ve got me going on the right track.’’

Knowing that his absence from the broadcast booth would invite speculation, Remy said he felt it was important to talk about dealing with depression.

“I’m not embarrassed to say so,’’ Remy said. “People go through it all the time. It’s probably best to tell the truth, and that’s what I did. And if it helps people, that’s good, too.’’

Stephen Smith can be reached at stsmith@globe.com.

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