Cancer’s physical and psychological symptoms: when to intervene and for which ones?

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Scientific interpretation

From the first signs of cancer until the end of treatment, the process can be gruelling, and at times, the challenges are many. In addition to physical symptoms, such as fatigue and pain, are the psychological symptoms, often taking the form of anxiety, depression and insomnia. These symptoms rarely present individually and generally interact with each other. Which symptoms are conducive to the emergence of others over time?

This knowledge would allow for the targeting of symptoms on which to act, and when it is best to act to prevent deterioration in the mental and physical state of people who have cancer.

This is what Trudel-Fitzgerald and colleagues (2013) tried to understand.

Expert advisor

Claudia Trudel-Fitzgerald, research scientist at the Harvard School of Public Health and clinical psychologist at the Ordre es Psychologues du Québec [Order of Quebec Psychologists]


Étienne FOUQUET, research assistant, Université de Sherbrooke

MARIE-ÉLISE LABRECQUE, professional researcher, Université de Sherbrooke 

This initiative was made possible through a collaboration with the Université de Sherbrooke.



Anxiety can present under various forms. The person may experience feelings of tension, worry, fearing the worst for the future, or sudden feelings of panic.


Depression is experienced as a loss of pleasure in things the person used to enjoy, accompanied by moodiness and/or a feeling of moving in low gear.


Insomnia is characterized by sleep problems, frequent and/or prolonged wakefulness during the night, or waking up very early in the morning.


Fatigue is not only the result of a lack of sleep. Symptoms include the feeling of being in poor physical condition or feeling that one has little physical resistance; feeling fatigued.


Pain as described in this article is physical pain: that is, a person feels significant discomfort or pain anywhere in their body.

Complete reference

Trudel-Fitzgerald, C., Savard, J., et Ivers, H. (2013). Which symptoms come first? Exploration of temporal relationships between cancer-related symptoms over an 18-month period. Annals of Behavioral Medicine, 45(3), 329-337.


Country: Québec, Canada

Recruitment of participants: Patients were recruited during their pre-operative appointment for surgery related to cancer, either at Hôtel-Dieu de Québec (CHUQ) or at Hôpital du St-Sacrement (CHA), in Québec, Canada, from 2005 to 2007.

Number of participants: 828

Method used: Longitudinal study that followed cancer patients from the beginning to the end of their treatment (the care trajectory).

Average age: 56.9 years

Percentage of women: 68.8%

Main types of cancers: breast cancer for women; prostate cancer for men.


Fatigue and anxiety can predict future symptoms.

1. The best predictor of a symptom over time is the symptom itself!

  • In fact, levels of anxiety, depression, insomnia, fatigue and pain experienced during a given period effectively predict the level of these same symptoms a few months later.

2. Fatigue predicts several symptoms around one year after surgery.

  • The relationship between fatigue and insomnia can seem counter-intuitive. However, people who have cancer, to offset the effects of fatigue that treatments involve, may take naps or lie down in their bed during the day. Although this strategy can be beneficial in the short term, it can disrupt the circadian sleep rhythm in the medium and long term.


  • Fatigue resulting from cancer treatments generally causes a decrease in physical activity, which can contribute to a depressive mood. The same is true for the decrease in social contact, which is often reduced due to fatigue. This social isolation can also contribute to sadness and a loss of interest linked to depression.


  • Fatigue can lead to reduced physical activity in terms of sports (e.g. walking, cycling) or movement related to daily activities (e.g. cleaning, gardening). In the medium and longer term, physical inactivity can cause muscle deconditioning, which can increase physical pain related to posture or to resuming physical activity in the future.

3. Anxiety effectively predicts insomnia and all the other symptoms several months later: depression, fatigue and pain.

  • Psychophysiological anxiety and catastrophic thinking (e.g. “I won’t be able to do everything I need to do at work tomorrow if I don’t sleep well” or “if I don’t sleep well, I will have terrible side effects after getting my chemotherapy tomorrow”) are symptoms of anxiety. They can increase the time needed to fall asleep or can prolong nocturnal awakenings.


  • It seems that interventions that focus on symptoms of anxiety, when they are done early in the cancer care trajectory, can prevent an increase of other symptoms over the following months. Also, they may reduce the risk of developing or aggravating sleep problems during the 18 months following cancer surgery.


What you need to know…


1. The cancer care trajectory varies from several weeks to several years.

  • Depending on the type and stage of cancer, patients receive different oncology treatments. For non-metastatic cancers, curative surgery can be followed by radiation therapy and/or chemotherapy treatments in the months that follow. In some cases, hormone therapy treatments will also be started and will continue for several years.

2. Physical and psychological symptoms are, in most cases, a normal reaction to a cancer diagnosis and treatment.

  • Getting a cancer diagnosis and starting treatment to treat the disease can lead, among other things, to worry, sadness, loss of energy, or trouble sleeping. These are normal reactions that are a challenge for many people. However, severe and/or persistent symptoms need to be addressed by a professional. Especially in cases where some symptoms can foster the development of other systems later on.

3. For more severe or persistent symptoms, a number of resources exist to help patients adapt to the illness. These resources are also relevant for those close to the patient (family, friends, colleagues) who often also must learn to live with someone they love who has cancer.

  • Psychotherapy, especially cognitive behavioural therapy, is recognized as being effective in reducing symptoms and helping a patient or loved one adapt to the illness. A number of formats are available, from self-administered interventions (e.g. a book) for less severe symptoms, to group or individual therapy with a psychologist for more severe and persistent symptoms. These services are usually offered in hospitals, under a doctor’s prescription, and in private clinics. Reputable and credible community organizations can offer occasional support to people who have cancer and their loved ones. Employee assistance programs can also offer helpful resources within organizations.


Cancer is a disease that affects not only the people who have it, but also their personal and professional circles. Studies show that individuals who receive social support, whether from family members, friends or work colleagues, report a better quality of life. This can be, for example, a listening ear when morale is low, help with household chores, or offering a drive to the hospital or to work.

Preliminary research results also suggest that patients who have a wider social network and those who have positive and strong connections with the members of their network tend to be more attentive to medical recommendations and adopt healthy habits, which are important factors in surviving the disease. In this way, personal and professional circles can contribute to better quality of life and life expectancy among people who have cancer.



Trudel-Fitzgerald, C., Fouquet, E., Labrecque, M.-E. (2019). Cancer’s physical and psychological symptoms: when to intervene and for which ones?. Global-Watch Scientific Interpretation available at


Trudel-Fitzgerald, C., Savard, J., et Ivers, H. (2013). Which symptoms come first? Exploration of temporal relationships between cancer-related symptoms over an 18-month period. Annals of Behavioral Medicine, 45(3), 329-337.

Pierre Breton
Author: Pierre Breton