For many women, surviving cancer means enduring not just physical pain but the unspoken emotional wounds of a system blind to mental health.
At just 40, Farhat had never imagined her world would shrink to hospital corridors, infusion drips, and the sterile hush of oncology wards. A spirited schoolteacher from Gulshan-i-Iqbal, Karachi, she was known for her laughter — loud, contagious, and always a beat ahead of the room.
But after her breast cancer diagnosis, the laughter disappeared. What followed was not just the slow unraveling of her physical health, but a silent, suffocating assault on her emotional wellbeing.
Sara, another breast cancer patient, endured mastectomy, chemotherapy, and the disorienting fog of fatigue and pain. But the darkest moments weren’t marked by physical suffering; they came in the long, sleepless nights filled with fear, anxiety, and an overwhelming sense of isolation. “Everyone talks about surviving cancer,” she whispered, “but no one prepares you for surviving yourself.”
Like countless women in Pakistan, these women found themselves trapped in a blind spot of our healthcare system: psychological support.
Farhat was recommended therapy, yes — but each session cost more than her monthly utility bills, and the nearest affordable counselling centre was two crowded bus rides and a month-long waitlist away. Her oncologist had done all he could for her body, but for her mind, there was nothing.
In a country where mental health is still spoken of in hushed tones and emotional pain is dismissed as weakness, her suffering went largely unseen. Even her family, loving but bewildered, urged her to pray harder, stay positive, and avoid “overthinking.” But what happens when the mind itself becomes a battlefield no prayer alone can soothe?
Their stories are not rare. And it forces us to ask: are we truly treating cancer or only the parts of it we can see?
The missing half of cancer care
Globally, the prevalence of anxiety and depression is 30 per cent and 33pc, respectively, according to an umbrella review carried out by Addisu et al. Some researches show the percentages to be even higher.
A Karachi-based study of 402 breast cancer patients found 59.7pc suffered anxiety, 69.4pc depression, and 47.5pc reported suicidal ideation. That said, what are the options a cancer patient has? A handful of psychotherapy centres exist, but most operate privately, and for the average patient, the cost of care remains far beyond reach.
Integrating mental health care into oncology remains one of the field’s greatest challenges. Despite the overwhelming prevalence of psychological distress, many cancer patients are left with unmet mental health needs.
The reasons are layered: limited time for distress screening, inadequate training of healthcare professionals, and insufficient resources to follow through when mental health concerns are identified. What is crucial to note here is that mental health support is often delivered separately from cancer treatment, leading to a disjointed and fragmented approach that leaves patients to piece together their own care.
We don’t have to look far for examples. In Sri Lanka, psychotherapy is being woven into cancer care, with the Ministry of Health recognising psychological support for patients and survivors as essential. Survivorship care, including counselling, has been formally built into the country’s National Strategic Plan for Cancer Prevention and Control.
Alongside this, Sri Lanka is strengthening palliative care services that incorporate psychosocial support, while also exploring ways to integrate complementary medicine with conventional cancer treatment.
Emotional healing has a price tag
This vision of holistic care stands in sharp contrast to Pakistan, where the prohibitive cost of therapy alone keeps psychological support out of reach for most patients.
A single session with a qualified therapist in Karachi can range from Rs3,000 to Rs8,000 — an amount far beyond what many middle income families can afford, especially when they’re already struggling to pay for diagnostic tests, medications, chemotherapy or even surgery. Unlike physical treatments, therapy is rarely a one-time intervention. It is ongoing, often requiring weekly or biweekly sessions — costs that quickly multiply into an overwhelming financial burden.
Yes, there are peer-led support groups in Pakistan that provide emotional comfort through shared stories, mutual encouragement, and a sense of community. However, they are not a substitute for professional mental health care.
Psychotherapy, especially when delivered by psychologists experienced in trauma and chronic illness, offers evidence-based interventions tailored to each patient’s psychological needs. It can address clinical depression, anxiety, post-traumatic stress, and adjustment disorders, issues that often go beyond the scope of peer support.
Treating the body and the mind
It is time for Pakistan’s healthcare system to recognise that cancer treatment cannot stop at surgery, chemotherapy, and radiation. Emotional wellbeing must be treated as an essential part of recovery, not an afterthought. Psychological screening and counselling need to be built into routine oncology care, particularly in public hospitals where most patients turn for treatment.
Provincial governments must invest in training psycho-oncology professionals, subsidise mental health services for cancer patients, and expand teletherapy to bridge the urban–rural divide. At the same time, civil society and health institutions must lead awareness efforts so that emotional suffering is no longer dismissed as weakness, but understood as a valid, treatable consequence of illness.
Because in the fight against cancer, emotional wellbeing is not a luxury, it is survival.
Training oncology staff to recognise depression in cancer patients is crucial for improving both care and outcomes. Simple tools like the Patient Health Questionnaire (PHQ-9) can be used in clinical settings to screen patients and ensure no one slips through unnoticed.
Farhat survived the surgeries, the chemotherapy, the physical pain, but the emotional wounds lingered, unspoken and untreated. And her story is far from unique. Across Pakistan, countless patients endure the same silent suffering, their mental health sacrificed in a system that sees only the tumour, not the trauma.
Until cancer is treated as a disease of both body and mind, true healing will remain out of reach. It is not enough to save lives; we must fight to save what makes them worth living.
Header Image: The image is created via generative AI