Your emotional reaction to cancer will depend on various factors that include your support system, coping style and perception of illness. As you struggle with issues of diagnosis and treatment, you may also face the social pressures that come from well-meaning friends who want more than anything for you to be OK. Psycho-oncologists address the emotional needs of cancer patients and have determined that a healthy adjustment to a cancer diagnosis includes three phases—initial response, distress and adjustment—that will take you through a normal grieving process.

The initial response to a cancer diagnosis is often shock and disbelief, followed by a period of distress characterized by mixed symptoms of anxiety and depression. As you learn about your options and begin to see a treatment plan form, you will enter into the adjustment mode. During this early time, you may experience persistent sadness, in addition to:

> Anxiety or depression

> Decreased interest in sexual activity

> Fatigue

> Difficulty concentrating, remembering and/or making decisions

> Insomnia or oversleeping

> Weight and appetite loss

> Restlessness and/or irritability

Many of these symptoms might be considered unhealthy, but for a person with a cancer diagnosis they are a normal part of the process of dealing with a new reality. However, feelings of hopelessness and guilt, or feeling stuck in one of the stages above, are signs that should be considered indicators of more serious distress.

Anxiety

Cancer patients participate more today than in past years in determining their treatment plan. But with that power comes the anxiety of making a decision, particularly when you have multiple options and no clear advantage to any one choice. The number of possible therapy options depends on your type of cancer. In addition, doctors may disagree about the best course of action when a standard of treatment does not exist for a certain cancer, adding another layer to a complex decision.

Some people find that researching their cancer helps alleviate anxiety. You can find information and support online, at your hospital library or patient education center and through nonprofit groups that may have support groups where you can talk with others who have shared your diagnosis (see Toolbox at curetoday.com/toolbox).

Concentrating on the things you can control helps in coping with your situation, including taking good care of your body by eating a healthy diet and exercising. You may find relief in completing practical tasks, such as setting up a system to deal with insurance, making sure wills and other legal issues are finalized or talking with family about unresolved problems or feelings.

A cancer diagnosis is stressful for anyone, and few people successfully manage it by themselves. Most people seek encouragement from friends, family or support groups. Others seek advice from clergy, nurses or social workers. Another useful resource offered by some hospitals is a patient navigator, typically a registered nurse, social worker or trained community member (sometimes a cancer survivor), who can help you “navigate” the health care system, appointments and financial issues. They won’t tell you what to do but will suggest questions to ask your doctor and help you establish priorities. Being prepared can decrease stress and anxiety.

However, remember that your cancer and your situation are unique. So when it comes to support, one size does not fit all. Talk with your team members to see what is available at your cancer center, and take advantage of programs that are helpful. Just be sure you are seeking support somewhere.

A cancer diagnosis will also affect your loved ones, so you may need to support for coping with family dynamics. You may feel too ill to fix dinner or may need a ride to the clinic. You may require time off from work, temporarily thwarting career aspirations and, conceivably, placing a greater financial burden on a spouse or partner.

Whether your cancer is early stage or advanced, the diagnosis will bring up feelings of mortality, which also cause anxiety. Addressing practical end-of-life issues, such as drawing up legal documents and making burial plans, may help lessen anxiety.

Positive Thinking

As you begin to tell others about your diagnosis, you may feel pressure to maintain a positive attitude, which can be especially difficult when you are scared, anxious or not feeling well.

Experts agree that adopting a “positive at all costs” approach can add a huge burden. No compelling evidence exists that emotional outlook affects survival, yet people unaffected by cancer often expect and encourage those with the disease to exhibit a positive approach despite how they are really feeling.

People’s reactions to cancer differ greatly. Just remember that it’s your and your family’s experience and there is no need to feel you have to please others by the way you cope.

Guilt

A cancer diagnosis may bring with it guilt that you did something to cause your cancer—or guilt that your family has to also go through it. While some cancers are linked to behaviors such as smoking, sun exposure or a common sexually transmitted disease known as human papillomavirus, it doesn’t do any good to look back. You have the capability to stop blaming and judging yourself by realizing you cannot change the past.

It’s not unusual to try and find an answer to why your cancer developed, but focusing on the cause can lead to unnecessary stress. A recent study of women newly diagnosed with breast cancer showed those who blamed themselves for their cancer experienced higher levels of distress than those who didn’t. The findings also suggest self-blame negatively affects a patient’s ability to psychologically adjust.

Guilt is a barrier to living your life fully, so experts recommend working through those feelings with a social worker or counselor. Other options include participating in a support group and keeping a journal about your feelings.

Depression

Studies indicate that nearly one-fourth of cancer patients will have symptoms of depression or an anxiety disorder during treatment, which is understandable. However, feelings of anger or sadness about your cancer and the changes it brings are normal and may actually help you cope. Persistent feelings of helplessness or hopelessness and a sense of worthlessness are not typical, and you should notify your doctor.

To distinguish between normal sadness about your circumstances and depression, note your mental state and see if in two weeks you feel better emotionally. Lingering feelings of overwhelming sadness and loss of hope may indicate you should discuss your feelings with a professional. Remember that some symptoms associated with depression, such as weight loss and fatigue, may be a result of cancer and its treatments. In addition, some therapies, including hormonal treatments and interferon, are associated with mood disturbances.

The National Comprehensive Cancer Network (nccn.org) developed distress management guidelines that can be used by healthcare professionals as a screening tool. (NCCN experts chose the word “distress” rather than “depression” because they felt the term carried less stigma and more accurately described patients’ emotional states.) The guidelines include a questionnaire asking patients to measure their level of distress on a scale of one to 10. According to the NCCN guidelines, patients with a high level of anxiety or depression should be referred to a mental health professional who can more accurately assess what type of treatment is warranted.

People with mild to moderate depression are often responsive to talk therapy. For these patients, support groups, buddy systems, cancer education programs and psychotherapy can be useful to regain a sense of competence and control.

For those with moderate to severe depression, medication and psychotherapy are an ideal combination. A range of antidepressants is currently available that vary significantly in terms of their side effects, tolerability and safety, and their use should be monitored. Remember, depression is a treatable disorder of the brain. It’s an illness, so don’t be afraid to get the help you need.

^ TOP OF PAGE