Each person’s emotional reaction to cancer will depend on various factors that may include an individual’s 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 found a pattern of response that identifies a healthy adjustment. The three phases—initial response, distress, and adjustment—take you through a normal grieving process that should be encouraged.

The initial response is often shock and disbelief. This is followed by a period of distress that lasts a few days to a week or two and is characterized by mixed symptoms of anxiety and depression. As you learn about your options and begin to see a treatment plan form, there is passage into the adjustment mode.

During this early time, you may experience persistent sadness, in addition to:
> Anxiety or depression
> Decreased sexual interest
> Fatigue
> Difficulty concentrating, remembering, and/or making decisions
> Insomnia or oversleeping
> Weight and appetite loss
> Restlessness and/or irritability

Normally, many of these symptoms would 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 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 (see “Medical Decisions”). But with that power comes the anxiety of making a decision. The number of therapy options available to you will depend on your type of cancer. Experts often 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.

Many people find that knowledge about cancer helps alleviate anxiety. You can find information and support online, at your hospital library or patient education center, and through nonprofit groups that focus on your specific cancer (see 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. Or deal with cancer in other practical ways, such as taking care of wills and other legal issues, and emotional ways, such as talking with loved ones about unresolved problems or feelings.

A cancer diagnosis is an enormously stressful event for anyone, and few people successfully manage it by themselves. Many people find help in a support group. 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 sort through priorities. Being prepared can decrease stress and anxiety. However, everyone’s situation is different, so discuss personal health questions with your physician and other members of your health care team.

Anxiety about the toll your disease may have on loved ones or your career may also become an issue. Cancer and its treatment affect not only you as the patient but your family as well. 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.

Fear and uncertainty about the end of life may also cause anxiety. End-of-life palliative care focuses on patients’ comfort and symptom relief, while incorporating spiritual and psychological counseling to help prepare for death. Addressing practical end-of-life issues, such as drawing up legal documents and making burial plans, may help lessen anxiety for some patients. 

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. False optimism is unrealistic, and experts say feeling that you are not “doing cancer right” can be 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, as well as their reactions to cancer, can differ greatly. For some, maintaining a positive attitude is their preferred method of coping.

Guilt

Labels about cancer can lead to guilt, which can be a huge burden for newly diagnosed patients. You may feel guilt about causing your cancer, about having your family go through it, or about not being able to do what you did before, if only for a short time. Guilt often comes from behaviors linked to cancer, such as smoking, sun overexposure, and a common sexually transmitted disease known as human papillomavirus that causes cervical cancer as well as other cancers.

It’s not unusual to try and find an answer to why your cancer developed, but focusing on the cause can lead to additional 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 throughout the year following diagnosis.

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, and must concentrate on moving forward. 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 journaling about your feelings.  

Depression

Studies show that nearly a quarter of cancer patients will have symptoms of depression or an anxiety disorder during treatment. 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. 

When diagnosing depression in cancer patients, physicians place more emphasis on symptoms such as loss of pleasure, hope, and self-worth that last for more than two weeks instead of side effects that can also be caused by cancer and its treatments, including fatigue and weight loss. In addition, some therapies, including hormone treatments and interferon, are associated with mood disturbances.

The National Comprehensive Cancer Network has developed systematic distress management guidelines that can be used by health care 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—for example, a psychiatrist, psychologist, or clinical social worker—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 help gain a sense of competence and control.

For those with moderate to severe depression, both medication and psychotherapy are an ideal combination. Although a broad range of antidepressants is currently available, antidepressants vary significantly in terms of their side effects, tolerability, and safety. The newer agents, such as the selective serotonin reuptake inhibitors (SSRIs), tend to have mild side effects and are often easier to take but require close medical monitoring, especially for the first several weeks of use.

Remember, depression is a treatable disorder of the brain. It’s an illness just like cancer, so don’t be afraid to get the help you need.

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