How to recognize normal reactions at diagnosis and know when help is needed
The emotional response to cancer will depend on various factors, including the patient’s support system, coping style and perception of illness. As patients struggle with issues of diagnosis and treatment, they may also face the social pressures that come from well-meaning friends who want more than anything for them to be OK. Psycho-oncologists, who address the emotional needs of cancer patients, have determined that a healthy emotional response to a cancer diagnosis includes three phases—initial reaction, distress and adjustment—that will take patients through a typical grieving process.
The initial reaction to a cancer diagnosis is often shock and disbelief, followed by a period of distress characterized by mixed symptoms of anxiety, anger and depression. As patients learn about their options and begin to see a treatment plan form, they will enter into an adjustment phase. During this early time, they may experience persistent sadness, in addition to anxiety or depression; decreased interest in sexual activity; fatigue; difficulty concentrating, remembering or making decisions; insomnia or oversleeping; weight and appetite loss; and restlessness or irritability.
Many of these symptoms might be considered unhealthy, but they are a normal part of the process of dealing with a new cancer diagnosis. However, feelings of hopelessness and guilt, or feeling stuck in one of the stages above, may indicate more serious distress.
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 they have multiple options and no clear advantage to any one choice. The number of therapy options depends on the 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. The Internet has made it easier and faster for people to find cancer information and support online, but it can also expose people to false and misleading claims. Many hospitals and treatment facilities have libraries or patient education centers that provide reliable resources, and nonprofit organizations may have support groups that enable patients to talk with others who have shared their diagnosis.
Many patients cope with their situation by concentrating on the things they can control, such as taking good care of their body by eating a healthful diet and exercising. Some patients 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 patients “navigate” the healthcare system, appointments and financial issues. In most cases, patient navigators won’t tell patients what to do but will suggest questions to ask their doctor and help them establish priorities. Being prepared can decrease stress and anxiety.
However, remember that each patient’s cancer and situation are unique. So when it comes to support, one size does not fit all. Patients should talk with their team members to see what is available at their cancer center and take advantage of programs that are helpful.
A cancer diagnosis also affects a patient’s loved ones, so support may be needed for coping with family dynamics. Patients may feel too ill to fix dinner or may need a ride to the clinic. They may require time off from work, temporarily thwarting career aspirations and, conceivably, placing a greater financial burden on a spouse or partner.
Whether patients have early-stage or advanced cancer, the diagnosis will likely bring up feelings of mortality, which also cause anxiety. Addressing practical end-of-life issues, such as drawing up legal documents, may help lessen anxiety.
Upon receiving a cancer diagnosis, some patients have a sense of guilt that they did something to cause their cancer—or guilt that their family has to also go through it.
While some cancers are linked to certain behaviors, it doesn’t do any good to look back. It’s not unusual for patients to try to understand why their cancer developed, but focusing on the cause can lead to unnecessary stress. A study of women who had recently received a breast cancer diagnosis showed that those who blamed themselves for their cancer had higher levels of distress than those who didn’t. The findings also suggested self-blame negatively affected their ability to psychologically adjust.
Guilt is a barrier to living life fully, so experts recommend patients work through those feelings by talking to a social worker or counselor, keeping a journal or participating in a support group.
Studies indicate that nearly one-fourth of cancer patients will have symptoms of depression during treatment, which is understandable. Feelings of sadness about their cancer and the changes it brings are normal and may actually help patients cope. However, persistent feelings of helplessness or hopelessness and a sense of worthlessness are not typical, so patients experiencing these feelings should notify their doctor.
To distinguish between normal sadness about their circumstances and depression, patients should note their mental state and determine if, in two weeks, they feel better emotionally. Remember, some symptoms associated with depression, such as weight loss and fatigue, may be a result of cancer and its treatments. Moreover, some therapies, including hormone treatments and interferon, are associated with mood disturbances.
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 varies significantly in terms of side effects, tolerability and safety, and their use should be monitored. Depression is a treatable disorder of the brain. It’s an illness, so patients shouldn’t be afraid to get the help they need to manage it.
Just as there's no single way to treat cancer, there's no one prescription for dealing with distress. Some patients benefit from speaking with a psychologist or social worker, others from taking antidepressants or anti-anxiety medications, exercising, meditating or even getting a pet. For more information about distress screening and management, as well as finding support nearby, visit cancersupportcommunity.org.
The Negative of Positive Thinking
As patients begin to tell others about their diagnosis, they may feel pressure to maintain a positive attitude, which can be especially difficult when they are scared, anxious or not feeling well.
Experts agree that adopting a “positive-at-all-costs” approach can add an unnecessary burden. No compelling evidence exists that emotional outlook affects survival.
People’s reactions to cancer differ greatly. Patients should remember that it’s their experience and there is no need to feel they have to please others by the way they cope.