How to recognize normal reactions when diagnosed with cancer and how to know when help is needed.
Each person's emotional response to cancer will depend on various factors, including an individual’s support system, coping style and perception of illness. As patients struggle with issues of diagnosis and treatment, they could 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 an adjustment phase. Following a diagnosis, they might 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.
Usually, many of these symptoms might be considered unhealthy, but for a person with a new 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, could indicate more serious distress.
Online or in-person support groups or professional counseling can help.
Patients with cancer participate more today in determining their treatment plan than in past years. But with that power comes the anxiety of making a decision, particularly when there are multiple options and no clear advantage to any one choice. The number of therapy options depends on the type of cancer. In addition, doctors might 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 relieve 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 often have support groups that enable patients to talk with others who share their diagnosis.
Often, patients cope with their situation by concentrating on the things they can control, such as taking good care of their bodies 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 friends and loved ones about unresolved problems or feelings.
A cancer diagnosis is stressful, and few people successfully manage it by themselves. Most seek encouragement from friends, family members or support groups. Others seek support from clergy, nurses or mental health professionals. 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 health care system, appointments and financial issues. In most cases, patient navigators won’t tell patients what to do, but will suggest questions to ask their doctors and help them establish priorities. Being prepared can decrease stress and anxiety.
It’s important to 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 health care team to learn about available resources.
A cancer diagnosis also affects a patient’s loved ones, so support could be needed for coping with family dynamics. Patients might feel too ill to fix a meal or might need a ride to the clinic. They might need to take 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 can also cause anxiety. Addressing practical end-of-life issues, such as drawing up legal documents, can help lessen anxiety.
Upon receiving a cancer diagnosis, some patients have a sense of guilt that they did something to cause their cancer — or that their family has to also go through it.
Although 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 made it harder to psychologically adjust.
Guilt is a barrier to living life fully, so experts recommend that 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 patients with cancer will have symptoms of depression during treatment, which is understandable. Feelings of sadness about cancer and the changes it brings are normal and could 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 and depression, patients should note their mental state and determine if, after two weeks, they feel better emotionally. If not, the patients should be evaluated to find out if the problem is clinical depression. Remember, some cancer therapies 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 for regaining a sense of competence and control.
For those with moderate to severe depression, medication and psychotherapy are an effective 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 counselor or social worker, others from taking antidepressants or anti-anxiety medications, exercising or meditating. For details about distress screening and management, visit CancerSupportCommunity. org.
Strategies known as integrative and complementary therapies can help with both the emotional and physical side effects of stress, worry and the disease and treatments themselves. These can include massage, yoga, acupuncture, meditation and therapies centered on music, art, writing or dance. Many hospitals offer such services, and others led by trained experts can be found in communities.
Integrative therapies may be, but are not always, part of palliative care plans, which are care strategies that don't aim to cure disease, but are meant to improve quality of life for patients during and after treatment by relieving symptoms. Experts agree that palliative care should be available early in the cancer journey, regardless of someone’s diagnosis or prognosis.
In addition, there are several programs designed to boost the physical appearance of women and men with cancer — through methods including makeup and wig application, stenciling in eye- brows for those who have lost hair, and even the staging of fashion photo shoots — that can also go a long way toward lifting spirits.
Telling Family Members
When deciding when, what and whom to tell about their cancer, patients should gauge their feelings about their diagnosis, their need to talk to someone about what they’re going through, and what tasks they anticipate needing help with. The American Cancer Society recommends creating a list of people to tell in person and others who should get the news from a friend or family member. Decide in advance how much detail to give.
When telling children about a health threat that will affect the whole family, consider the family’s usual way of dealing with sadness, as well as each child’s age and preparedness for difficult situations, suggests Karen Hurley, Ph.D., a psychologist at Cleveland Clinic. Giving children information in small chunks, conveyed with positivity but a note of realism, can work well, Hurley said in a talk to people with predispositions to hereditary cancers. Once the immediate family has been told, the American Cancer Society suggests that the patient consider the types of responses that make him or her feel angry or upset, and planning answers that will quickly put such conversations to rest.
To avoid repeated discussions about treatments and health status, patients can ask a loved one to set up a page on a website such as CaringBridge.org and share group updates with friends and relatives. Those finding it difficult to discuss their feelings with loved ones may benefit from joining an in-person or online support group or consulting with clergy, nurses, mental health professionals and/or patient navigators.
The Negative of Positive Thinking
As patients begin to tell others about their diagnosis, they could feel pressured to maintain a positive attitude, which can be difficult when they are scared, anxious or not feeling well. False optimism is not only unrealistic, but an unnecessary burden. There is no solid evidence that emotional outlook affects survival, yet people unaffected by cancer often expect and encourage those with the disease to stay positive despite how they are really feeling. 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 with it.