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The emotional side of fighting cancer is in many ways as challenging as the physical side. Your doctor is there to support you, as are social workers, oncology nurses and other people on your healthcare team. People close to you are likely to be your strongest sources of emotional support—family members, friends, neighbors and church members. There are numerous local and national organizations that can put you in touch with others who are cancer survivors or who have also just been diagnosed with cancer. Support may be by phone or in person, or in a support group. If you have access to a personal computer, there are Internet-based cancer support groups, some general and some for particular cancers and side effects.

Sometimes people have trouble asking for help. If this is an issue for you, think about specific things people can do for you. Make a list of the things you could use help with, and then start asking those closest to you to help, starting with the easiest thing on the list. You may be surprised how willing people are to help.

Sometimes talking with a social worker or a chaplain at the JACC can also provide emotional support. A good counselor, especially one familiar with the issues cancer patients face, may be of great assistance if you are feeling distressed emotionally. A counselor may help you deal with sadness, depression and feelings of being overwhelmed. Counselors can offer talk therapy, make suggestions for behavior modification that can help you feel better, and/or may work with your doctors to obtain medications that may positively influence your mood. Medications that target anxiety and depression can be considered by discussing your emotional distress with a doctor. You do not necessarily have to be evaluated by a psychiatrist.

When Coping is Difficult
Some emotional illnesses can emerge out of the stress of having cancer. These illnesses are often treatable, so be sure to speak to your doctor if you or someone you care for appears to be suffering from these problems:

• Anxiety disorder. Too much worrying can stop patients from enjoying their lives. It may even interfere with seeking the treatment they need.
  
• Post-traumatic stress disorder. After a very stressful event, such as having cancer and being treated for it, a person can have a strong negative reaction. This reaction might include persistent nightmares or unpleasant memories. Someone with this disorder may avoid any reminder of cancer, and may withdraw from loved ones or follow-up care.
  
• Depression. Major depression, in which a person feels so hopeless that they cannot function normally, may be a problem for cancer patients. If you have strong feelings of guilt, worthlessness, hopelessness, feel suicidal or cannot feel pleasure for 2 weeks or more, you may have depression and should talk to your doctor. Other symptoms of depression can include: feeling low on energy, sleeping too much or too little, worrying all the time, crying frequently and rapid weight gain or loss. Depression may be treated with medicine and non-medicine therapies, so tell your doctor if you think you are severely depressed.

Talking to Family and Friends
Your family and friends will usually be your strongest sources of support as you go through diagnosis and treatment. Their support can range from help around the house and going to exams with you to simply listening to how you feel. As you share the news of your cancer with your family and friends, be aware that they have different ways of coping with difficult news and the challenge that cancer represents. Some friends may be scared by your cancer and pull away as you go through treatment, while others will become better friends to you as they respond to your need for support.

Normal schedules and family roles may be changed as treatment and its side effects occur. It is helpful to talk to each person in the family about the changes ahead as you begin your journey into cancer treatment. If you share that a treatment may cause a change in mood, for instance, this will help everyone maintain a smoother relationship with you. They may be able to better understand where an unexpected mood is coming from. The challenge of cancer may actually become an opportunity for you and your family to become closer as you express your care and love for each other in new ways

Certainly one of the most difficult things to do is to tell a child that a family member has cancer. Children need to hear different amounts of information, depending on their maturity and ability to understand. They will notice if a loved one has less time for them, or is unhappy or moody, or looks or acts sick. Having a conversation before the child finds reason to question a parent being ill is the best thing. If you don’t tell the child anything, he or she may question whether the change in the loved one is somehow their fault. Younger children are especially susceptible to thinking that something they have thought or done may have caused a problem. Older children often want to be included when major events happen to the family and welcome the opportunity to be of help.

When speaking to children, use simple, age-appropriate language. Try to stick close to the truth, especially regarding how serious the situation may be. You may have to repeat this information a few times for it to sink in, particularly if it is not happy news. It is good to repeat that it is “no one’s fault” that the loved one is sick.


Talking to Your Employer
If you are in the workplace, you will need to make a decision about what to tell your employer about your cancer diagnosis. Some patients choose to be very open and let all their co-workers know, while others choose only to provide the amount of information needed to their direct supervisor or Human Resources department to allow going to treatment.

Taking Time Off From Work
The 1993 Family and Medical Leave Act allows employees with serious medical conditions to take a total of twelve weeks of unpaid leave per year without risking their positions. This law applies only to workplaces of 50 or more employees, and companies may exempt (not include) their highest paid employees. You must have worked at least 25 hours per week for one year to qualify for this leave.

After completing treatment, you may feel a mix of emotions—relief that treatment is over and anticipation of “normalcy” in your life as far as how you feel, your work schedule and relating to friends, family and co-workers. You may also find that you feel somewhat adrift and anxious. This anxiety is common, because you don’t have the frequent reassuring presence of doctors and treatments to show you are actively fighting your cancer.

When cancer is no longer detectable in your body, you are considered to be in remission. Doctors do not like to use the term “cured” for cancer patients until a patient has had no evidence of cancer for a number of years, at which point your risk of that cancer’s recurrence is considered very minimal.

Ask your doctor what timeframe is considered “curative” for your cancer, and make sure you understand the following items:

• Follow-up exam and testing schedule
• Signs of recurrence to watch for
• Management of any long-term side effects you may have from treatment, especially lymphedema

Many cancer survivors find that continuing to participate in support groups after treatment is helpful when making the adjustment to “dancing with NED.” NED is the condition of having “no evidence of disease.” Some survivors find it rewarding to volunteer with organizations that help new patients with one-to-one counseling, driving to appointments or other activities. Some find they want to work on finding the cure for their cancers. Yet others wish to completely forget their treatment experiences and try and return their lives to “normal” as much as possible.

No one of these coping strategies is “right.” It is worth noting, however, that a recent study of breast cancer survivors found that many survivors are haunted by fears of recurrence. Investigators found that those survivors who disclosed their hopes, fears and concerns with people who were close to them had a better mental and physical quality of life than those who did not share their feelings. The results of the study suggest that social support may be important to a good quality of life for long-term survivors. Another study of breast cancer survivors, by Dr. David Spiegel of Stanford University in l989, documented that those who participated in support groups once a week lived an average of twice as long as those who didn’t. The National Coalition of Cancer Survivors is an excellent source of information for survivors about a range of topics, including insurance eligibility, employment issues and quality of life issues.

Many patients also participate in the JACC Cancer Survivor’s Support Group or the Patient Workshops. If you are interested in learning more about these support groups, please call the Social Services Department at (806) 725-7984.

Lewis, Julie A. Journal of Behavioral Medicine ~June 2001