The Emotional Impact of A Cancer Diagnosis
About Cancer
In the United States, men have a 1 in 2 lifetime risk of developing cancer; for women, the risk is 1 in 3. Because cancer touches people of all ages, races, incomes, and geographic regions, at some time in their life everyone will talk with a person who has cancer. There are no simple rules to follow when talking with someone who has cancer, because each person and situation is unique.
The word "cancer" itself is frightening, because it makes many people think of death. However, people with cancer do not always die. About 9.6 million people with a history of cancer are alive today. New treatments are also continually being developed. Thus, the fear you might feel when you learn that a friend or relative has cancer should be tempered with hope.
There are more than 100 different types of cancer. Most cancers can be treated, and research is constantly finding new ways to treat cancer.
Cancer is not only an acute illness, but also a chronic (ongoing) one. The type of cancer and when it is diagnosed will affect the way a patient copes with it. Some people live with cancer for many years. This means that the patient may have to adjust to different types of treatment at different stages of the disease. Family and friends also have to adjust to these stages and treatments and provide emotional support and hope along the way.)
Ways of Coping
During the course of their illness, people with cancer may express anger or hostility toward those around them. Though this can be upsetting to family members and friends, it may help to remember that people often "displace" their anger and frustration with a trying situation onto people close to them. Because they cannot express their anger to the disease itself (the real cause of their frustration and sadness), they feel angry instead with family and friends, or whoever happens to be close at hand. Unfortunately, it is the people closest to them who usually bear the brunt of this anger. If this happens to you, understanding that the person with cancer is lashing out because they are overwhelmed, frustrated, afraid, and angry about their situation may help you to cope with their feelings.
Some people with cancer become childlike and dependent in their behavior during illness. This may be a way of letting the family know they feel helpless or weak. Though the range of their daily activities may be limited by the disease, it is usually best for the person with cancer to continue accepting as much responsibility as possible. Continuing to be a responsible adult can give a person a sense of confidence and control, while becoming completely dependent on those around them can eventually make them feel more helpless and victimized. It is easy to make the mistake of being overprotective, but resist the urge to cater to a patient's over-dependence.
Going through the cancer diagnosis is often an anxious time for people. They fear the changes associated with having cancer, such as possible pain, loss of income, body changes, and adjustments in their personal relationships. Because they have so much anxiety in their lives, sometimes people with cancer become upset or frightened for no apparent reason. They may become suspicious of sudden changes in the attitudes and behavior of those around them, or imagine changes when there are none. If this happens, special effort on the part of family and friends may be necessary to understand and reassure them.
Sometimes people with cancer believe the disease is a result of something they did or did not do. Family members may also feel guilty and express this by changing the way they act toward the person with cancer. They may try to make up for what they see as their failures in the past. These feelings and reactions are common, but keeping guilty feelings inside is often unhelpful. Even though it may be difficult to do so, try to discuss such thoughts and feelings openly with everyone involved.
"There is a fear that goes through you when you are told you have cancer. It's so hard in the beginning to think about anything but your diagnosis. It's the first thing you think about every morning. I want people diagnosed with cancer to know it does get better. Talking about your cancer helps you deal with all of the new emotions you are feeling...Remember it's normal to get upset."
When you are told you have cancer, the diagnosis affects not only you, but also your family and friends. You feel uncertain about what changes will take place in your life and in theirs. You may feel numb or confused. You may have difficulty listening to, understanding, or remembering what people tell you during this time. This is especially true when your doctor first tells you that you have cancer. It is not uncommon for people to shut down when they hear the word "cancer."
When you face cancer, your experiences and personal beliefs help determine what the diagnosis means to you. As you are forced to confront your own mortality and cope with the many demands of cancer, you may examine your religious beliefs, personal and family values, and priorities in life. Accepting the diagnosis and figuring out how cancer fits into your life is challenging.
People diagnosed with cancer may wonder who to tell and how they should tell them. They often feel pressured to share their diagnosis but are able to do so only when they are ready. Most people cannot anticipate how long it will be before they feel comfortable enough to discuss their cancer with others.
Feelings Associated With Cancer
After a diagnosis of cancer, you may feel shock, disbelief, fear, anxiety, guilt, sadness, depression, and anger. Each person may experience some or all of these feelings, and each will handle them differently.
Shock may be your first emotion after a cancer diagnosis because no one is ever prepared to hear that they have cancer. It is not unusual for people with cancer to wonder why it happened to them or to think life has treated them unfairly. You may doubt the accuracy of the diagnosis, especially if you don't feel sick.
You may be fearful or anxious. While some people fear cancer itself, others may be afraid of cancer treatments and wonder if they will get through their treatment. Fear of pain and suffering is one of the greatest fears many people with cancer and their families have.
You may feel guilty. You might ask yourself what symptoms could have been noticed earlier or wonder what behavior or action could have caused your cancer. You might question your environment at home or at work. Or you might worry that other members of your family will also get cancer. At this time we do not know what causes most cancers. A small number of cancers are hereditary, meaning family members may have an increased risk of developing certain types of cancer. This can cause additional concerns for the person newly diagnosed with cancer.
You may feel hopeless or sad if you see cancer as a roadblock to a life full of health and happiness. It is difficult to feel optimistic, especially if the outlook for the future is uncertain. Even just thinking about treatment and the time it will take out of your life can be daunting. Feelings of sadness or uncertainty can be compounded by the individual's personal history of cancer experiences.
You might feel angry. While some people may not outwardly express their anger and frustration, others may unintentionally direct their anger toward family members, friends, or health care professionals. If you are only trying to vent your feelings, let people know you don't expect them to have solutions to your problems.
Coping with Your Feelings
"The best prescription is knowledge."
- C. Everett Koop, MD, former United States Surgeon General
It is easier to face the reality of a new or scary situation if you learn as much as you can about it. Cancer is a complex group of diseases. There is a great fear of the unknown and uncertainty of the outcome. Knowledge can help lessen the fear of the unknown. There is much to learn about each type of cancer and its treatment, possibility for recovery, and rehabilitation. Be your own advocate.
Although people facing cancer cannot change their diagnosis, finding reliable and up-to-date information, communicating with family members, friends, and their health care team, and seeking out sources of support can help them take control of their situation and make informed decisions.
Working through your feelings about cancer is important because how you feel can alter how you view yourself, how you view life, and what decisions you make about treatment.
Try the following suggestions:
Make a list of questions to ask your health care team.
Bring a family member or friend along to appointments with your doctor or with other members of your health care team. They can serve as an extra pair of ears and support.
Ask if important conversations can be tape-recorded.
Take notes and ask your health care team to spell unfamiliar words.
Ask your health care team to explain things when you don't understand.
You will not be able to change everything in your life. Focus on what you can change in order to gain a greater sense of control over your situation.
Delores, cancer survivor: "Daily walks and later running helped me keep my sanity after I was diagnosed."
Other things you can do to deal with your emotions:
Ask for support from family, friends, and others. If friends or family members are not able to provide support, find others who can. Health care professionals, such as social workers, psychologists, or other licensed health professionals and support groups are additional sources of support.
Seek spiritual support through prayer or the guidance of a chaplain, pastor, rabbi, or other religious leader.
Pay attention to your needs for rest, nutrition, and other self-care measures.
Find ways to appropriately express your feelings, such as talking or writing in a journal.
Allow yourself private time and space.
Walk or exercise. Get your doctor's approval before participating in physical activities or sports.
Find out what helped other patients and families cope with cancer, and/or talk with other people diagnosed with the same type of cancer.
Make changes at home to create a healthier environment, and/or talk with your doctor about making healthy lifestyle choices.
If you feel sad all the time, are having trouble sleeping or thoughts of suicide, these are signs that professional help is needed. Other symptoms that may require treatment include feelings of panic, intense anxiety, or crying constantly. If you think you might need professional help, talk with your doctor.
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For Spouses, Family & Friends
Sometimes family members are the first to learn of a loved one's cancer diagnosis. How does a family decide when or if to tell them? Should they be told? Are some people too emotionally fragile, too young, or too old? While most people can handle the news of a cancer diagnosis, each person takes a different amount of time to adjust and figure out what their diagnosis means to them.
If you are a family member trying to decide if you should tell a loved one they have cancer, consider this. You may think you are sparing them bad news, but they will sense something is wrong when they have many tests and/or don't feel well. Resentment can result when family members keep the diagnosis a secret from the person with cancer. Although you thought you were protecting the person with cancer, that person now might view you as dishonest.
When people with cancer are not told about their diagnosis, they are unable to make important decisions about their treatment and their life. There may be things they want to do, personal matters they want to take care of, and legal papers that may need to be updated. Even when a person has a cancer with a good prognosis, families need to discuss decisions about end-of-life care, including living wills, advance directives, and durable power of attorney.
Often before one can express feelings, he or she must sort them out. Friends and family members may feel like scapegoats when their loved ones try to vent their feelings. If you are the target of anger and frustration, remember you are not the cause of this anger. Cancer is the reason for this anger. Even though family members and friends try to respond with love and friendship, it is natural to feel their own anger and frustration, and sometimes express it.
Because they often have more responsibilities while handling many different emotions, families also have a difficult time adjusting to a diagnosis of cancer. Family members have to cope with their own emotions while also being sensitive to the needs of the person who has cancer. If the person with cancer feels the need to talk before others in the family are ready, you could say something such as "I'll be here when you are ready to talk." Your presence is also a way to show your support for the person with cancer.
Families and friends often try to raise a person's spirits by saying, "Everything will be all right." But people with cancer and their families know everything is far from all right and might wonder if things will ever return to normal. Families and friends are also experiencing many different feelings, and they should also be allowed to share them. Being honest about these feelings can allow everyone to work through difficult times and enjoy the good days together.
Talking with Someone Who Has Cancer
Family and friends may struggle to find the "right" words to say to someone who has been diagnosed with cancer. There is no right way to act or perfect words to say. Just listening to the person with cancer is often more helpful than talking. Reassuring them of your love and support is one of the most important things you can do for them. Most people with cancer do not want to face the experience alone and will need support from their family and friends. "I'm here for you" are the best words you can say to show your support for someone with cancer.
Not everyone with cancer wants to talk about his or her feelings. They may have other ways to express their emotions, such as writing in a journal or yoga, or they may prefer to keep their feelings private. People with cancer might just want you to help them maintain their "normal" routine. Just be yourself and continue to do things with the them just as you would if they didn't have cancer. Sometimes this isn't possible, but if you continue to spend time with them, they can talk with you about their feelings if they change their mind.
Sean, cancer survivor: "I did not like to talk about my cancer with my friends or my family. I just wanted to get it over with. My oncologist had one of his patients who was diagnosed with testicular cancer a few years ago call me. He had the same treatment I received and was my age so we could easily relate. He told me it would be a tough 6 months but I would get through it. Knowing that he made it through the same treatment was helpful."
Changes in the Family
A diagnosis of cancer changes a family forever. Figuring out "what's for dinner" or "what your plans are for the weekend" is suddenly less important. Family and personal values are questioned and priorities are tested. Unsettled feelings and arguments may resurface during a family's struggle with cancer. Often a family must sort out and revisit old, unresolved feelings before they can start to battle cancer as a family.
Cancer can cause role changes in the family. The head of the household may now be more dependent on other family members. Others may need to work outside the home or work different hours to accommodate changes in the household. When family members take on new roles, the way they interact within the family can change. New responsibilities may overwhelm some family members.
Parents might look to their children for support. If the children are old enough, they may be asked to take on more responsibilities within the household. These requests often come when children themselves need support. The behavior of younger children might regress in response to the stress on the family. This is their way of dealing with cancer and how it has changed their family. Adolescents who at this age are often rebelling and spending more time with friends may instead cling to their families for support.
As a friend or family member helping to take care of the patient, you also have needs. Taking care of yourself will allow you to be able to care for others. When your needs are met the patient will also benefit. Overdoing is different from doing. Know your limits and rest when you need to. This rule applies to both caregivers and patients.
Peter, caregiver for his wife: "As a caregiver, your life is not going to be the same. It is essential that you maintain a healthy, high-quality level of physical and mental fitness so that you can still carry on with your life, while also helping the one in treatment. Find compassionate and understanding friends with whom you can talk to relieve your stress. In this way, you will be more available, physically and emotionally, to aid your cancer partner and to engage in candid discussions that are so important. In short, take care of yourself at the same time, paying attention to diet, exercise, and sleep requirements, to better help others and yourself. While being realistic, try to remain optimistic."
Often families find themselves treating the person like an invalid although they are fully capable of doing for themselves. Sometimes people will not want you to help them with activities such as bathing and dressing.
While the patient may object to getting outside help, friends and family members should assess their own limitations and get outside help when necessary. Certified nursing assistants, home health aides, and other resources can help with the care of the patient. Local churches may be able to help with cooking, shopping, transportation, and general housekeeping. Professional services may also be helpful although there usually is a fee involved.
Coping Within the Family
How a family handles cancer is greatly determined by how the family has dealt with crises in the past. Those who are used to communicating effectively and sharing feelings are usually able to discuss how cancer is affecting them. Families who solve their problems as individuals instead of a team might have greater difficulty coping with cancer.
Cancer treatment includes care for the patient and the family, not just the cancer. A mental health professional may already be a part of your cancer care team. If not, talk with your doctor or nurse to learn about additional resources that can help you cope with cancer in your family.
Some family members have said they have avoided the family member because they felt as if they had nothing to offer, didn't know how to act, or felt they could do nothing to help make the situation better. Family and friends can find ways to relieve their stress by participating in activities outside the home. Resources outside the home, such as individual counseling or support groups, can serve as outlets for the frustrations you are facing within your family.
Visiting....
Some people may have difficulty visiting people with cancer, particularly those with advanced disease. When someone is very ill and his or her appearance has changed, it can be shocking and upsetting. Sometimes simply seeing a lot of medical equipment around a loved one can be upsetting. Remember that this is the same person you have always known and cared about, and try to relate to them in the same way you have in the past. Doing so will help both of you to focus on what's going on inside, not outside. The pleasure you give by your visit and the warmth you are able to communicate will be appreciated. When words fail, a loving look or touch can say a lot.
If you are unable to keep your composure during such a visit, it's all right. Explain to your friend or relative how much you care about them and how upset you are that they are going through such a difficult experience. Don't be afraid to show your feelings, but make sure the person with cancer doesn't have to comfort you. That may be too much for most people to manage at this stage.
A List of Some Basic Do's and Don'ts
Do:
Take your cues from the person with cancer. Some people are very private while others will talk more about their illness. Respect the person's need to share or their need to remain quiet.
Let them know you care
Respect decisions about how the cancer will be treated, even if you disagree.
Include the person in usual work projects or social events. Let them be the one to tell you if the commitment is too much to manage.
Listen without always feeling that you have to respond. Sometimes an empathetic listener is what the person needs the most.
Expect the person with cancer to have good days and bad days, emotionally and physically.
Keep your relationship as normal and balanced as possible. While greater patience and compassion are called for during times like these, your colleague should continue to respect your feelings, as you respect his or her feelings.
Offer to help in concrete, specific ways.
Don't:
Offer unsolicited advice or be judgmental.
Take things too personally. It's normal for the person with cancer to be quieter than usual, to need time alone, and to be angry at times. These feelings are normal, so don't worry.
Be afraid to talk about the illness.
Always feel you have to talk about cancer. The person with cancer may enjoy conversations that don't involve the illness.
Be afraid to hug or touch your friend if that was a part of your friendship before the illness.
Be patronizing. Try not to use a "How sick are you today?" tone when asking how the person is doing.
Tell the person with cancer, "I can imagine how you must feel," because you can't.
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