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The Emotional Aspects of Dealing with Cancer

Cancer Survivors Face Emotional Challenges After Successful Treatment

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30 May 2006

Your bout with cancer - or maybe a battle royal - is over. You beat the disease, withstood the treatment. You're a survivor.

But after treatment, many women find themselves dealing with emotional fallout -- fear of recurrence, depression, body changes, loneliness, and changing relationships -- to name a few.

The June issue of Mayo Clinic Women's HealthSource offers steps to deal with life's chapters after cancer:

Be honest: Don't be afraid to admit your emotions to yourself and others. Often, this can help eliminate confusion and promote bonding, particularly between you and your partner. (No matter how long you've been together, your partner can't read your mind!)

Reserve judgment on yourself and others: Realize that the current circumstances aren't your fault and that feelings come and go. Even if you don't feel appreciative, loving, or happy at the moment, your emotions tomorrow could be different. Try not to be critical of how loved ones have handled things during your illness or how they're handling your return to health.

Clarify expectations: As you move on, make clear to your family and friends what you can and can't do. Encourage your family members to be open about their expectations of you, too.

Stay connected: Staying connected to yourself, to others, to your spirituality, is one factor most often cited as being helpful when recovering from cancer. Interact with family and friends, participate in organizations that nourish social interactions or spiritual beliefs, or join a support group for cancer survivors.

Laugh as often as possible: Laughing promotes the release of endorphins, brain chemicals that help fight pain and depression. Take care of yourself: To feel your best, try to stay your healthiest. Focus on appropriate exercise, sleep, and a healthy diet.

Ask for help: Some women feel they shouldn't complain after surviving cancer. Getting professional help to adjust to these emotional challenges isn't a sign of weakness, but one more step toward growing stronger and taking care of yourself.

Mayo Clinic
http://www.mayo.edu/news
http://www.medilexicon.com/medicalnews.php?newsid=44222

Message Board Comments To This Article

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Post by Kathy_from_England on May 30th, 2006, 8:35pm
The above article refers to women. I would suggest that this applies to men, and to other health conditions.

Many people in our online community say:
"I now feel well.....so why on earth am I depressed?"

Understanding that this is a natural reaction is one of the first steps towards feeling better.

Post by marb on Jun 8th, 2006, 4:30am
I agree that you feel differently after surviving cancer, especially if you were not suppose to live, several times over. You are considered a miracle, and indeed are, but you are the same person that you were before. However, people look at you differently. I also had to deal with guilt over living when others did not. Younger people with so much to live for had died and yet I was here. My biggest question was, why am I alive. I had to search for the reasons that God allowed me to live. What did He want me to do, or to be? I should have been ecstatically happy, but instead was living with questions and uncertainity. Perhaps you enjoy life more and eternity becomes more important and more real than before. You are very thankful that you have these extra months and years, but you are also living with the possibility of the cancer returning. And when the oncologist repeats that you are at high risk, not out of the woods, and still have an 80 to 85 percent of it returning, you live waiting for the other shoe to drop. You just expect to feel on top of the world for being a survivor, yet you don't always feel that way. I would be interested in how other survivors feel. Marb

Post by dsankey on Jun 8th, 2006, 12:48pm
That article was so very apt this morning Kathy because i broke down today.......i mentioned to Andy just yesterday that i seem to be full of self pity at the moment and have put my friends on a back boiler as i don't seem to want to talk to them. I think my hormones have a large part to play in how i am feeling at this moment.....but, i read all that article and cried yet again. I don't think i can 'handle' going through the menopause anymore.....i'm only 39 yrs old and my body has changed through cancer treatment etc.

I feel the same way as you Marb.........i am living a death sentence and i suppose we, with cancer, are all living like that......waiting....always waiting. I know i am. I have had a chest infection for over 10 days now and i keep thinking allsorts.....it's only natural after being diagnosed with cancer.

Great article Kathy,

Love Denise xx

Post by Risu on Jun 8th, 2006, 4:28pm
I feel the same, Marb and Denise. Every day seems to be lived with emotional caution. With my health, especially the recent scare, I practice a lot of denial because I'm instantly afraid it's cancer again...."Did they miss something? What if it really did metastasize?"

Going through early menopause, having all the intimacy issues due to scar tissue, the slow healing from the radiation as well, now the unexplained pain...all these things pile up day to day and sometimes just boil over. I feel that I yell at my children far too much, and my husband not enough! LOL.

Denise, I can empathize with you and will be glad to cry with you.

love and hugs,

Lisa

Post by marb on Jun 10th, 2006, 2:26am
Thanks Denise and Lisa for sharing your feelings. I guess emotions don't always make sense. I know that God is in control but still.....I'm not sure my feelings reflect that. Unexplained pain is a real downer. Always thinking it is the cancer back again, even if you are unlikely to have cancer in the heart or leg. :o The oncologist can not be definitive as to where it may metasticize, or even how I will know it is back. He said it is likely to return to the abdomen area and I should feel something. However, there was no pain at all when the surgeon opened me up for a different reason, and found massive stage three cancer. Sooooooo, we wait. :( I will hold you both while you cry. :-* Love, Marb

Post by josey on Jun 10th, 2006, 3:30pm
I find that when I first thought about cancer I thought about "death", but now I know its not death, but "fear".

Always a fear of it returning, or not left yet. It's always on your mind even though it may be on the back burner, but it is always lingering.

My tumor was removed in november and chemo ended in march, and I feel people dealing with me like I'm "normal" again, and I guess I am, but I still and will always have the FEAR. It doesn't lead my life, but its always lurking.

Now, here I am waiting for another scan to see if the cancer is back in my liver. Again, dealing with fear. Everyone around me is saying "don't worry, its nothing", and I hope to God they are right, but even if it comes back as noncancerous, there will still be fear of it coming back again anyway in another time, or place.

I try very hard to keep upbeat, and for the most part I do. I allow myself time to be depressed or sad and then pick up my britches and move on. I feel that I am very lucky in the sense of my own being that I dislike being depressed so would be unable to be depressed for long. It's just not built into my psyche for me to be like that. And that is one thing I am thankful for.

Every day I write in a blessings book and I find it really helps me. Keeps me focused on what is real and true. I don't hide from my fear, but face it. I know its there and it will probably always be there, but it will soon be a part of me too which I will call "ME".

This site really helps. Knowing there are others who know EXACTLY what I am feeling is again a blessing. We are not alone.

Love and prayers to you all

Post by Pepper on Jun 22nd, 2006, 3:17am
Hi all, I have found Ostomyland so supportive but then today I found this subject and the tears started to flow again for me and for you. Waiting for the the other shoe to drop is so apt. I am terrified of my checkups as something always seems to need either another scan, just to check or the removal of another piece of me. I am so grateful for the support I get from my surgeon and being able to access all the medical support I need but some days it just isn't enough. I have just started to see a psychologist and the most interesting thing is that she says things that I read on this website. I do need face to face contact though and I keep trying to find someone in a similar situation, same sex preferred, sorry guys - your comments on the site are great but... and about the same age just to talk to and mostly laugh at the funny things that happen. I keep upbeat most of the time so as not to worry family and friends.
I feel very much a second class citizen at times even though the fact that I have a stoma is not known to many people.
Back to one piece after disasterous trial with a two piece again. Maybe that is contributing to the misery. Going to get off now and ring a friend and find lots of things to laugh about. And I would love to see the DVD of the irrigation if you ever managed to do it. The video that Kathy from England recommended for the guy in Italy was amazing. I haden't seen anything like this before. What a well behaved stoma!

Sorry, once more for the saga. Hugs to everyone. Hugs are the best...Pepper

Post by shirley on Jun 22nd, 2006, 8:29pm
Hi Pepper,
Had to write you a reply.
Sometimes something can trigger a response or disturb feelings you thought were under control or were not even aware of.
Did you feel any better for having shed some tears?
I know what you mean about having a buddy.
I used to meet up with a local colostomy group (once a month) and felt as though they were like me, from the same species.
Are there no groups near to you?
I became involved in an unofficial way with the Colostomy Association and often help out on the information stand at local events.
Please dont feel like a second class citizen, I found it a very humbling experience having had cancer.
Sending you lots of (((HUGS)))
We do understand what you are going though.
Love and positive vibes coming your way.
Love
Shirley
xx

Emotional Effects of Cancer: Detailed Information

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Living with cancer is an experience that can affect every aspect of your life. Not only is your body affected, but also your mind and your spirit. You may experience many emotional reactions to all of these changes. When cancer treatment ends, the emotional effects may continue or new emotions may surface.

There is no ?standard? emotional response to cancer survivorship. Each survivor is different, as is each experience. Most likely you will experience a mix of emotional reactions, some of which may even be positive. For example, you might feel satisfaction in deepening personal relationships or confidence in finding strengths within you.

On the other hand, some of your emotional reactions might be uncomfortable or confusing, and at times you may feel overwhelmed by conflicting feelings. If this is how you feel during your journey through cancer, you are not alone. Many cancer survivors say that managing their feelings can be just as difficult as dealing with their medical issues.

Changes in emotions or mood are common throughout the cancer experience. For example, at diagnosis, you may have felt afraid, sad and worried. Perhaps you felt more confident after you decided on a treatment plan. During treatment, you might have had many changes in your mood. Many cancer survivors describe the treatment time as an emotional roller coaster?some days are ?up? while other days are ?down.?

After treatment ends, many survivors are surprised to find that they continue to have changes in their emotions or mood. For some, completing active treatment brings a time of great emotional distress. Many survivors describe the time after treatment as one of the most emotional?and unusual?periods of their lives. You may have similar reactions as you adjust to life after cancer treatment. Understanding what some of these emotions are can help you manage them and feel confident about survivorship.

What will survivors learn from this document?

This document provides an overview of the emotional effects that survivors sometimes face when treatment ends. Although many different experiences and many different points of view are represented, no single document can cover all the emotions that are experienced by cancer survivors. As you read about emotional aftereffects, keep in mind that you may have none, some or all of these concerns. Or you may experience these emotions more or less strongly than other survivors. Even though you may not experience all of these emotions, chances are you will recognize at least some of them at some point in your survivorship.

Why are emotional effects sometimes confusing after treatment ends?

Perhaps you expected to be thrilled and feel relieved. You may indeed feel this way when treatment ends. However, you may be surprised to find that you also have uncomfortable feelings and unanswered questions. Is the cancer gone for good? Will I face more side effects from the cancer or the treatment? I?ve made it through treatment?shouldn?t I feel completely happy? What is going to happen now?

You may be surprised by the mixture of feelings you have when treatment ends and the process of moving on with life begins. This can happen for several reasons.

Emotions often surface unexpectedly. Knowing what some of these emotions are can help you understand what you are experiencing and help you find ways to manage your reactions.

What are some emotional effects associated with the end of treatment?

When treatment ends, you might feel excited about your future, relieved that treatment is over, and ready to move on with your life. Or you might feel worried about the future, angry that you had cancer, or embarrassed that you had to rely on others for help and support. Many people have mixed feelings. You may have none, some or all of the feelings and reactions listed below. You also may have thoughts, feelings and reactions that are not mentioned.

Knowing about some of the most common emotional effects may help you understand and manage your feelings. Noticing the difference between some of these emotions (for example, sadness vs. guilt) is not always easy. Use the resources in the Additional Resources document to help you learn more about them.

Some common emotions are:

Fear of recurrence

Will the cancer come back? Fear of recurrence is one of the most common concerns for survivors. You might feel especially worried about the cancer coming back if you continue to have symptoms or if you have aftereffects from the treatment. You may also feel at risk because:

Anxiety (Feeling worried or nervous)

Some survivors say that the time right after treatment ends is one filled with insecurity and anxiety. You may feel that something bad is about to happen. Perhaps you feel that the threat of cancer coming back is constantly hanging over your head. Follow-up appointments, symptoms of common illnesses (like a cold), questions about how the cancer experience will affect your future?all of these may cause you to feel anxious.

Worries about self-image or body image

If you experienced physical changes, you may sometimes worry about how you look to other people. You may feel differently about your body after you have had cancer and treatment. Your sense of who you are and how others see you can be challenged as you try to adjust to post-treatment survivorship.

Sadness or depression

Sadness is a feeling of unhappiness, unrest or mental suffering that can be caused by an unexpected change, stressful situations or a loss of some kind. Sadness may be the most surprising of all the post-treatment emotional effects. However, feeling sad is a common response, especially in the early months after treatment ends. While you were focusing your energy on your diagnosis or treatment, you may not have had a chance to ?let down? and really think about the changes that were happening in your life. You might have experienced losses that are painful and hard to accept. Feeling sad is a normal response as you try to adjust to any changes or disruptions that have happened.

Depression is something different than sadness. Just as with sadness, depression may be caused by stressful situations or unexpected change or loss, but it may also be caused or made worse by chemical changes in the brain. The sadness that comes with depression lasts for a longer amount of time and may be very strong.

Some symptoms of depression include:

Depression is a real and treatable medical problem. If you have any of these symptoms, or other symptoms that are keeping you from feeling like yourself or feeling good, talk to a mental health professional and your health care team right away.

Grief and loss

Losing someone or something that is important naturally causes pain and sadness. Grief is the natural human response to loss. Grief is more than simple sadness or depression because it happens over a long period of time and usually includes emotions such as denial, anger and acceptance. Survivors and their families may face many types of losses as a result of the cancer experience, such as the loss of a job or career, the loss of financial or emotional security, the loss of physical function or health, or the loss of an important goal or lifelong dream. Understanding and managing grief is a process that may happen over a long period of time and can include a wide range of thoughts and feelings.

Guilt

Guilt is another emotional effect of cancer that can surprise you after completion of your treatment. Guilt is a feeling you experience when you think you are to blame for something. You may think that something you did caused your cancer. You may feel guilt because you survived while others did not, or you may worry that you have placed too much of a burden on loved ones. Whatever the cause, guilt is a complex emotion that can be difficult to acknowledge and express.

Uncertainty

You may feel unsure about different aspects of your life. The condition of your health can be a primary area of concern. You may find yourself becoming nervous as your follow-up appointments or important anniversary dates (such as the date of diagnosis or the date of completing treatment) get closer. You might worry more than usual about your health?there may be no such thing as ?a simple cold? or ?only a headache.? You and your family may find it hard to make plans for the future. Even though uncertainty affects different people in different ways, all cancer survivors live with some uncertainty about their future.

Anger

Anger is a feeling that can have various levels, from mild irritation or frustration to rage or fury. Challenges in many areas of your life can bring up anger. You may feel cheated out of the chance to have a normal life. You may struggle with physical or emotional aftereffects of treatment. You are most likely to feel anger when you are reminded of what you have lost because of cancer. Physical, financial, spiritual, emotional or social distress can also lead to anger.

Emotional numbness

The sensation of being drained, worn out or just unable to feel anything because of overwhelming experiences is common among survivors. After the stress of treatment, you may feel unable to manage anything more. You may ?shut down? all of your feelings in order to protect yourself. If you often find yourself thinking ?I just don?t care? or ?It doesn?t matter,? then you may be experiencing emotional numbness.

Spiritual distress

The ability to make sense out of life?s experiences is important to your sense of well-being. You may look for different ways to understand your cancer experience, especially if your treatments were difficult or your illness was seriously life-threatening. Sometimes understanding why things happened the way they did can be hard. The search for meaning often begins at diagnosis and can continue for many years after treatment is over. The question ?Why me?? may be hard to resolve, especially if you are living with uncertainty about your health and your future. The picture of your life the way it is now may be very different from the way you thought it would or should be. You may experience spiritual distress as you redefine your values and goals and search for what now gives your life its quality and meaning.

Are these emotions and symptoms normal?

Having some emotional effects some of the time is normal and common during survivorship. However, feeling depressed, worried, stressed or overwhelmed most of the time is a sign that you need help managing your emotions. You should talk with a mental health professional or your health care team about the cause and treatment choices for any emotional effects if they are very intense, last a long time or interfere with your daily activities.

Will all cancer survivors experience emotional effects?

You may have all, none or only a few of these feelings and reactions. Every survivor will feel and respond differently. Knowing that these emotional reactions are common and sometimes expected can be a starting point for living well and accepting your feelings after treatment.

You may be at higher risk for emotional distress if:

What are some situations that might lead to emotional distress?

You and your family may be dealing with a broad range of issues, including physical, social, emotional, financial and spiritual challenges. Believing the myth that you can just pick up your life where you left off makes living with these challenges even more difficult, and it increases the struggle to deal with uncomfortable emotions.

Examples of situations that may lead to emotional distress include:

What are some signs that you may be experiencing emotional effects?

Emotions can trigger reactions in your body, in your behavior and in the way you think about things.

Some physical reactions might include:

Some reactions in your behavior might include:

Some reactions in the way you think about things might include:

Will the emotional aftereffects ever go away?

Researchers are just now beginning to study and learn more about the long-term emotional effects of the cancer experience. Their work shows that, over time, most survivors can adjust in positive ways to the stresses of cancer and its treatment.

Emotional reactions to cancer can change over time. Your feelings at the beginning of your journey with cancer may be very different from those you have at the end of treatment or beyond. Gradually, as you adjust to or accept the cancer experience and allow yourself to become comfortable with your feelings, many of the emotional effects will become less intense and happen less often. Memories of the distress of diagnosis and treatment usually begin to fade. You may see that other life events become more important and the cancer experience becomes less important.

Even so, reminders of your experience with cancer can bring up emotional effects for years after treatment has ended. Examples of reminders might include:

Can strong emotions cause cancer to come back?

Researchers have studied the relationship between emotions and cancer extensively. There is no convincing evidence that emotions can cause cancer. However, there is research supporting the idea that taking a positive approach to treatment and playing an active role in your care can improve both your physical and mental sense of well-being.

Why is paying attention to emotional aftereffects important?

Paying attention to your feelings, especially uncomfortable feelings, can be hard when you and others may have wanted and expected to just get on with life. Yet paying attention to your emotional reactions after treatment has ended is important for many reasons.

Expressing emotions instead of keeping them inside lowers stress and promotes mental and physical health. Ongoing stress can affect your hormones and your immune system, and this may slow down the healing process. There is evidence that social support as well as professional mental health support can improve the quality of life for cancer survivors.

Paying attention to your feelings can also help you:

Cancer brings changes that are not always for the worse and may bring about healthy personal growth. The cancer experience and your emotional responses to it can become important resources as you face your future.

Lots of information on this site:
http://www.livestrong.org/site/c.jvKZLbMRIsG/b.670273/k.D445/Emotional_Effects_of_Cancer_Detailed_Information.htm

Message Board discussion of this topic:
http://ostomyland.com/phpBB/viewtopic.php?t=1171

Health-Care Workers Urged To Be Alert To Suicide Risk Amongst Cancer Patients

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21 Oct 2006

A Canadian oncologist has urged doctors and other healthcare professionals to be more aware of the potential risk of suicide among cancer patients and to offer extra support to the most vulnerable and their families.

In a study published on line (Thursday 19 October) in Annals of Oncology[1] the author said that while suicide is comparatively rare, his analysis of 1.3 million cancer cases in the United States[2] revealed that 19 out of every 1,000 male cancer patients and four out of every 1,000 female cancer patients took their own lives a total of 1,307 men and 265 women.

At around 24 suicides per 100,000 among cancer patients per year, the rate was between two and two and a half times that of the general American population (10.6 per 100,000 per year, which also includes the cancer population).

The nearly five-fold preponderance of males to female cancer suicides reflects the male-female ratio for suicide in the general population.

The risk of suicide varied according to a number of different factors, including gender, prognosis, the stage of disease, the type of cancer, ethnicity and family situation, according to the study's author Dr Wayne Kendal, a radiation oncologist at the Ottawa Hospital Regional Cancer Centre.

"If we were to draw a composite picture of the patient most at risk, this would be a widowed white male, with a new diagnosis of possibly head and neck cancer or multiple myeloma, with widespread and perhaps high-grade disease or maybe a history of other cancers. By contrast, a patient with decreased risk of suicide would be a woman of African-American heritage, with perhaps colorectal or cervical cancer, and living with her spouse," said Dr Kendal.

Looked at overall, i.e. men and women combined, the cancers involving the highest suicide rates were those of the lung and bronchus, bladder, head and neck, oesophagus and myeloma, with lower rates for those of the breast and liver. However, when it was split according to sex, the results were different.

The suicide rates for most cancer sites in females were similar to each other, except for colorectal and cervical cancer, which were lower. Among males, the highest rates were for head and neck cancer, liver cancer and myeloma. Rates among bladder, oesphagus and lung and bronchus cancer were no higher than for other male cancers. Leukaemia, prostate and brain cancers had a lower suicide risk than other male cancers.

Both sexes were more likely to commit suicide if their cancer had already spread from its primary site to distant organs by the time it was diagnosed, with a higher suicide rate being detectable for men with intermediate stages.

Another difference between the sexes was that the highest suicide rate among men was immediately after diagnosis, whereas among women it appeared more or less constant over time.

Both sexes had an increased risk if they were divorced, but the risk for men was more than halved if they were married. For women it was about a third lower.

African-Americans had a lower risk, consistent with the lower risk for African-Americans amongst the general population, possibly due to religious beliefs, family support and a cultural rejection of suicide: the rate among African-American males with cancer was in fact more in line with that of female cancer patients.

"Many of the extremes of risk seen within the male cancer cohort were not as apparent among the females," said Dr Kendal. "Particularly with sites involving greatest risk for males, such as head and neck cancer and myeloma, it looks as if issues around quality of life, coping, symptom control and psychological distress were important. The almost five-fold fewer recorded female suicides could mean that lower statistical power might account for the lack of a similar findings, or it could be that female cancer patients did experience similar problems but were less inclined to react through self-directed violence - much as we see in the general female population."

One apparent anomaly was that, although poor prognosis was associated with higher risk, pancreatic cancer, which has generally a very poor outlook, did not carry any higher suicide risk than that of other cancers. Refusal by the patient of either surgical or radiotherapy treatment did not heighten risk: however there was a statistically significant higher risk of suicide when surgery was deemed contraindicated - indicative of advanced cancer or additional health problems.

"Clearly, any conclusions about risk factors can only be speculative," said Dr Kendal. "It could be that in cancers where surgery or radiotherapy were not deemed appropriate, patients felt a sense of hopelessness. In cancers, such as those of the head and neck, particularly oropharyngeal cancer, where pain and difficulty feeding are factors, or in myeloma where we see a lot of chronic pain, weakened bones and fractures, quality of life issues might play a role."

He said that, within this particular study, it was not possible to differentiate from the data between suicides associated with affective illnesses or substance abuse versus those motivated by desire for relief from terminal illness or the avoidance of being a burden to others.

"However, the data did confirm that married status lowered the risk of suicide and, overall, it seems plausible to conclude that depression played a likely role in many of the suicides."

Dr Kendal concluded: "We must get the message out to physicians, nurses and social workers that they should be aware of the potential for suicide in their cancer patients and that maybe, by giving people in need, and their families, more support and providing better symptom control we might be able to foster the desire to continue living."
http://www.medilexicon.com/medicalnews.php?newsid=54585

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