A cancer diagnosis is a life-changing event and can upend one's life priorities and routines. Emotional responses such as shock, sadness, anger, disappointment, and confusion are common. With the added anxiety of awaiting test results and appointments, it can feel like your entire world is caving in. Ms. Siti Mariam, Senior Therapist, offers her perspectives on the emotions and behavior surrounding diagnosis and treatment; and when therapy can help
Hearing the physician say, "you have cancer," can be extremely distressing. While some respond with anger and denial, others would react in disbelief, as they reel from the shock of hearing the news. Ultimately, there is no right or wrong way to respond, but it remains a piece of news that is hard to bear.
"There is a range of emotions that someone experiences upon hearing his diagnosis. The feeling of shock and helplessness is quite common. Words like cancer, tumor, or tissue growth are frightening to hear and make it sound like receiving a death sentence or being punished. Those who keep up with a healthy lifestyle and exercise can feel betrayed and a sense of injustice as they have tried so hard to stay healthy. They do not feel that they should or deserve to get cancer," Ms. Siti says.
People tend to worry more about the future when it comes to cancer.
"Questions such as 'What is going to happen to me?’, ‘How am I going to tell my family?’, ‘Am I going to die?’, and ‘Is there a cure?' reflect common concerns," she adds. When mixed in with the added anxieties related to unexpected cancer medical costs, time away from work or home, extended care supervision and observation, it can add up to become a stressful time for a patient and their loved ones.
On the other hand, Ms. Siti says that some may feel relieved that there is closure to understanding the symptoms that they are experiencing.
"But, even so, when the diagnosis comes after weeks and months of tests and with heightened anticipation, the emotions felt may not be any less distressing compared with others whose diagnosis came from a health screening or tending to what seemed like a common symptom," Ms. Siti adds.
The reaction to a cancer diagnosis can be overwhelming, leaving one feeling numb and lost. Unfortunately, it is also typical that patients often cannot remember and process their physician's advice during an arranged family consultation. These moments are stressful as patients are also expected to make decisions quickly about treatment
Although receiving a cancer diagnosis is challenging, some cope better than others.
“When someone has journeyed with or knows someone who has or had cancer and seen the challenges, they might respond better compared to someone who has never had any personal encounters with anyone dealing with cancer.
“The prior knowledge and experience can give them a better idea of what to expect. Some seek out others who had or are journeying with cancer so that they can use their knowledge to inform their decisions and be psychologically prepared.
Such knowledge can help them cope better as they deal with the intensity of the physical pain and discomfort, and the emotions as they journey with cancer,” Ms. Siti says.
Personality and coping style on a broad level are also other influencing factors.
“Someone who is stoic may appear calmer when they receive the news. Another who is a deliberator might need a lot of time and space to process and have the news sink in. With regards to coping style, some people might cope by not dealing with the bad news because it is too much to handle while others get into action mode, and want to know everything that can be done to treat and manage the condition. Regardless, everyone’s style is different and it is okay to ask for more information and time before making important decisions,” she explains.
Age does not necessarily influence copying style, but the goals and attitudes associated with cancer treatment might differ across age groups.
“Elderly cancer patients may have more complex needs as they may have other chronic conditions. Hence, if they think that they are going to be a burden to their family, they may not opt to go for active treatment. Generally, they may feel that they have lived a fulfilled life and do not want to trouble their family and others.
“However, I have also seen many older patients who believe that they should not give up and will try their best to beat the cancer. What drives these patients are their beliefs and values about life and living.
“In the case of younger patients, they are normally more eager to try to beat the condition. They are probably at a different life stage than the aging patients such as starting on or in the midst of establishing a career, or have young children. Thus, they feel as if life is not yet complete so they want to have a chance to live out their plans and dreams many years into the future,” Ms. Siti says.
Like in a normal grieving process, a patient might go from the stages of shock and denial upon learning his cancer diagnosis to the final stage of accepting the news. However, it does not mean that the person has finally let go of their grief or will no longer experience shock or anger, being in denial, or bargaining. Rather, the person has learned to accept cancer as a part of his life.
“Having hope is very intuitive and it is what makes us human. Once the treatment begins and no matter how strong you are, the feeling of hopefulness can arise,” Ms. Siti says. However, this feeling can fluctuate, depending on a person’s physical, emotional, and mental states during treatment.
“It can change within hours, days, or weeks. Today, I might feel good because I am able to keep my food down and managed to get a good night’s sleep. In the afternoon, I might feel lousy and hopeless because the doctor has just told me that the tumor has grown despite the treatment,” she attempts to relate how a patient might feel.
The emotional and mental states of a person with cancer during the treatment cycle can be profoundly affected by the kind and stage of cancer, the symptoms, and the side effects of the treatment. When we talk about pain in cancer, we are not only referring to the physical pain, but also the emotional, psychological, and spiritual pain.
“For those who are acutely experiencing the symptoms and side effects including chronic pain, it is not surprising that they may show depressive symptoms such as being moody, easily irritable, faced with a sense of helplessness, anxious, or even suicidal,” she advises.
The main thing about living with acceptance is not giving up on life and living. Ms. Siti says she knows of instances of patients deciding to try to live more meaningfully, even when the treatment outcome is not panning out as expected or when the condition worsens.
"Some start to create legacies (an example is creating a recipe book) so that they can leave a mark of themselves even after they pass away. Others reconnect with and strengthen their spirituality and religiosity. For many of these patients, it is important to be at peace. This may mean being at peace with whatever amount of time they might seem to have left and living with quality rather than just living and breathing. Remember that being at peace is a state of mind and even those experiencing a lot of pain can have this state of peace," she elaborates.
A common belief is that cancer patients need to stay positive and hopeful. However, putting on a brave face all of the time can feel very draining and may not always work well.
“There has been research that positivity can improve one’s general health and that is also true in coping with cancer. However, it should not be used to mask a worry or to settle unrealistic expectations which can add to the burden and stress.
“I would think that it is impractical to expect someone to always be able to be positive and hopeful because even among those who are physically well, we cannot always be positive and upbeat,” she highlights.
“I have had patients who told me that they intentionally alienated themselves because well-meaning as certain people were, they found it hard to hear their advice and well wishes because at those times ‘they just don’t understand what I am going through’ and ‘I don’t want to be pitied.’
Many also do not have the energy to socialize or keep up the appearance that they are okay, when actually, they may not be. On a personal note, I have stopped telling my friends with cancer that they must not give up and fight on unless I am certain that is what they really want to do. Being present, available; and not say much can be even more impactful,” she adds.
The cancer journey can often be beset with loneliness as some patients find it hard to convey their thoughts and emotions in a manner that resonates with others.
According to Ms. Siti, the red flags are for when thoughts of wanting to harm oneself present and perhaps lead to stopping treatment suddenly or when active suicidal thoughts occur and possibly develop into making concrete plans to end life. These are clear signs that professional help might be urgently needed. Strong support from loved ones is so crucial at this point.
However, she advises that the passive wish to disrupt the treatment plan might not necessarily indicate a suicidal intent.
"It is essential to differentiate between intentionally wanting to end suffering and pain, which is likely suicidal, versus accepting cancer but wanting to focus on how to live with the disease. If you are unsure, speak to your doctor or see a mental health professional," she emphasizes.
Depression and anxiety are also common among people with cancer.
"Finding that you have more and more days where you no longer want to get out of bed, shower, eat, and have very little motivation to do anything; these can be signs of depression. Also, giving up a religion, becoming obsessive over fears to do with living and dying, feeling that you have no control over anything, missing your medical appointments, or experiencing a drastic change in personality are possible signs that a person might not be coping well," she adds.
Ignoring these signs can affect the quality of life and impair daily functioning, Ms. Siti cautions.
"Seeking therapy or counseling is very much an individual choice. If you find that you need the space to understand and make meaning of your situation, or learn to cope better, attend therapy or counseling.
“You can choose to to talk to a mental health professional who has the experience of supporting people with cancer. Do seek help early and not wait until you reach your breaking point. The cancer might not be something in your control but getting help to manage your distress is under your control," she advises.
There are several psychosocial options in the private and public sectors. "You can get psychosocial support from community organizations that support people with cancer. Depending on the kind of support you need, the help might include individual counseling, or opportunities to join support groups or attend social activities including outings with others journeying with cancer,” Ms. Siti outlines.
All public hospitals have counselors, social workers, psychologists, and expressive therapists such as music and art therapists. "Patients can obtain a referral if they are being treated for cancer at these facilities. Counseling and therapy are also available in private clinics and centers. When in doubt, speak to your doctor about the issues you might be facing, who can recommend the relevant support,” she adds.
There is no doubt that cancer is scary. But sometimes, overthinking only creates more fear and causes someone significant distress. Ms. Siti shares five tips on managing cancer-related anxiety and starting to live life as should be:
She summarizes, “Remember, there is no one-size-fits-all approach to managing the emotions surrounding cancer. However, the most important thing is let your body and emotions guide you to tell you what you need and what to do, but not to overwhelm you; and do not let your psychosocial health take a backseat to cancer treatment.”