Living with Cancer

Emotional Responses

Dealing with the diagnosis
You may feel shocked when you're told you have cancer. It's often difficult to take in the diagnosis immediately – you might hear the words but not believe them.

There are many reasons for this shock: cancer is a serious disease, and most people feel afraid and unsure about treatment, side effects and the likely impact on family and work.

Cancer can also feel like a threat to your way of life. You may wonder if you'll be the same person as before, if you'll be able to do the things you usually do and if your relationships will change.

Having these thoughts and feelings is a natural reaction to a difficult situation. Knowing this can help you find ways to manage these feelings.

Over time, you may find that your strong feelings about cancer fade. Although your life has changed in some ways, in other ways it goes back to a more regular pattern and you feel more or less like your usual self. However, this may not happen, instead you may continue to feel worried and upset and these feelings can interfere with your life.


Common reactions
For many people, the first few weeks after they're diagnosed with cancer are very stressful. You may have trouble thinking clearly, eating or sleeping. This can last from several days to several weeks. It's common to feel that you're on an emotional rollercoaster.

Feelings you may experience
Fear  It's frightening to hear you have cancer. Most people cope better when they know what to expect. 
Anger  You may feel angry with health care professionals, your God, or even yourself if you think you may have contributed to the cancer or a delay in diagnosis. 
Disbelief  You may have trouble accepting that you have cancer, especially if you don't feel sick. It may take time to accept the diagnosis.
Sadness It's natural for a person with cancer to feel sad. If you have continual feelings of sadness, and feel sleepy and unmotivated – talk to your doctor – you may be clinically depressed.
Guilt  It's common to look for a cause of cancer. While some people blame themselves, no-one deserves to get cancer.  
Loneliness It's natural to feel that nobody understands what you're going through. You might feel lonely and isolated if your family and friends have trouble dealing with cancer, or if you're too sick to work or socialise with others and enjoy your usual activities. 
Loss of control  Being told you have cancer can be overwhelming and make you feel as though you are losing control of your life.
Distress  Many people, including carers and family members, experience high levels of emotional suffering as a direct result of a cancer diagnosis.

TIP: If you're having trouble dealing with any of your emotions, consider talking to family and friends, seeking professional help through a counsellor, psychologist or psychiatrist, or joining a support group.


Shock and denial
Shock
Shock is often the first reaction when a doctor tells someone they have cancer. You may
  • Feel numb
  • Not believe what is happening
  • Be unable to express any emotion
  • Find that you can only take in small amounts of information
  • Ask the same questions repeatedly
  • Need to have the same information repeated to you

Needing to have information repeated is a common reaction to shock. You just can’t take anything in at first.

Your disbelief may be so strong that you find it difficult to talk about your illness with your family and friends. Or you may find that you need to talk about it over and over again to help the news to sink in.

Denial
Some people choose to cope with their situation by pretending it’s not happening. It’s not that this is necessarily a conscious decision. It can be a gut reaction. You may just feel overwhelmingly that you can’t think about it whenever anyone brings the subject up.
You may find that you
  • Don’t want to know anything about your cancer or treatment
  • Prefer to talk about it as little as possible or not at all
This is another completely natural reaction. If you feel this way, you can tell the people around you quite firmly that, for the time being, you don't want to talk about your illness.

But in extreme cases, denial can be unhelpful. Some people deny their cancer so firmly that they convince themselves that either they aren’t ill at all, or that their illness isn’t cancer. If this reaction starts to get in the way of your treatment or makes your overall situation even worse, you may need professional help from a psychologist or counsellor.

Other people being in denial
Sometimes you may find denial happens the other way round. You may need to talk about your cancer, but your family and friends may be the ones in denial. They may
  • Try to dismiss the fact that you are ill
  • Seem to ignore the fact that you have cancer
  • Play down your anxieties and symptoms
  • Deliberately change the subject
People can react in this way because they are frightened of cancer themselves. They may be embarrassed by talking about it. Or they may be terrified that someone they love has a life threatening condition. If they don't talk about it, they can try to pretend it isn't happening.
 
But if you want their support, and to share how you feel with them, this behaviour may hurt or upset you. If you feel like this, try to
  • Tell them how you feel
  • Reassure them that you know what is happening
  • Explain that talking to them about your illness will help you
Talking about your cancer
Talking about your situation really can help. If you would like to share your feelings with someone, but don’t feel you’re able to talk to your friends and family, it may help to talk to a counsellor.

If you would like to talk to someone outside your own friends and family, NCSM’s Resource & Wellness Centre can help. Call us at 03-2698 7300.


Sadness and depression
Many people feel sad after a cancer diagnosis or while being treated for cancer. It’s normal to feel sad when dealing with a stressful or upsetting situation. You may grieve the loss of good health or your ability to enjoy life as you used to. Many people with cancer even have passing thoughts of suicide, although they never act on them.
 
Sometimes people with cancer or their caregivers find that their mood never lifts or that it gets worse over time. Depression is much more than simple unhappiness. Clinical depression, sometimes called major depression, is much more than feeling unhappy or blue. It is not a sign of personal failure or not being able to cope.
 
Some people with cancer will be clinically depressed at some point during their cancer journey. These factors can add to the risk of depression:
  • side effects of some chemotherapy drugs, biological therapies and hormonal therapies
  • side effects of pain-relieving drugs like opioids
  • having advanced cancer
  • nutrition problems
  • pain
  • blood or hormone problems
  • lack of family support
  • previous history of depression or suicide attempts
  • history of alcohol or drug abuse
  • having other illnesses at the same time
If depression does occur, it can usually be treated successfully. The first step is recognizing it and getting the right help as soon as possible. The main symptom of depression is a sad, despairing mood that:
  • lasts most of the day every day.
  • lasts for more than 2 weeks.
  • affects performance at work or at school or affects social relationships.
Other symptoms of depression can include:
  • feeling useless, hopeless, helpless or negative.
  • loss of interest or pleasure in work, hobbies, activities and relationships that you usually enjoy.
  • less energy or extreme tiredness (fatigue).
  • trouble concentrating, remembering or making decisions.
  • feeling nervous, restless or irritable.
  • change in appetite and weight.
  • change in sleep habits such as trouble sleeping (insomnia), early-morning waking or oversleeping.
  • frequent thoughts of suicide (which should always be taken seriously).

These tips may help you feel less sad or depressed:
  • Talk to family members or friends about these feelings. It may also help to talk to someone who has had a similar cancer experience. It may be hard to tell your family and friends how you really feel because you want to protect them. Finding the courage to talk to just one person can be the first step to feeling better.
  • Seek out positive people and events to keep your spirits up. Many people find contact with pets soothing.
    Eat well and be as physically active as possible. Exercise releases endorphins, which are natural mood-boosters.
  • Try to relieve tension with yoga or meditation.
  • Look to your spiritual faith for comfort. Talk to a spiritual leader or clergy member for help in hard times.
  • Talk to your healthcare team or your family doctor. They can refer you to a mental health expert who specializes in treating depression.
  • Ask your doctor, psychiatrist or psychologist about medicine to treat depression. Do not take any over-the-counter or natural health products for sadness or depression without talking to the healthcare team. People with symptoms of depression should not try to treat themselves with natural health or herbal products. Some of these products may not be suitable for major depression or may interfere with cancer treatments.
Depression and the risk of suicide
Depression can become very serious. Someone who is depressed may refuse to eat or take medicines, or they may hurt themselves or even plan to end their life. It’s important to find out whether thoughts of suicide are related to depression or to cancer symptoms. Identifying and treating depression or the symptoms of cancer can lessen the risk of suicide.

If you have frequent thoughts of suicide, talk to your doctor or someone on your healthcare team right away. They can refer you to a mental health professional.

If someone you know says they’re thinking of suicide, take it seriously, even if it seems like an offhand comment. If the person refuses to talk to a doctor, then talk to the healthcare team about getting help.


Hope and adjustment
Adjusting to cancer can be a gradual process that takes time. It’s hard to predict how quickly or easily someone will adjust to the situation.

You may adjust better if you try to:
  • Eat well every day
  • Get up and dressed every day
  • Continue with your normal responsibilities as much as possible
  • Accept offers of help or ask for help
  • Stay involved in activities that you enjoy and have meaning for you
  • Exercise regularly if possible
  • Share your feelings
  • Keep your social life active
  • Find some time just for you every day to relax
People often feel more hopeful once the shock of the diagnosis lessens. Hope allows people to cope with hard things in the present and to imagine a positive future. Hope is very personal – you might find it easy to be hopeful or you might find it hard to bring hope to what is such a tough experience.

Although hope is very important to people with cancer and their loved ones, it’s also important to keep a balance between realistic hope and false hope. Having a realistic picture of the future helps people make better decisions about their treatment and any long-term plans.

People find hope in different ways. You may find hope by enjoying nature or spending time with your family. Your faith may give you hope, or you may be inspired by stories about people who have overcome cancer or who lead active, fulfilled lives during and after treatment.

For some people, a cancer diagnosis brings renewed clarity and purpose to life, and this can bring hope. Others find hope in starting new projects or making plans for the future.


Stress and anxiety
The challenges and changes that cancer brings can make people with cancer, their caregivers or loved ones feel stressed and anxious. Anxiety is a very common response to a cancer diagnosis. When you’re stressed, you may feel nervous or like you can’t turn off your thoughts. Symptoms of stress and anxiety include:
  • excessive worrying
  • muscle tension
  • trouble sleeping or getting too much sleep
  • restlessness
  • fast heartbeat, trembling, shortness of breath, chest tightness, nausea, dizziness or high blood pressure
  • tiredness or exhaustion
  • trouble concentrating
  • irritability
  • impatience
People can have different levels of stress and anxiety, from a lower level to a higher level, depending on their situation or how they perceive it. Anxiety may be highest when a person is waiting for test results, at the time of diagnosis or while waiting for treatment to start. 

People may also feel anxious:
  • when treatment needs to be changed or when it finishes.
  • if cancer does not respond to treatment.
  • when they have physical changes or challenges because of cancer or its treatment.
  • when they have severe pain.
  • if they don’t have enough support from others.
  • as a side effect of some medicines.
These tips may help you manage stress and anxiety:
  • Try to figure out what makes you feel anxious.
  • Talk with someone you trust.
  • Spend time with people who make you laugh.
  • Think about what’s important and try to manage your time by making a realistic list of things to do each day. Try to create some balance in your life.Make sure to include things that you enjoy.
  • Decide how much you want to know about your situation. Some people can ease their anxiety by learning more about cancer and its treatment. Others feel best if they just follow the plan their healthcare team gives them and don’t ask extra questions.
  • Keep a journal or diary during treatment. Writing down thoughts and feelings can help relieve anxiety. A journal is also a good place to write positive feelings, so you can look at them again when you feel low.
  • Try meditation, relaxation techniques or regular exercise to help manage stress.
  • Eat a healthy diet, get enough sleep and be active.
  • Cut down on drinks containing caffeine, such as coffee, tea or cola drinks. Switch to decaffeinated drinks.
  • Look at support or resources available to help cope with and relieve anxiety. Sometimes talking to someone who has had a similar cancer experience can be very helpful.
  • Suggest a class that teaches people how to manage stress.
  • Refer you to a social worker, counsellor or other mental health expert.
  • Prescribe anti-anxiety drugs.

Fear and uncertainty
A cancer diagnosis raises many fears. It can make you feel as if your life is out of control and that you don’t know what the future holds. It’s normal to be afraid of the unknown. Uncertainty can make you feel angry, afraid, anxious or irritable.

The time between diagnosis and the start of treatment can be very hard. You may:
  • wonder if you will die or lose someone you love.
  • worry about pain.
  • be afraid of cancer treatment.
  • worry about how you will handle work, day-to-day tasks or finances.
  • wonder how family will react and cope.
  • be afraid that you can’t do the things you enjoy or have to put your plans on hold.
  • feel helpless.

These tips may help cope with your feelings of fear and uncertainty:
  • Learn about cancer and its treatment. Some people find that looking for information and using that information to make decisions helps them feel more in control. Others prefer not to know too much. They are comfortable simply following the directions of their healthcare team. Tell your healthcare team how much you want to know.
  • Ask questions. Tell the healthcare team if you don’t understand what they’re saying or when you want more information.
  • Look beyond the cancer. Many people feel better when they stay busy. Some can still go to work but may need to adjust their work schedule. Hobbies such as music, crafts or reading can also help take your mind off cancer for a while.
  • Try to think about what you can do, rather than what you can’t do. Remind yourself that you are coping, no matter how bad you feel.
  • Remember that the uncertainty that comes with a new cancer diagnosis often fades as you and your family come to understand more about the disease, the treatment and how you can better cope.
  • Counselling and support programs may help. Talk to your doctor or another member of your healthcare team if fear or uncertainty is interfering with daily activities. You might like to talk to a social worker, a counsellor or someone who has been through a similar cancer experience.

Loneliness and isolation
People with cancer may feel lonely or isolated from others. You may feel too sick to take part in the activities you used to enjoy. Sometimes you may feel that no one understands what you’re going through, even when you’re with people you care about.
Sometimes family or friends have a hard time dealing with cancer and may not visit or contact you as often as they did before. This doesn’t mean they don’t care. They may just be afraid to see someone looking sick or worry they will say the wrong thing.
Family and caregivers can also feel lonely. They can feel as though they’ve lost their best friend or that they have no one to talk to about what they’re going through. They may feel overwhelmed by new responsibilities. They may feel like they don’t have time to see friends or do activities they enjoy. They may also feel overlooked by the healthcare team, other family members or friends, who tend to give most of their attention to the person with cancer.

These tips may help with loneliness:
  • Let people know what is happening and that it would be nice to see them.
  • Try phoning an absent relative or friend, send an email or write them a letter.
  • Talk to other people who have cancer or are caring for people with cancer. Many people feel better when they join a support group or connect with others who are facing or have faced the same challenges.

Not understood/other people’s reactions
Sometimes you may come up against reactions from family and friends that seem insensitive or uncaring. Some people may avoid or withdraw from you, some may appear too positive or make light of your situation. These reactions may make you feel hurt, angry or frustrated. Try not to take their reactions as a sign that they don't care. It may be that they need more time to take in your diagnosis before they're ready to face it. 


Helping your family adjust
Cancer is difficult for everyone it affects. Your family also needs to adjust to the diagnosis. Family members may deal with their feelings in a different way to you. Your family may experience similar anxieties and need as much information, support and advice as you. Family members might express their own fear about the diagnosis, at the possibility of losing you, and at their inability to do anything about the disease.

They may also worry about how the illness will change their lives. It might help family members having difficulty dealing with your diagnosis to contact a counsellor. A Cancer Council nurse can help you find a counsellor or psychologist.


When friends stay away
Cancer can change friendships. Some friends handle it well; others cut off all contact. Friends stay away for different reasons. They may not be able to cope with their feelings or they may not know how to respond to changes in your appearance. Your friends may still care for you, even if they stay away.

If you think that awkwardness rather than fear is keeping a friend from visiting, call them to ease the way. Remember that you can't always know or understand all the reasons why some people avoid you. You may find that talking about your illness helps everyone cope with it better.

Tips
  • Make time to talk. Don't wait for the ‘right' time – it may never come.
  • Don't fall into the trap of thinking, ‘if they really cared they'd know what I need'. They're not mind-readers.
  • Be honest about your thoughts and feelings even if it's upsetting.
  • Focus on understanding each other, as this is more important, at least initially, than trying to solve the problem.
  • Really listen to what the other person has to say, putting aside your own thoughts and judgments, to try to understand where they're coming from.
  • Talk openly about what's happening and what you need, and make some specific suggestions. For example, you may like someone to drive you or keep you company at the doctors.

Sexual inadequacy
Cancer and its treatment can affect your ability or desire to have sex. This can be caused by many things, such as changes in how your body functions, pain, stress or side effects. Some people are simply too tired to think about having sex, while others may be upset or embarrassed by changes to the way their bodies look or work. These kinds of concern about body image, and their effect on sexuality, are very common.

For women, hormonal treatments, pelvic surgery or radiation therapy – as well as early menopause – can change the size of the vagina or cause vaginal dryness. This can make it hard or painful to have sex. These treatments can also decrease sexual desire.

Men who have had surgery (for example, for prostate or colorectal cancer) may have problems getting an erection or ejaculating. Some of these side-effects may go away over time, while others may be permanent.

It can be very hard to deal with changes to your sex life. The changes can upset you or make you angry, but they can also be a chance to learn new ways of giving and receiving sexual pleasure. Surviving cancer doesn’t mean that you can no longer have a satisfying sex life – but you may need to change how you have sex.

It helps to talk openly and honestly with your partner about your feelings and tell them what does and doesn’t feel good. If these conversations feel awkward, you can also talk to a counsellor or psychologist. These professionals can help you talk openly about your problems, work through your concerns and come up with new ways to help you and your partner find pleasure together.