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Emotions and cancer

Most people experience many emotions as they learn to live with cancer. These can change from day to day, hour to hour or even minute to minute. People will work through their feelings in their own way and in their own time. How you react and adjust to living with cancer often depends on how you face other problems and crises.

Many factors can affect your emotional reactions, including your age, your previous experience with cancer, your family or support system and your spiritual and cultural beliefs. Learning about the emotional effects of cancer can help you cope. It can also help you understand and support others through these hard times.

Feelings of fear, uncertainty, denial, anger, guilt, stress, anxiety, loneliness, isolation, sadness and depression are all a normal part of the cancer experience. It’s also normal to feel hope, relief, surprise, acceptance and determination. You may feel any or all of these emotions at some time or another.

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.

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Denial

Some people with cancer don’t believe or accept their diagnosis. This feeling is known as denial. In some ways, a short period of denial can be helpful because it gives people time to adjust to the diagnosis and feel less overwhelmed by the news. But it can be a problem if it lasts too long (several weeks or months) and stops a person from getting treatment or making important decisions.

People cope with cancer in their own way. A person may cope by not talking a lot about their cancer or by being optimistic when the outlook is actually not very good. But these ways of dealing with a cancer diagnosis don’t always mean they’re in denial. True denial is when someone never accepts or acknowledges the diagnosis. This is very rare.

Denial may get in the way of talking about cancer. It can cause tension in a relationship if one person is in denial, while the other person has accepted the diagnosis and wants to get on with things.

If you feel that you or your loved one is in denial about the cancer diagnosis, allow some time for the news to sink in. Most people accept the diagnosis by the time treatment begins. If denial gets in the way of making treatment decisions or changes relationships, think about talking to a social worker or a counsellor.

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Anger

You may feel angry at different points during your cancer journey. Anger is a normal response to what feels like a very unfair situation. You may be angry at:

  • the cancer
  • your healthcare team
  • friends and family who are in good health
  • yourself
  • your body
  • your god

These tips may help you control your anger:

  • Recognize anger. Don’t pretend that everything is okay if you’re feeling angry. Try to describe or talk about your feelings.
  • Ask yourself if your anger is hiding other feelings. Sometimes people get angry rather than express emotions like fear or sadness.
  • Talk to your family and friends about feeling angry. Explain that you may seem angry or moody at times, and that really you’re angry at the cancer and the situation, not at them. Talking can help you feel a lot better.
  • Release anger through exercise, yoga or relaxation exercises. Keep a journal or blog about your feelings.
  • Change your surroundings. Take a break or a walk and give yourself some quiet time if you feel something stressful is about to happen.
  • If you’re worried about someone’s anger:
    • Try to talk to them about it.
    • Take a break from each other.
    • Ask a good friend, family member, social worker or counsellor for help.

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Guilt

Sometimes people with cancer feel guilty. There are many reasons for this.

  • People may wonder if they could have noticed symptoms earlier or done something to prevent the cancer or make it less serious.
  • Others may feel that they caused the cancer, because of their lifestyle or work environment.
  • People often worry that their children or other family members will also get cancer.
  • Some feel bad for upsetting others or because they think they’re being a burden.
  • A person might envy other people’s good health and be ashamed of feeling this way.

Caregivers, family members or friends may also feel guilty for some of the same reasons mentioned above or for these reasons:

  • They are healthy while someone they love is ill.
  • They can’t help as much as they want to or feel they aren’t doing a good job of helping.
  • They feel stressed or lose their patience with others.
  • They cannot make the person with cancer feel better.
  • They may feel they’ve caused the cancer.

These tips may help lessen the guilt:

  • Try to remember that cancer isn’t anyone’s fault and that no one deserves to be ill.
  • Remind yourself that there is no one or perfect way to give support.
  • Counselling and support programs can help with feelings of guilt. Tell the doctor or another member of the healthcare team if you would like to talk to a social worker, a counsellor or someone who has been through a similar cancer experience.

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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.

The treatment for anxiety will depend on how it affects a person’s daily life. Sometimes the symptoms of stress and anxiety can be very severe. Talk to the doctor or healthcare team if you feel stressed or anxious most of the time. They may:

  • 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

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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.

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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.

About 1 in 4 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 hormonehormoneA substance that regulates specific body functions, such as metabolism, growth and reproduction. 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 heathcare 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.

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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.

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