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Chapter 4

The Emotional Toll of Cancer

Receiving a cancer diagnosis is life changing. When people hear the words You have cancer, their minds turn off. Those words may be the only thing they take away from the doctor’s appointment. There’s a whirlwind of emotions, and it can be hard to take everything in. Because processing the information is so hard, patients should write down their questions, concerns, emotions, and everything in between.

Patients, families, and doctors sometimes overlook the emotional difficulties that arise when dealing with a cancer diagnosis. Remember that you’re not alone in your journey: family, friends, doctors, nurses, support groups, and social workers are all there for you. In this chapter, we discuss the emotional aspects of a cancer diagnosis and where you can go for help.

Why You Want an Emotional Support Team

What’s the right emotional response to hearing you have cancer?

 There is no “right” response.

 Crying is normal.

 Anger is normal.

 Yelling is normal.

 Denial is normal.

 Many people feel a loss of control over their lives.

Remember, a person’s emotions are not the enemy in this situation. Patients need to work through these emotions. To do so, a patient should form an emotional support team made up of family, friends, neighbors, counselors, and others.

Being honest with the emotional support team—whoever that may include—can help alleviate fears, worries, doubts, and other painful emotions. Whether you’re a patient, a family member, or a close friend, don’t be afraid to seek help.

Picking the Pros as Part of the Team

Seeking out an emotional support team is helpful for many cancer patients. The professional part of this team can include survivorship groups, counselors, social workers, psychologists, and psychiatrists.

In fact, there are psychologists and psychiatrists who specialize in working with patients with cancer. This is because depression and anxiety are common responses to a cancer diagnosis. It can be hard to deal with this on your own.

I always urge patients and families to seek help early and often. Many cancer patients and families benefit from talk therapy, medications (such as antidepressants or antianxiety medications), and other treatments these providers may offer.

Seeking psychological help is a normal part of dealing with cancer. The cancer center working with the patient can help direct you to the resources available inside or outside the center.

Did I Bring This On Myself? The Blame Game

Guilt is a common emotion that arises upon receiving a cancer diagnosis. Some people feel as if they brought the cancer on themselves because of habits such as smoking or drinking. Addictions such as drug use, smoking, or alcoholism are real medical problems that can be hard to treat.

I want to stress that no one deserves cancer.

Coping with cancer is a heartbreaking process, and the person diagnosed shouldn’t be made to feel guilty. Instead, they should focus on growing their medical and emotional support teams and pursuing their passions. Of course, quitting those bad habits may be helpful in the long term (see chapter 12, on nutrition and lifestyle, for help).

Get Organized: Regaining a Feeling of Control

We need to take a step-by-step approach to cancer and a person’s emotional reaction to it. To start, remember mistake #1: not knowing the diagnosis and stage of cancer. To help keep information straight, make a treatment binder that has all the documents regarding diagnosis, treatment, and medical information.

In this binder, break information into groups: Medication List, Medical Appointments, Diagnosis, Pathology Reports, Scan Reports, Side Effects, and Other. I prefer a three-ring binder; you can then hole-punch papers to organize information into sections. This may help you bring order from the chaos.

Organization helps bring back a feeling of control over everything that is happening, which helps decrease the anxiety many patients feel. But if you or family members can’t work on this binder right away, don’t feel like you have to.

When you feel ready, make a system that works for you to stay organized. There are many premade organization systems out there. Find whatever works. I talk more about maintaining patient information in the next chapter, on determining cancer treatment.

Faster Is Not Better: Allowing Time to Formulate a Treatment Plan

When someone finds out they have cancer, we doctors may need more information (another scan or biopsy) before we decide on treatment. Many patients have trouble waiting. They push doctors and nurses to get started with treatment right away.

Commonly, I hear patients say, “Doc, I have cancer. Don’t you get it? I want to get started with my treatment today.” I can understand and sympathize with these feelings, both the stress and the anxiety.

There is one principle of cancer care I always share with my patients:

A comprehensive cancer plan, with all the needed clinical information, is always better than a fast treatment plan.

Getting started quickly can lead us down the wrong road. If this happens, it can affect the outcome of treatment. Thus we should get all the clinical information before making a decision on treatment.

This delay can lead the patient to feel frustrated and even angry. Recognize these feelings, and know that everyone is working hard to help the patient deal with the cancer. Always advocate for the best care, but try to keep in mind that the doctors want to get started with the treatment too; we just want to make sure we have all the information we need first. This sometimes means fighting with insurance companies to get another scan, biopsy, or genetic test.

Don’t Quit Your Day Job and Move to the Bahamas . . . Yet

After a diagnosis of cancer, patients often rush to make big life decisions or changes. Some patients feel the need to sell their house, move, change jobs, or even file for divorce.

Some patients are trying to escape their current life. Others are searching for the life they wish they’d lived.

I urge patients to not make big financial or personal decisions soon after a diagnosis of cancer. Let the news settle. Make time to talk to family and friends about fear, anxiety, and uncertainty. Discuss everything going on with your emotional support team, and seek help and encouragement.

“Eternity Is in Love with the Creations of Time”: Pursuing your Passions

Cancer can make clear what is most essential to each of us: family, painting, playing the violin, traveling the world, writing a book, and so much more.

As a result, patients tend to react in one of two ways to a cancer diagnosis. Some patients use this turn of events to hold even closer the things they value. Other patients push the things they care about most as far away as possible. They desire to shield loved ones from a life they fear is doomed.

Many people make rash decisions in trying to get away from their families, hoping to spare them the pain of the diagnosis, treatment, and potential outcomes. It is in trying to protect those they love in this way, ironically, that they often hurt their loved ones the most. Family and friends only wish to be there with the patient through this journey. Rather, patients should use the cancer diagnosis to bring loved ones closer. I also urge patients with cancer to pursue dreams and passions, no matter what stage of cancer they’re in.

But didn’t I just say not to make major life changes or choices after a diagnosis? You’re right. I wouldn’t make those major changes right after a diagnosis. But after a treatment is agreed upon, patients can start thinking about making their dreams and passions a reality. Dreams and passions are a critical part of who we are. (So feel free to start planning that trip to the Bahamas.)

My favorite quotation comes from poet William Blake on the subject of creation: “Eternity is in love with the creations of time.” This creation could include traveling the world, writing your book, or seeing the Chicago Cubs play in Wrigley Field. A goal or dream gives you something to look forward to and allows you to pursue what’s most essential in your life. I urge patients to discuss dreams and passions openly with their medical and emotional support teams.

Seeking Spiritual Support

Even if you aren’t religious, this next section is worth a read.

Please know that you don’t need a religious affiliation to take advantage of spiritual support. Chaplains are spiritually trained practitioners who help patients in all stages of illness. They are well versed in a variety of religious practices. They may also connect patients to a spiritual leader or pray with them directly.

Some people are afraid to ask for spiritual support after a cancer diagnosis. They don’t want to bother the rabbi or priest. But I’ve found that the spiritual leaders of communities love being involved in the care of patients. For patients, friends, and family, getting help is just a matter of reaching out.

If a patient has a connection with a religion but doesn’t have a spiritual leader, doctors can connect them to chaplain services. Do not ignore the spiritual side of a cancer diagnosis. A spiritual guide can be part of an emotional support team.

Many providers forget about this aspect of care; go ahead and ask about it! We’re always happy to help you find your way.

Preparing for the Journey of Cancer

Cancer is a journey. Doctors, nurses, social workers, religious leaders, and spouses all go through this journey with the patient—no matter where it leads. Know that whether you’re the patient, a spouse, another family member, or a friend, you aren’t alone on this journey.

Patients should seek out emotional and spiritual help early in this process. Not doing so is the second common mistake patients make:

Mistake #2: Not seeking emotional and religious support early