Helping Cancer Patients Deal with Emotional Issues
The emotional effects of a cancer diagnosis can be overwhelming. When first diagnosed, I felt anger and a tremendous feeling of loss of control.
Expected reactions to this life-threatening illness may include sadness, worry, trouble sleeping, and uncertainty about what is next. Cancer survivors may experience many of these symptoms.
Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) can affect anyone who has experienced a serious threat of violence or death. It can be characterized by the inability to relax for fear that the trauma will return, and avoidance of things associated with the trauma. The difference between the normal stress of facing a cancer diagnosis and PTSD is that the individual with PTSD has an inability to get on with life after the cancer is gone. In PTSD, the individual ruminates about the trauma, cannot get over it, and relives the trauma.1
A study by Smith, published in the Journal of Clinical Oncology studied the incidence of PTSD among long-term survivors of non-Hodgkin lymphoma.
The participants in the study included 566 patients with an average of 12 years since diagnosis. 51% reported no PTSD. 12% reported resolution of the symptoms. 37% of the patients reported persistence or worsening of symptoms.
Independent predictors of PTSD included aggressive NH lymphoma, chemotherapy-related side effects, low income, and negative impact of cancer on their quality of life.1
Coping with cancer, even after treatment
As a cancer NHL survivor, this research really hit home. Coping with cancer could put patients at risk for PTSD. Many cancer patients experience symptoms for months after finishing cancer treatment even if in remission. Symptoms of PTSD may include:
- Withdrawal and detachment: The patient is angry and may avoid talking about the illness and his/her feelings. I can relate to this as I did not want to answer family questions about my illness. Instead, I designated my husband as the point person to tell our family and friends about my illness. I had no patience for the inquiries.
- Flashbacks-panic attacks, extreme stress, physical symptoms like fainting, palpitations, or nightmares.
- Avoidance of reminders of the trauma or situation. This can interfere with livelihood and social life.
- Insomnia-secondary to worry, unable to clear the mind of thinking. At times my mind was like a video camera. I was unable to fall asleep as I worried about all possible things that could go wrong.
- Lack of motivation, loss of interest in day to day activities, sleeping too much. I experienced incapacitating fatigue and really lost interest in daily activities while receiving chemotherapy.
- Anger and varying degrees of irritability. I was angry upon my diagnosis and the resulting chemotherapy and the unknown.
- Memory loss and blocking out of the recent trauma.
- Feeling jumpy and never completely at ease. During my treatment, I worried constantly and could not relax.
- Use of drugs or alcohol to self-medicate.
Counseling and support are key strategies to deal with the emotional response to a cancer diagnosis. The cancer survivor must be made aware that there is nothing wrong with getting help to manage the emotional effects.
Screening for psychosocial distress has now become a focus for the cancer survivor. Patients must be educated about what to expect and whether they have a good support system. Patients with a good relationship with their physician are less likely to experience PTSD.
Complementary treatment such as meditation, talking with a therapist, relaxation training, and support groups have been effective strategies to deal with the emotional response to a cancer diagnosis.
I was fortunate to have a great relationship with my physician, a very supportive family system, and participated in yoga and relaxation exercises. These factors allowed me to deal positively with the emotional response to living with the uncertainty of non-Hodgkin lymphoma. It is most important to pay attention to the quality of life, to live better and longer.
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