Cancer and mental health

• TYPE OF PSYCHOLOGY: Emotion; personality; stress

A diagnosis of cancer is a major mental challenge. In addition to their physical symptoms, cancer patients must deal with their fears, denial, anger, sadness, and depression. They may feel hopeless and powerless, and unless their mental health problems are severe, they usually must seek out support and assistance on their own. Cancer can, however, serve as the impetus for patients to make life changes and set priorities.

Introduction

There is no single psychological response to cancer. Individuals respond in their own ways, based on their past experiences. Some common emotions include fear, denial, anger, sadness, depression, hopelessness, and powerlessness. For most people, the diagnosis of cancer causes fear of the unknown and fear of deformity, suffering, loss, and death. This is also a common reaction to other severe illnesses such as heart disease.

Adapting to Cancer

Most people view the diagnosis of cancer as a loss. In this case, the loss would be of good health and potentially a long life. In On Death and Dying (1969), psychologist Elisabeth Kübler-Ross set forth a theory of how people respond to the prospect of dying. Later scholars discovered that her stages of adaptation to the prospect of death—denial, bargaining, anger, depression and sadness, and acceptance—are similar to the stages of adaptation to change. Acceptance is the goal, but a person can go back and forth through these stages many times, and some people are unable to achieve acceptance. Cancer patients may go through these stages in dealing with their disease. Some patients become stuck in one of these stages and are unable to progress any further. This is not necessarily a failure on their part, but rather a reflection of their personality and acquired coping skills. With a chronic illness such as cancer, acceptance is really only for the moment because of the ongoing changes in condition experienced by patients.

In many instances, cancer patients do not go beyond denial of their illness and its implications for their lives. Sometimes, family members feel that a person would be unable to cope with having cancer, so they do not reveal the true diagnosis to the patient. Other patients refuse to accept that they have cancer, and they continue to deny its impact the rest of their lives. Some people, despite developing a severe form of cancer, do not seek medical care until the cancer is advanced. Denial is a pathological response to cancer in that it can rob the patient and the person's friends and family of the opportunity to express their love and to comfort one another.

Bargaining is an often brief interim stage in which patients try to strike a bargain with their body, with some spiritual figure, or with life. Such a bargain might take the form of a promise to attend religious services for the rest of a patient's life if the cancer is cured or disappears. It is unusual for a person to become stuck in this stage. It usually becomes obvious that the cancer has not been cured, and the deal is fruitless.

Another emotion that cancer patients often experience is anger. They may be angry at their doctors, at their bodies, or at life. Although their anger may be justified, it can drive away other people who might be of assistance. Some patients cannot let go of their anger, and it continues to simmer beneath the surface. However, retention of anger can lead to insomnia, heartburn, increased pain, and muscle tension.

Some people are able to let go of their anger, only to become stuck in depression and sadness. This can lead to feelings of hopelessness and an unwillingness to live their altered lives. Tremendous strides have been made in the treatment of cancer, and for many people it becomes a chronic illness rather than a death sentence. However, the treatments can have severe side effects and can be life altering. Some patients give up on life altogether, and may be at risk of exacerbated health issues or even suicide. Certainly, coping with cancer treatments is difficult for most people.

In general, the goal is acceptance of the disease and its treatments. This acceptance provides the cancer patient with a realistic view of the challenges of the disease and the willingness to undergo the treatments and deal with the side effects and limitations placed on their life. Often, the patients who learn to accept the disease do best with their cancer diagnosis, and this attitude may even contribute to better health outcomes. Acceptance gives patients the ability to learn about their illness and its treatments so that they can determine what is best for them, which in turn can increase their feelings of power over their illness.

Changes in Life View

Dealing with a potentially life-threatening condition such as cancer often causes people to review their lives and decide what is important to them. As a result, they may change jobs or retire, devote more time to their loved ones, or even leave a problematic relationship. They may also find the strength to accomplish things that previously seemed impossible. Cancer survivors often state that they feel that their cancer was a gift in a way because it led them to appreciate their lives more and to make difficult but desired changes.

Living with cancer can increase people's courage as they learn to face their mortality and the uncertainty of their future life and to value their relationships. Studies involving breast and ovarian cancer survivors describe the redefinition of the patient's self. People often define themselves by their appearance or by a favorite body feature such as their hair or their figure. Cancer can force patients to redefine themselves, which is a very difficult task.

Another emotional issue faced by cancer patients is that many blame themselves for getting cancer. In the past, some experts theorized that people with certain personalities or who had particular reactions to stressful situations were more likely to develop cancer. However, it has been proved that this is not the case. People cannot prevent cancer by their mental efforts, nor can they cure it by imagining bodily defenses destroying it. Still, leading a healthful lifestyle can significantly lower people's risk of developing cancer, although it cannot prevent it entirely.

People Affected

Cancer affects people of all ages, not just adults. Those with childhood cancer often cope well with cancer because they are better able to focus on the moment and not worry about the past or future. They do not judge their experiences but rather adapt to their lives as they are. In contrast, adolescents can find cancer particularly difficult to deal with because they want most to fit in with their peers. They do not want to be different and to stand out from the crowd, as a sick person often does.

Cancer most often attacks adults, who have choices as to how to deal with the changes in their health. Young adults tend to be angry because of the impact of cancer on their lives and feel that it is not fair that they have the disease. Older adults are more likely to be aware that they are at risk for conditions such as cancer and that they are not going to live forever. For the elderly, cancer can be more problematic. If they have been struggling with the changes of advanced age, cancer can be another sign that life is coming to an end. In fact, research has demonstrated that older people are more likely than younger people to commit suicide after a cancer diagnosis.

In addition to the cancer patient, the family of the patient suffers. Every day, family members are faced with a sick individual, who may not be able to contribute to family life as before. In some cases, it may be necessary to get outside care for the cancer patient, such as a home health aide or a nurse. Family members also must deal with the fear that the patient will die. Having a family member with cancer can be a heavy burden, and support for families of cancer patients can be hard to find.

Treatment Options

There is no formal treatment for mental health issues related to cancer. Patients who are receiving cancer treatments often have the support of the medical staff, but once patients have completed treatment, they are typically on their own in dealing with mental health issues. If patients have severe mental health issues, most likely their physicians will make sure that they get psychiatric care. However, patients with less severe mental problems must seek out support on their own. Many medical centers have support groups for patients with specific types of cancer. Support groups can vary in their effectiveness, although if a medical professional conducts the group, it is more likely to be helpful. A medical professional, such as a registered nurse, can draw generalizations from patient issues and assist patients in searching for solutions to their problems. On the other hand, some patient-led support groups can become forums in which patients simply vent their frustrations and complain; this may be helpfully cathartic, but may also exacerbate negative feelings if it accomplishes nothing constructive.

When dealing with a cancer diagnosis, patients often need to provide much of their own mental health care. After being diagnosed, patients should take the time to understand what they are facing and how they feel about it. Their feelings are normal, as are their fears. Instead of trying to be artificially upbeat, patients should focus on confronting their true feelings and, when possible, eventually letting them go—especially when these feelings involve negative emotions such as anger, which can escalate symptoms such as pain and stomach upset and can increase emotional pain.

Often when people have a serious illness, their family members are able to express the love that they have for them by providing assistance and emotional support. There are many stories of how a cancer diagnosis strengthened a marriage or other family relationship. In normal life, people often forget that everyone will eventually die and that there is no apparent schedule for this. A diagnosis of a life-threatening disease can force family members to realize that they could lose a loved one. As a result, they may no longer take each other for granted, but rather begin to express their love every day.

Cancer patients may find it difficult to deal with the reactions of others. Some people may voice platitudes such as "It will all work out for the best." This type of statement is not particularly helpful to cancer patients, but it does reflect the difficulty that society has in dealing with serious illness and death. Other people may just ignore the fact that the patient has cancer. People have the tendency to try to insulate themselves from the reality that a friend or loved one has cancer. They find it hard to deal with a person's cancer because it forces them to confront their own fears.

Some cancer patients may benefit from learning as much as they can about their condition and its treatments. It is generally advised that patients approach their physicians with questions or suggestions rather than remain passive and defer to whatever the physician chooses. Becoming involved with their treatment and learning about their disease can give cancer patients a feeling of having some control and power in a situation in which it is easy to feel powerless. Cancer patients are often urged to try to control whatever aspects of their care and treatment they can. Even a small thing such as scheduling treatments according to the patient's schedule can help the patient feel some control.

Humor may seem impossible when facing cancer, but it can be helpful to the patient who is facing cancer. The cancer patient should try to see the humor in some of the situations in which they find themselves. There is absurdity in many of the situations that life presents, even cancer. Cancer patients may find that humorous movies or television programs can help cheer them up. Writer Norman Cousins describes using laughter therapy to treat his neurological disease in Anatomy of an Illness (1979), and many researchers since have indicated the beneficial effects of humor on mental health.

Cancer patients should insist that they be treated with respect by their health care providers. They should find a physician who treats them as a peer and member of the treatment team. If patients encounter condescension on the part of their physician or the medical staff, they should find another physician. Cancer patients should tolerate nothing less than respect from their physicians.

Cancer patients should do whatever it takes to nourish their spirit. Many people find it helpful to speak with a spiritual leader, to attend religious services, and to pray. Many religions involve belief in an afterlife, which can be quite comforting for cancer patients.

Various forms of alternative medicine—including therapies such as acupuncture, reflexology, and Reiki—may decrease the level of stress and pain in cancer patients. Similarly, massage therapy can help cancer patients relax mentally and physically. Vitamin supplements, herbs, or herbal tea (taken with the permission and knowledge of the doctor treating the cancer) may comfort patients or help them feel more whole. Visualization and meditation can assist cancer patients in coping with the changes in their lives and give them strength to deal with their treatments or pain.

Cancer patients should not be reluctant to ask for help from family members, friends, or outside agencies. The goal for cancer patients should be to simplify their lives so that they can rest when necessary and make the most out of life.

Recognizing the Signs

In a 2022 article published by the MD Anderson Cancer Center, author Sarah Zizinia notes that cancer patients can have increased risks of mental health issues, including depression, anxiety, and thoughts of suicide. It is therefore important for caregivers and family members to recognize such challenges as they present themselves. Some natural predispositions exist, such as the patient being male, older, and having advanced cancer. Behaviors may emerge such as being reckless, not finding joy in things patients were formerly passionate about, and feelings of hopelessness. MD Anderson recommends several actions that can be taken at this point. The first is to begin conversing with the patient about the concerns. It is also advisable to seek professional help from a psychologist, psychiatrist, social work counselor, or other mental health professional. Last, a safety plan should be developed that identifies triggers and determines planned responses should the triggers be activated. 

Bibliography

"Anxiety, Fear, and Depression: Having Cancer Affects Your Emotional Health." American Cancer Society, 24 May 2016, www.cancer.org/treatment/treatments-and-side-effects/emotional-side-effects/anxiety-fear-depression.html. Accessed 7 Mar. 2019. 

Bertero, Carina, and Margaret Chamberlain Wilmoth. "Breast Cancer Diagnosis and Its Treatment Affecting the Self: A Meta Analysis." Cancer Nursing, vol. 30, no.3, 2007, pp. 194–202.  

Botti, Mari, et al. "Barriers in Providing Psychosocial Support for Patients with Cancer." Cancer Nursing, vol. 29, no.4, 2006, pp. 309–16.

"Cancer Support Community Addresses Elevated Need for Mental Healthcare with New Mental Health Programs and Initiatives." Cancer Support Community, 23 Jan. 2023, www.cancersupportcommunity.org/news/cancer-support-community-addresses-elevated-need-mental-healthcare-new-mental-health-programs. Accessed 1 Nov. 2024.

Carr, Brian I., and Jennifer Steel, eds. Psychological Aspects of Cancer. Springer, 2013.  

"Emotions and Cancer." National Cancer Institute, 23 Nov. 2021, www.cancer.gov/about-cancer/coping/feelings. Accessed 7 Feb. 2023. 

Healy, Bernadine. Living Time: Faith and Facts to Transform Your Cancer Journey. Bantam, 2007.  

Galgut, Cordelia. The Psychological Impact of Breast Cancer. Radcliffe, 2010.  

Lunsford, Natasha Buchanan. "5 Things Cancer Survivors Should Know About Their Mental Health." Centers for Disease Control and Prevention, 17 May 2018, blogs.cdc.gov/cancer/2018/05/17/cancer-survivors-mental-health. Accessed 7 Mar. 2019. 

"Psychosocial Support Options for People with Cancer." American Cancer Society, 6 June 2023, www.cancer.org/cancer/survivorship/coping/understanding-psychosocial-support-services.html. Accessed 1 Nov. 2024.

Schnipper, Hester Hill. After Breast Cancer: A Common Sense Guide to Life After Treatment. Bantam, 2003.  

Thiboldeaux, Kim, and Mitch Golant. The Total Cancer Wellness Guide. Benbella, 2007.  

Wise, Thomas N., Massimo Biondi, and Anna Costantini, eds. Psycho-Oncology. American Psychiatric Pub., 2013.

Zizinia, Sarah. "How to Support Cancer Patients during Mental Health Struggles." MD Anderson Center, 10 Oct. 2022, www.mdanderson.org/cancerwise/how-to-support-cancer-patients-during-mental-health-struggles.h00-159543690.html. Accessed 1 Nov. 2024.