When the diagnosis is Cancer
A Guide for patients and their loved ones
Common Reactions to a Cancer Diagnosis
Cancer usually comes as a shock. Right after the
diagnosis, many patients feel angry, frightened, and
confused. Denial also is a common reaction.
How a person deals with these intense feelings will
depend on her or his personality and coping style. Some
may find themselves lashing out in frustration or anger.
Others may withdraw and want to be left alone.
Research shows that sharing fears and anxieties—with
loved ones, counselors, clergy, or support groups—can
help both emotionally and physically. In fact, a strong
support system is thought to bolster the immune system.
In one study, women with terminal breast cancer who
belonged to a support group lived twice as long as those
who did not.
However, cancer patients shouldn't feel rushed to
open up. It takes time to accept and sort through the
many emotions.
There are many other ways besides talking to express
feelings. Some ideas:
- Write in a journal.
- Paint and become involved in other artistic hobbies.
- Pray or pursue other spiritual pursuits.
- Exercise.
- Read poetry, philosophy, self-help, and other books.
- Take time to reflect.
Throughout treatment, cancer patients can expect
days when despair, fear, and emptiness seem to take
over. But there also may be many happy days filled with
hope and joy.
Identifying ways to cope with all of these feelings
can help. It's also important to recognize when feelings
become too intense to handle or when sadness turns into
major depression.
Signs of depression include a loss of interest in
everyday activities that lasts longer than two weeks.
Anyone who suspects they're suffering from depression
should see a doctor.
Getting Involved in Treatment Decisions
Research suggests that cancer patients who are well
informed about their disease and actively participate
in decisions about their treatment feel better emotionally
than those who do not.
For instance, breast cancer survivors who were involved
in making decisions about their follow-up tests scored
significantly higher on quality of life measures than
those who did not. Specifically, these women reported
less pain and greater energy.
Exactly how involved cancer patients want to be in
their own care will vary. Some people want details on
the pros and cons of every treatment option so they
can make an informed decision. Others may prefer to
leave decisions to their doctor or a loved one. One
small study found that 57% of lung cancer patients wanted
an active role in treatment decisions.
Cancer patients who want to be involved in their
care can begin by asking their doctor questions about
their diagnosis and various treatments. For instance,
new cancer patients might ask:
- What is my exact diagnosis?
- What treatment choices do I have? Which one(s) do
you recommend and why?
- What risks and side effects does each treatment pose?
- What is the regimen for each treatment? For instance,
how often will I need to receive treatment? How long
with my treatment last?
- What are the chances that treatment will succeed?
- Will I need to change my normal activities?
- What will treatment cost? Is it covered by my insurance?
- Would a clinical trial—or the test of a new drug
or procedure—be appropriate for me?
It may help to make a list of questions before meeting
with a doctor. Many patients also bring along a friend
or family member for support. It can help to take notes
or tape record important discussions. Treatment decisions
are difficult to make, and patients often need to take
some time to consider the various options and to consult
loved ones.
Cancer patients who want additional information on
their disease can find a wealth of information at their
local library and on the Internet. The following organizations
also provide lots of helpful material free of charge:
Coping with Treatment Side Effects
Experts say it is sometimes difficult to tell whether
the pain, fatigue, and other symptoms associated with
cancer are due to the disease itself or to the treatment
that some patients receive.
For example, many chemotherapy regimens typically
cause fatigue, nausea, appetite loss, mouth sores, and
hair loss. Radiation therapy may prompt fatigue and
appetite loss. And cancer surgery usually causes post-operative
pain.
Newer approaches, such as immunotherapy and bone
marrow transplants, carry side effects, too. And, even
if patients decide not to treat their cancer, they may
have to cope with fatigue, pain, and other symptoms
caused by the cancer itself.
Fortunately, several effective strategies can help
patients ease many of the discomforts associated with
cancer and cancer treatment.
Fatigue
- Save your energy for the day's most important activities.
- Take short naps.
- Try short walks or other light exercises rather than
long exercise sessions.
- Use relaxation techniques, such as imagery or meditation.
- Limit caffeine and alcohol.
- Let other people help with tiring activities.
Nausea and Vomiting
- Work with your doctor to find an anti-nausea medication
that works for you.
- For morning nausea, try eating soda crackers or another
dry food before getting out of bed.
- To avoid strong odors, eat foods cold or at room
temperature.
- Wear loose-fitting clothing.
- Try drinking unsweetened apple juice, grape juice,
or caffeine-free sodas such as ginger ale without fizz.
- If mouth sores are not a problem, suck on mints or
sour candy.
Appetite Loss
- Eat frequent snacks or small meals instead of three
regular meals.
- If solid food lacks appeal, substitute juice, soup,
eggnog, liquid supplements, or milk shakes.
- To spark the appetite, take a walk before meals.
- Ask whether it is safe to enjoy a glass of wine or
beer with meals-alcohol helps stimulate the appetite.
- Make eating an enjoyable occasion—for instance, share
meals with family or friends or turn on the radio or
television.
Mouth Sores
- Ask for topical or oral painkillers.
- To lessen irritation, eat foods cold or at room temperature.
- Choose soft and soothing foods, such as ice cream,
bananas, applesauce, mashed potatoes, cooked cereals,
yogurt, cottage cheese, and custards.
- Avoid foods that are:
- high in acid, such as tomatoes,
oranges, and grapefruits
- salty, such as salted pretzels
- spicy, such as hot salsa
- crispy, such as raw vegetables and toast.
Hair Loss
- Use a mild shampoo, a soft hairbrush, and low heat
on the hair dryer.
- Avoid dyes, permanents, and hair relaxers.
- If you'd like to make hair look thicker and fuller,
choose a short haircut.
- Consider purchasing a wig or hairpiece or wearing
attractive hats or scarves.
Pain
- Tell your doctor about your pain, including how it
feels, where it is, how strong it is, how long it lasts,
what helps it or makes it worse, and how medication
has affected it.
- For persistent pain, take medication regularly and
avoid skipping doses.
- Perform relaxation exercises, which can reduce tension,
soothe anxiety, and lessen pain.
How Family and Friends Can Help
Families react to cancer in different ways. One family
member might escape distress by spending long hours
at work. Another may try to manage anxiety by taking
over information gathering and decision making.
A crisis like cancer causes some families to fight,
while others draw closer together. And while some adults
revert to childish rivalries, children may display surprising
maturity.
Family members and close friends often find it hard
to face their own upset feelings about a loved one's
diagnosis. They may withdraw out of fear because they
don't know what to say. Sometimes they can provide the
most help simply by sitting still and listening to the
patient.
If friends or family members offer to help but don't
know what to do, suggest a specific task. These might
include:
- providing transportation to the hospital
- making necessary telephone calls
- cooking dinner or scheduling a group of friends to
make meals for several weeks
- babysitting for a child
- scheduling a regular card game to replace evenings
out
- reading aloud to the patient
- taking the caretaker out for a break.
References
1. "Effect of Psychosocial Treatment on Survival
of Patients With Metastatic Breast Cancer." D. Spiegel
et al. Lancet. Vol. 14, No. 2(8668), pp. 888-891.
2. "Involvement in Decision-Making and Breast Cancer
Survivor Quality of Life." M. Robyn Andersen and Nicole
Urban. Annals of Behavioral Medicine. Vol. 21, No. 3,
pp. 201-209.
3. "Lung Cancer Treatment Decisions: Patients' Desires
for Participation and Information." J.R. Davidson et
al. Psychooncology. Vol. 8, No. 6, pp. 511-520.
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