Saturday 27 / April / 2024
A diagnosis of cancer has the potential to result in marked psychological distress and life interruption. This observation comes from studies in which patients are assessed before and after a definitive cancer diagnosis. Women diagnosed with cancer experience an increase in pain and declines in the realms of physical and social function, and ability to perform emotional and physical roles, compared with women who did not receive a cancer diagnosis.
One recent study conducted by the psycho-oncology team in the Sultan Qaboos University Hospital and in collaboration with the Royal Hospital in Muscat found that about 28% of people with cancer had anxiety, while 21% had depression. The goal of this article is to document the psychological processes along the cancer trajectory; and the importance of paying attention to the concept of healthy coping.
Cancer survivors may experience loss in a variety of spheres. Some loses may be easy to see and name, while other losses can be harder to recognise. A loss may be temporary or permanent, life-altering, or a minor inconvenience. For example, hair loss from treatment can be very devastating to some people, but has less effect for others. Any type of loss may be an emotional experience. Other loses can include financial losses (job opportunities), emotional (sense of control), and/or physical losses (inability to conceive).
People diagnosed with cancer usually go through the stages of loss and grief. This is not necessarily only associated with cancer as an illness, but also with other chronic illnesses that have serious ramifications on a person’s future. Typically the first stage of loss includes denial and isolation, which is not only a healthy response but necessary to protect the person from overwhelming feelings of shock. It can last for days, but if it takes more than two weeks then it can lead to difficulties in the management and treatment of illness.
Once the complex feelings in the denial stage get at least partially processed, the person may get a lot of anger to wake up in this difficult world. Anger can result from feeling vulnerable and helpless. Sometimes anger stems from other emotions such as frustration, worry, or sadness. Rationally, the person knows that no one is to blame for the illness. Feeling guilty is also common at this stage which leads to even more anger. Then comes bargaining that is the attempt to regain control of the uncontrollable. This stage may also entail making a secret deal with God to postpone the inevitable. This is another defence mechanism to protect people from the painful reality. After bargaining, attention moves into the present moment.
Feelings of emptiness and depression can be felt on a much deeper level. This feeling is a natural response to the cognitive awareness of loss and does not necessarily need to be fixed, rather to be embraced as a necessary step of healing. Finally acceptance comes that is often confused with being “all right” with what has happened. This stage is about accepting the reality that the person has cancer. No person will like this reality, but eventually it will be accepted.
It is important to keep in mind that processing the stages of loss is a highly personalised process and that there is no deadline to it and no correct way to do it. Going through the stages of loss does not necessarily mean that it has to be linear, rather it can be circular and people can revisit some stages later even if they have already passed through them. This depends on the cognitive awareness of loss.
Coping strategies are the psychological processes of dealing with life challenges and the ways of meeting those goals and challenges.
For people with cancer, some of these challenges maybe medical and physical, while others can be emotional, interpersonal or religious. Coping aims to help the person remain emotionally intact while moving on with their lives as much as possible. As it is always the case, a coping strategy that can work for one person may not work for another, as the cancer experience is highly personal. Coping is a process that extends over time and may differ depending on the stage of a person’s illness. The positive coping strategies discussed below can promote your psychological well-being, and thereby enable the person to feel more resilient. These effects may also enhance the immune system’s response against cancer cells.
1. Facing the reality of your illness
One of the helpful ways to promote your psychological well-being is to ask brave questions about your cancer and the advantages and disadvantages of each treatment modality. Although denial is a way of coping to protect a person from being overwhelmed, prolonged denial can prevent a healthy acceptance and coping with the illness in an effective way.
2. Maintaining hope
It is crucial to have a realistic level of optimism about the course of illness. This usually comes after accepting the reality of the illness.
3. Proportion and balance
Finding a balance in the emotional responses of optimism and at the same time of worry, is important. The medical situation provides the person with a basis for both.
4. Expressing emotions
People who express their emotions enjoy a better psychological adjustment than those who suppress their feelings. Emotional expression is helpful as it gives an outlet for your feelings, and an opportunity to receive support from loved ones.
5. Mobilisation of social resources
The mobilisation of social support network is associated with better psychological outcomes. That is why it is advised to utilise loved ones’ support to help in the emotional adjustment.
6. Being proactive
Being proactive by learning about the illness and the available treatments is associated with less emotional distress. Assuming a passive attitude is associated with more emotional distress.
7. Positive reframing
Many people find benefit in their cancer experience although the experience of cancer can be an awful experience. Benefit finding can be achieved through reflection on one’s values and life priorities leading to changes in lifestyle and relationships.
8. Positive religious coping and spirituality
Positive religious beliefs can be utilised to help with coping with cancer. People who do so benefit in having a greater sense of peace and strength, and show an improved psychological adjustment.
9. Maintaining self-esteem
Cancer can be a threat to various aspects of a person’s self-esteem. The danger is depression while the opportunity lies in finding additional sources of self-esteem (your coping skills or spirituality for example).
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Zena M. Al Sharbati is clinical psychologist and a member of the Cancer Care Services Team, Dept. Behavioural Medicine at Sultan Qaboos University Hospital
