Being diagnosed with cancer is one of the most frightening experiences a person can have. If you, a family member or a friend has been diagnosed with cancer, then coping with the emotional reaction to the diagnosis is as much a part of the experience as dealing with the medical aspects of treatment. It may also be an opportunity to examine how you view yourself, your life and your relationships. As a clinical psychologist specializing in the care of cancer patients and their families I have been fortunate to share many of your journeys, and I would like to address some of the concerns that I often hear about.

When initially diagnosed with cancer, most patients report feeling a sense of shock and have a difficult time actually believing the diagnosis. Fear, anger and sadness are very common reactions. Difficulties sleeping and changes in appetite are to be expected. Concerns about finances, daily functioning, relationships, and physical changes are normal:

How will I be able to support my family?
Am I going to lose my hair?
Will people treat me differently? Will people pity me?

Other profound questions are also common:

Will I survive?
How long do I have to live?
Will I see my child grow up, graduate, start a family?
Did my personality, emotions or stress cause my cancer?

If Only I Hadn't Been So...
Many patients when diagnosed with cancer believe that stress or their personality caused the cancer. Despite the popular media buzz, there is no compelling scientific evidence to support the assertion that stress causes cancer or that who you are as a person effects your risk of developing cancer. Stress and emotions are normal aspects of everyone's life. Losses in life, such as the death of a loved one or illness in one's family are extremely difficult and painful, but part of life. Even positive events such as a wedding or a new home can be stressful. Emotions do not cause cancer. You would not be human if you did not feel upset when diagnosed with cancer or someone you loved becomes ill. How you manage these parts of life is really about the quality of life. For example, rather than smoking, excessively worrying, heavily drinking alcohol when difficult events occur one needs to develop better skills to cope. Exercise and relaxation techniques can be very beneficial to both mental and physical health. As you or your family member or friend goes through this experience try to bring this perspective with you.

While attempting to deal with the fear and sadness and multiple other concerns, patients are also confronted with frightening, and often confusing medical information, and are asked to make decisions about their treatment. Anxiety interferes with the ability to assimilate information, thus it is not uncommon for patients to feel overwhelmed and have a hard time concentrating and processing information. The following are some simple and straightforward actions that can be taken to help during this period:

Write down questions before seeing your doctor.
Write down the responses provided by your physician.
If possible, bring a friend or family member with you when you see your doctor. These partners can provide support and help think through the information provided by your doctor.
As an alternative, ask your doctor if you could audiotape your consultation so that you can review it later.

While treatments for cancer are still rigorous, we have come a long way in managing side-effects and most patients report that chemotherapy and radiation were a lot easier than they had anticipated. Often it is the fear of the unknown that is most frightening, and once a course of treatment is selected and treatment begins many patients begin to experience a renewed sense of hope and are able to continue in some of their daily activities. It is impossible to go through cancer and not change as a person and in the way life is viewed. At the end of treatment patients will often examine their cancer experience and their lives. Priorities and relationships may change, how time is spent and with who is also reviewed. The focus on the present usually becomes more important and finding a balance with planning for the future can be a challenge. For many people cancer is a new beginning and an opportunity to live life in a more fulfilling and enriching way. Psychotherapy can be useful during this review process and in helping to implement changes.

Given the emotional distress associated with cancer, many patients today recognize that having the services of a mental health professional available to help cope during this difficult time can be very valuable. Cancer centers providing comprehensive services where mental health professionals are part of the treatment team are becoming much more common. Comprehensive cancer centers provide the opportunity to work with mental health professionals (e.g., psychologists, psychiatrists, social workers) as a part of their treatment team, who understand their diagnoses and treatments. It is not uncommon for mental health professionals outside in the community to have the same misconceptions and lack of understanding about cancer treatments as patients have. Typically, the focus of these sessions is on helping patients to develop ways of dealing with their diagnosis and treatment and how these affect their everyday life. In addition, mental health professional can help analyze information provided and aid in treatment decision making, allow patients to have a place to vent and talk about their feelings, as well as teach new coping strategies (e.g., relaxation/imagery) to help deal with cancer. Consultation with a psychiatrist or psychologist may also be indicated in the following circumstances:

Severe, prolonged sadness/depression or anxiety/panic attacks that interferes with daily functioning.
Family/partner problems that may interfere with treatment.
Prior history of a mental illness (e.g., depression, bipolar disorder, schizophrenia)
Limited social support (e.g., single with or without children; elderly)
Other significant stressful events occurring during diagnosis or treatment (e.g., loss of a partner or child).
Strong family history of cancer.
History of substance abuse.
Pain.
Sexual difficulties due to treatment.
Smoking cessation.

At the Mount Sinai Comprehensive Cancer Center we recognize that cancer affects the mind and the spirit as well as the body and have an integrated, full-time, psychosocial, pain management, and nutrition team to provide support services to our patients. Support groups for patients and family as well as stress management groups are facilitated on a regular basis.