Diagnosis: Cancer affects about 13.7 million Americans who are at various stages of living with their cancer, according to 2012 numbers from the American Cancer Society. Although cancer mortality statistics are generally improving, people fear the diagnosis of cancer. When people first learn that they have this disease, the response may be disbelief. They may think the worst and feel overwhelmed. Many questions will surface and may not have definite answers. To provide the best care, the health care team will need to make certain tests and stage the cancer to see how far the disease has spread. With this information, patients and their health care providers can make decisions on treatments to cure, to control the disease, or to minimize symptoms. Each person experiences cancer differently; becoming a partner in the treatment plan means making choices in many aspects of life.
Education: C. Everett Koop, former surgeon general of the United States, advised that “the best prescription is knowledge.” One effective way for patients to face life with cancer is for them to learn as much as possible about the specific diagnosis. Numerous sources are available to provide further education on cancer in general and in detail. Cancer patients may want to know about statistics, risk factors for their type of cancer, staging terms and what they mean, treatment options, and the likelihood of the patient to survive and recover from the cancer and treatments (prognosis).
The first contact for patient education is the health care provider. These professionals can offer information specific to the patient such as the type of cancer, stage of cancer involvement, and options for therapy. Cancer patients should take the initiative to talk with their health care providers to fully understand their unique situation. With that information, patients can pursue other avenues of education.
There are many sources for learning more about cancer. Information can range from simple explanations to complex scientific documentation. Patients can read articles in popular magazines, buy books on most aspects of cancer care, study health care journals, or look up their cancer on the Internet. Generally, reliable information comes from well-respected and well-established cancer care centers, cancer care organizations, government agencies, or health care organizations.
Another source of education is other cancer patients. Attending local support groups and conversing with others who are at different stages of cancer can support and encourage patients. Online Web sites offer message boards where cancer patients can share their personal experiences. Though these can be useful, it is important to remember that this type of information comes from a particular person’s point of view. Cancer patients need to seek further information and clarification from their health care providers or other reliable sources before acting on what another cancer patient says.
Coping with cancer: A cancer diagnosis can be stressful for both patients and their families. Patients respond in different ways to their cancer. Many emotions may surface, such as shock, disbelief, fear, sadness, anxiety, depression, anger, and guilt. Patients may question why they have cancer and what lies ahead. Disbelief may come to those who feel physically well. Fear is a common emotion, but the reasons may range from fear of the treatments and side effects to fear of death and the impact on remaining family members. Fear feeds anxiety, which can interfere with normal daily functioning.
Guilt is another common emotion of cancer patients. Patients may replay their lifestyle choices and wonder if something they did caused the cancer. They may feel guilt over the decisions they made that stole precious time from their life or guilt about their priorities. As some cancers tend to be hereditary, cancer patients may worry about the impact on their children.
Feelings of sadness and hopelessness can block recovery and resumption of meaningful life activities. Depression can come with sleep problems, loss of appetite, feelings of worthlessness, decreased energy, irritability, or lack of interest in activities once enjoyed. Physical symptoms such as headache or digestive problems may occur. Feeling sad is a normal reaction when people learn that they have cancer, but if depression continues and thoughts of suicide surface, patients may require help through counseling and prescribed medications.
Cancer patients experience the feeling of loss of control, autonomy, dreams, choices, or the future. Loss is a normal feeling and allows cancer patients to grieve over actual or perceived interruptions in their lives. Counseling may be useful for both cancer patients and their families.
Taking action: Cancer can be a long-term disease and last for many years. Cancer patients experience an initial adjustment to their diagnosis and treatment. The focus of their first thoughts may be on dying, but as time goes on, these thoughts shift to their normal lives. Taking certain steps can help cancer patients reengage in their usual activities of daily living.
One helpful step is paying attention to personal needs for rest, nutrition, recreation, and relationships. Relaxation activities such as meditation and guided imagery can assist in healing and encourage good mental health. Adequate nutrition is important to keep the immune system at an optimal level.
Participating in activities that patients enjoy, such as going to the movies, listening to music, going to lunch with friends, or pursuing their hobbies, can relieve depression. Creative expression though journaling, writing poetry or stories, reading, or drawing can keep patients’ minds off cancer and minimize projecting into the future. Simply going shopping can be a boost to the morale.
Starting or resuming an exercise program can help cancer patients increase strength, improve flexibility, and build endurance. Studies show that exercise can also improve long-term survival. Radiation treatments can result in fatigue, but light or moderate walking can boost energy and stimulate the appetite. Another benefit of exercise is that the release of natural body chemicals, called endorphins, can improve patients’ moods and help relieve pain. Various levels of exercise, such as walking, swimming, cleaning the house, gardening, or dancing, can provide pleasure as well as health benefits.
Almost daily the media reports on the value of alternative or complementary therapies. Cancer patients may become interested in these therapies as ways to relax, to reduce side effects of cancer treatment, or to cure their disease. Some of these practices, such as massage, guided imagery, acupuncture, or hypnosis, may be useful when used along with traditional cancer treatments. Vitamins and herbal supplements have gained monumental popularity in the United States. Although some sources claim that herbs and vitamins can cure cancer, these statements are often unfounded. Cancer patients should speak with their health care providers before using alternative therapies.
Sometimes cancer patients are unable to perform activities of daily living without assistance. However, by seeking help they can continue to go to the grocery or to church. Friends and family often welcome the opportunity to provide meals or transportation so that they can show love to the cancer patient. Asking for help is not always comfortable for cancer patients who covet their autonomy. However, taking action to seek help is a healthy behavior.
Sexuality:
Having cancer does not alter the human need for sex and intimacy. However, having this disease can temporarily alter people’s attitudes and desires. Changes in emotions are normal for cancer patients but can affect their relationship with their partners. Physical side effects from cancer treatments such as nausea, vomiting, and fatigue can decrease interest in sex. Cancer therapies can affect the patients’ body image and lessen the confidence in their attractiveness. Women may experience dryness of the vagina, and men may have trouble having or maintaining an erection.
Some people believe that cancer can be passed to another person by intimacy. Partners may be hesitant to engage in sexual intercourse with cancer patients. Also, cancer patients may need to refrain from sex for a period of time because of surgery or a lowered immune system. This can be difficult for both the cancer patient and the partner. Communication is key to resolving misunderstandings. Cancer patients should be open and honest about their concerns with their health care professionals. These professionals can help make referrals for counseling and support when needed.
Family dynamics: Cancer changes all aspects of family life. Priorities change and unresolved emotions may surface. There may be more struggles in the family dynamics. Roles may change as cancer patients must use energy and time to take treatments or care for themselves. A reassignment of roles can be overwhelming, especially for older children or youths who now become caregivers. Patients must be allowed to continue to fill as many parts of their family role as possible and not be treated as an invalid. If the dynamics of family life become dysfunctional, a family counselor can help.
Spiritual support: Cancer is a serious illness that can challenge people’s spiritual beliefs. Spiritual distress (unresolved spiritual conflict or doubt) can compromise patients’ coping skills. Unlike religion (a set of beliefs, practices, or doctrine), spirituality includes the person’s sense of purpose, relationship to others, and beliefs about life’s meaning. Some cancer patients may feel they are being punished by a higher power or may lose their faith, while others experience a deepening of their faith during their illness.
Pastors, rabbis, or other faith leaders may be valuable resources during this difficult time. Some home health and hospice care agencies have chaplains on their interdisciplinary teams and offer home support for cancer patients. The best person for cancer patients to talk with is the one who provides compassionate and supportive communication. Spiritual support can create an improved quality of life for cancer patients. Patients may experience decreased stress, anxiety, or pain. Connecting to others results in less isolation. Spirituality can help cancer patients tolerate treatments better and bring peace in a time of chaos.
Life after cancer: Cancer survivors face different challenges. Intensive cancer therapy can leave people with lifelong health concerns. After the treatments or surgery are complete, patients have new questions. Will the cancer come back? Will my life be the same as before I was diagnosed with cancer? Will I need continued observation? Where do I go from here?
There will be follow-up care that includes regular medical checkups, usually with the primary physician. Tests will most likely occur at specific intervals to check for continued remission (when the cancer is reduced or disappears). If any tests indicate concerns, cancer patients are referred to the cancer health care provider for further assessment.
Many survivors say that life has new meaning for them, and they see life in a new light. Priorities have changed. Their bodies have changed. Cancer patients may have made new friends and developed new relationships. Even their diets may have changed. Life and all it has to offer have changed forever.
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