Reactions to a Diagnosis of Cancer

Millions of Americans alive today have a history of cancer.

For them, cancer has become a chronic (on-going) health problem, like high blood pressure or diabetes.

Just like everyone, people who have cancer must get regular checkups for the rest of their lives, even after treatment ends.

But unlike other chronic health problems, if you have cancer you probably will not need to take medicine or eat special foods once you have finished treatment.

If you have cancer, you may notice every ache, pain, or sign of illness. Even little aches may make you worry. You may even think about dying. While it's normal to think these thoughts, it's also important to focus on living. Although some people do die of it, many with the disease are treated successfully.Others will live a long time before dying from it. So, try to make the most of each day while living with cancer and its treatment.

No one knows the story of tomorrow's dawn.--Ashanti (African) Proverb

You will have many feelings after you learn that you have cancer. These feelings can change from day to day, hour to hour, or even minute to minute.

Some of the feelings you may go through include:

•     denial
•     anger
•     fear
•     stress
•     anxiety
•     depression
•     sadness
•     guilt
•     loneliness

All these feelings are normal.

Learning that you have cancer can come as a shock. How did you react? You may have felt numb, frightened, or angry. You may not have believed what the doctor was saying. You may have felt all alone, even if your friends and family were in the same room with you. These feelings are all normal.

For many people, the first few weeks after diagnosis are very hard. After you hear the word "cancer," you may have trouble breathing or listening to what is being said. When you are at home, you may have trouble thinking, eating, or sleeping.

People with cancer and those close to them experience a wide range of feelings and emotions. These feelings can change often and without warning.

At times, you may:

•     be angry, afraid, or worried
•     not really believe that you have cancer
•     feel out of control and not able to care for yourself
•     be sad, guilty, or lonely
•     have a strong sense of hope for the future

Here are many of the feelings that come up when people find out they have cancer:

Hope

Once people accept that they have cancer, they often feel a sense of hope. There are many reasons to feel hopeful.

•     Cancer treatment can be successful. Millions of people who have had cancer are alive today.
•     People with cancer can lead active lives, even during treatment.
•     Your chances of living with--and living beyond--cancer are better now than they have ever been before. People often live for many years after their cancer treatment is over.

Some doctors think that hope may help your body deal with cancer. Scientists are looking at the question of whether a hopeful outlook and positive attitude helps people feel better. Here are some ways you can build your sense of hope:

•     Write down your hopeful feelings and talk about them with others.
•     Plan your days as you have always done.
•     Don't limit the things you like to do just because you have cancer.
•     Look for reasons to hope.

However long the night, the dawn will break.
--Hausa (African) Proverb

You may find hope in nature, or your religious or spiritual beliefs. Or you may find hope in stories (such as the ones in this book) about people with cancer who are leading active lives.

Denial

When you were first diagnosed, you may have had trouble believing or accepting the fact that you have cancer. This is called denial. It can be helpful because it can give you time to adjust to your diagnosis. Denial can also give you time to feel hopeful and better about the future.

Sometimes, denial is a serious problem. If it lasts too long, it can keep you from getting the treatment you need. It can also be a problem when other people deny that you have cancer, even after you have accepted it.

The good news is that most people (those with cancer as well as those they love and care about) work through denial. By the time treatment begins, most people accept the fact that they have cancer.

Anger

Once you accept that you have cancer, you may feel angry and scared. It's normal to ask "Why me?" and be angry at:

•     the cancer
•     your health care providers
•     your healthy friends and loved ones

And if you are religious, you might even be angry with God.

Anger sometimes comes from feelings that are hard to show--such as fear, panic, frustration, anxiety, or helplessness. If you feel angry, don't pretend that everything is okay. Talk with your family and friends about it. Most of the time, talking will help you feel a lot better.

Talking to one another is loving one another.
--Kenyan Proverb

Fear and Worry

"The word 'cancer' frightens everyone I know. It's a diagnosis that most people fear more than any other."

It's scary to hear that you have cancer. You may be afraid or worried about:

•     being in pain, either from the cancer or the treatment
•     feeling sick or looking different as a result of your treatment
•     taking care of your family
•     paying your bills
•     keeping your job
•     dying

Your family and close friends may also worry about:

•     seeing you upset or in pain
•     not giving you enough support, love, and understanding
•     living without you

Some fears about cancer are based on stories, rumors, and old information. Most people feel better when they know what to expect. They feel less afraid when they learn about cancer and its treatment.

Stress

Your body may react to the stress and worry of having cancer. You may notice that:

•     your heart beats faster
•     you have headaches or muscle pains
•     you don't feel like eating or you eat more
•     you feel sick to your stomach or have diarrhea
•     you feel shaky, weak, or dizzy
•     you have a tight feeling in your throat and chest
•     you sleep too much or too little
•     you find it hard to concentrate

Stress can also keep your body from fighting disease as well as it should.

You can learn to handle stress in many ways, like:

•     exercising
•     listening to music
•     reading books, poems, or magazines
•     getting involved in hobbies such as music or crafts
•     relaxing or meditating, such as lying down and slowly breathing in and out
•     talking about your feelings with family and close friends

If you're concerned about stress, talk to your doctor. He or she can suggest a social worker or counselor. You could also find a class that teaches people ways of dealing with stress. The key is to find ways to control stress and not to let it control you.

Pain

Even though almost everyone worries about pain, it may not be a problem for you. Some people don't have any pain. Others have it only once in a while. Cancer pain can almost always be relieved. If you're in pain, your doctor can suggest ways to help you feel better. These include:

•     prescription or over-the-counter medicines
•     cold packs or heating pads
•     relaxation, like getting a massage or listening to soothing music
•     imagery, such as thinking about a place where you feel happy and calm
•     distraction, like watching a movie, working on a hobby, or anything that helps take your mind off your pain

There are many ways to control pain. Your doctor wants and needs to hear about your pain. As soon as you have pain you should speak up. Dealing with your pain can also help you deal with the feelings discussed in this section.

When you describe your pain to your health care providers, tell them:

•     where you feel pain
•     what it feels like (sharp, dull, throbbing, steady)
•     how strong the pain feels
•     how long it lasts
•     what eases the pain and what makes it worse
•     what medicines you are taking for the pain and how much they help

If you conceal your disease, you cannot expect to be cured.
--Ethiopian Proverb

Pain scales and pain journals

Pain scales or pain journals are tools that you can use to describe how much pain you feel. These tools can also help your doctor, nurse, or pharmacist find ways to treat your pain.

You are the only person who can talk about the pain you feel. When it comes to pain, there is no right or wrong answer. On many pain scales, you are asked to rate your pain as a number from 0 to 10. For example, you would rate your pain as "0" if you feel no pain at all. You would rate your pain as "10" if it is the worst pain you have ever felt in your life. You can pick any number between 0 and 10 to describe your pain.

When you use a pain scale, be sure to include the range. For example, you might say, "Today my pain is a 7 on a scale from 0 to 10."

A pain journal or diary is another tool you can use to describe your pain. With a journal or diary, you not only use a pain scale but also write down what you think causes your pain and what helps you feel better.

Control and self-esteem

When you first learn that you have cancer, you may feel as if your life is out of control. You may feel this way because:

•     you wonder if you will live or die
•     your daily routine is disrupted by doctor visits and treatments
•     people use medical words and terms that you don't understand
•     you feel like you can't do things you enjoy
•     you feel helpless
•     the health professionals treating you are strangers

Even though you may feel out of control, there are ways you can be in charge. For example, you can:

•     Learn as much as you can about your cancer.
•     Ask questions. Let your health providers know when you don't understand what they are saying, or when you want more information about something..
•     Look beyond your cancer. Many people with cancer feel better when they stay busy. You may still go to work, even if you need to adjust your schedule. You can also take part in hobbies such as music, crafts, or reading.

Sadness and depression

Many people with cancer feel sad or depressed. This is a normal response to any serious illness. When you're depressed, you may have very little energy, feel tired, or not want to eat.

Depression is sometimes a serious problem. If feelings of sadness and despair seem to take over your life, you may have depression. The box below lists eight common signs of depression. Let your health provider know if you have one or more of these signs almost every day.

Early signs of depression

Check the signs that are problems for you:

•     a feeling that you are helpless and hopeless, or that life has no meaning
•     no interest in being with your family or friends
•     no interest in the hobbies and activities you used to enjoy
•     a loss of appetite, or no interest in food
•     crying for long periods of time, or many times each day
•     sleep problems, either sleeping too much or too little
•     changes in your energy level
•     thoughts of killing yourself. This includes making plans or taking action to kill yourself, as well as frequent thoughts about death and dying.

Depression can be treated. Your doctor may prescribe medication. He or she may also suggest that you talk about your feelings with a counselor or join a support group with others who have cancer.

Turn your face to the sun and the shadows fall behind you.
--Maori Proverb

Guilt

Many people with cancer feel guilty. For example, you may blame yourself for upsetting the people you love. You may worry that you are a burden to others, either emotionally or financially. Or you may envy other people's good health and be ashamed of this feeling. You might even blame yourself for lifestyle choices that could have led to your cancer. For example, that lying out in the sun caused your skin cancer or that smoking cigarettes led to your lung cancer.

These feelings are all normal. One woman with breast cancer said, "When I start to feel guilty that I caused my illness, I think of how little children get cancer. That makes me realize that cancer can just happen. It isn't my fault."

Your family and friends may also feel guilty because:

•     they are healthy while you are sick
•     they can't help you as much as they want
•     they feel stressed and impatient

They may also feel guilty when they don't think they can give you all the care and understanding you need.

Counseling and support groups can help with these feelings of guilt. Let your doctor or nurse know if you, or someone in your family, would like to talk with a counselor or go to a support group.

Loneliness

People with cancer often feel lonely or distant from others. You may find that your friends have a hard time dealing with your cancer and may not visit. Some people might not even be able to call you on the phone. You may feel too sick to take part in the hobbies and activities you used to enjoy. And sometimes, even when you are with people you love and care about, you may feel that no one understands what you are going through.

You may feel less lonely when you meet other people who have cancer. Many people feel better when they join a support group and talk with others who are facing the same challenges.

Shared joy is a double joy; shared sorrow is half a sorrow.
--Swedish Proverb

Not everyone wants or is able to join a support group. Some people prefer to talk with just one person at a time. You may feel better talking to a close friend or family member, a social worker or counselor, or a member of your faith or spiritual community.

Gratitude

Some people see their cancer coming back as a "wake-up call." They may realize the importance of enjoying the little things in life. They go places they've never been. They finish projects they had started but put aside. They spend more time with friends and family. They mend broken relationships.

It may be hard at first, but you can find joy in your life. Take note of what makes you smile. Pay attention to the things you do each day that you enjoy. They can be as simple as drinking your morning coffee, sitting with a pet, or talking to a friend. These small, day-to-day activities can give you comfort and pleasure.

You can also do things that are more meaningful to you. Everyone has special things, both large and small, that bring meaning to their life. For you, it may be visiting a garden in your city or town. It may be praying in a certain chapel. Or it could be playing golf or some other sport that you love. Whatever you choose, embrace the things that bring you joy when you can.

Summing up: Learning you have cancer

You will have many feelings as you learn to live with cancer. These feelings can change from day to day, hour to hour, or even minute to minute.

Feelings of denial, anger, fear, stress and anxiety, depression, sadness, guilt, and loneliness are all normal. So is a feeling of hope. While no one is cheerful all the time, hope is a normal and positive part of your cancer experience.

Adapted from "Taking Time: Support for People with Cancer," a publication of the NIH/National Cancer Institute.

By National Institutes of Health

The National Institutes of Health, a part of the U.S. Department of Health and Human Services, is the nation's medical research agency — making important discoveries that improve health and save lives. NIH is the largest single source of financing for medical research in the world, seeking new ways to cure disease, alleviate suffering and prevent illness. By providing the evidence base for health decisions by individuals and their clinicians, NIH is empowering Americans to embrace healthy living through informed decision-making. NIH is made up of 27 institutes and centers, each with a specific research agenda, focusing on stages of life, like aging or child health, or particular diseases or body systems.