For Any Cancer Diagnosis
Q. I'm a cancer survivor and am wondering if I should seek counseling now that my treatment has ended?
The decision to pursue counseling is always very personal. As a post-treatment cancer survivor, you may be dealing with concerns that are different than those you had at the time of your initial diagnosis. The post-treatment phase may be a time to reevaluate purpose, direction, and priorities. We know that many cancer survivors have fears of recurrence and other anxieties that friends and loved ones may not fully understand. Speaking with a counselor can help.
CancerCare offers a number of ways to get support including counseling and support groups. A support group provides a safe place for people coping with similar issues to share and learn from each other. Many people find the opportunity to relate to others in this way enormously helpful and powerful.
You may also want to listen to our Connect Education Workshop, Managing the Stress of Survivorship.
Going forward, keep in mind that taking care of yourself emotionally is equally as important as looking after your physical needs.
Q. Since I've been diagnosed, I've been anxious and sometimes feel overwhelmed by my thoughts, which I can't seem to "turn off." Are there any ways I can help myself to feel more calm?
Anxiety is a natural emotional experience for eveyone. When someone has to cope with a cancer diagnosis, anxiety (or worry) can increase, intruding on an individual’s ability to regain a sense of calm, clear his or her thoughts and feel more control over the issue at hand. Chronic anxiety can lead to fatigue and depression over time, so it is important to find techniques that can offer relief from the stress of cancer, even if just for short periods of time.
When confronted with crisis, our bodies trigger a “fight or flight” response. Part of this physical response is rapid, shallow breathing, which increases blood flow through the heart and puts extra oxygen into our bodies. A person under chronic stress will continue to take shorter, more shallow breaths, which will in increase stress and create a continual state of anxiety.
Here’s a simple breathing exercise that can help calm you:
- Sitting down, place one hand on your chest and the other over your navel.
- Take three breaths and observe your breathing. For most people, the chest area tends to rise more than the abdomen.
- Now, take in a deep breath and extend your abdomen. Picture your lungs as long, narrow balloons, filling up from the end to the front; and from the bottom to the top.
- Hold the breath and silently count to five; then, exhale loudly.
- Do this for three breaths and then sit quietly for a moment. If you feel lightheaded, hold the next breath for a shorter time. Most people find there is a calming feeling that follows.
The beauty of this exercise is you can do it anywhere, anytime. The goal is to reduce stress by returning yourself to a natural state of breathing.
You can find more relaxation techniques in CancerCare’s fact sheet, Relaxation Techniques and Mind/Body Practices: How They Can Help You Cope With Cancer.
Q. One of the toughest times I have is when I go to bed at night. After I turn off the lights and am in the dark, my thoughts go immediately to my cancer and possibly dying from it and all the things I should do in preparation. Any suggestions?
Anxiety is very common among cancer patients. For some it occurs when they wake up, and for others, as they try to go to sleep. You mention three concerns which trigger anxiety as you’re trying to fall asleep. The first is turning off the lights, the second is the fear of dying, and the third is wanting to have your affairs in order.
The dark can be an especially scary place for people facing a life threatening illness. Absence of light is a metaphor of the darkness of unknowing. Try changing your bedtime routine – relax into your pillow with the light on. Like a child who sees monsters in the dark, turning on the light, even dimly, can provide comfort and a sense of control, allowing you to relax and fall asleep.
Your second concern, fear of dying, triggers a “fight or flight” reflex, hardwired into all of us for survival. Using mindful meditation, focus on your breath while non-judgmentally looking at your thoughts when your mind wanders, especially thoughts of worry. When you feel anxious, gently bring your focus back to your breath. Breath, specifically oxygen, is life, which fuels us, and aims to keep us in balance. Anxiety makes us take short breaths depriving our body and mind of oxygen and making us more anxious. When anxiety is high, take a deep breath, hold it for a comfortable amount of time, then release it, and repeat. You can do this for a few minutes or until you fall gently to sleep. You might also try listening to a pre-recorded guided imagery exercise, if you have difficulty meditating on your own.
Finally, thinking about unfinished business, especially if there is a perceived timeline, often makes people anxious. Putting one’s affairs in order does not mean giving up on life, it simply means taking care of, and continuing to invest in our lives. With the worry of cancer it can be hard to focus on individual tasks, thereby increasing one’s anxiety. Try writing down the things you need to take care of, and then prioritize them. Use creative visualization, by imagining yourself doing and finishing each task, and enjoying a sense of accomplishment as each task is completed. These visualizations can serve as a first step and increasing the likelihood of completion, which in turn can free you of the worry that is keeping you awake at bedtime.
To learn more about reducing anxiety, please read our fact sheet, Relaxation Techniques and Mind/Body Practices.
Q. My treatments for cancer aren't always easy. More and more, I am thinking negative thoughts, which only increases my anxiety. What can I do to calm my mind and help make my treatment sessions go more smoothly?
We’ve all heard the saying, “We are what we eat.” No one disputes that since it’s apparent the food we put into our mouths replenishes cells and becomes our physical bodies. Less commonly heard is, “We are what we think.” This is because it is much less apparent what direct impact our thoughts play in our well being. Unlike food, which can be quantified and controlled, our thoughts are affected by external sources often outside our control including people, places and things. Now, the growing field of psychoneuroimmunology (PNI) shows that the mind and body are constantly communicating, back and forth.
If negative thoughts come up for you in managing your cancer, guided imagery exercises can help you counter them with positive thoughts, so the body can be more relaxed. One imagery exercise is called Creative Visualization, which is used in sports psychology, business and other areas where people confront challenges. It’s a simple technique that uses your imagination to envision an event as you would like it to happen.
Before receiving a chemotherapy treatment, you might take time to quietly sit and visualize how you would ideally like treatment to go. It helps to think about details such as what clothing you’re wearing, how the weather feels, or where you’ll be sitting or lying when you get your treatment.
During your treatment, you can continue to visualize the chemotherapy (or radiation or surgery) as it travels through your body and “confronts” the cancer cells. Use your imagination: employ super heroes (yourself or others), magic wands, or loved ones providing comfort, hope and strength to defeat the cancer. This technique can ease the mind’s tendency to worry and help you focus on “rallying” healthy cells and the immune system to defeat disease.
If you have difficulty coming up with your own Creative Visualization exercise, it might be easier to listen to a pre-recorded Creative Visualization exercise. You can find a large number of CDs and audiobooks on this subject by doing a search (using keywords “guided imagery” or “creative visualization”) at Amazon.com. Also, a good book on the topic is Creative Visualization: Use the Power of Your Imagination to Create What You Want in Your Life, by Shakti Gawain (New World Library Publishers).
Q. How can a cancer survivor deal with fear of recurrence?
Fear of recurrence is very common and understandable in the context of your recent cancer experience. There are several ways in which you can manage this anxiety in order to live a full and meaningful life:
- Ask your oncologist about chances of recurrence, regular tests to schedule to check for signs that the cancer may have returned and steps you can take to increase the chances that it will not.
- Assess your life and look at your daily routine. Are there things you could improve about your diet? Ways to increase your physical activity? Things you can do to help you relax? To sleep better?
- Read our publication After Treatment Ends: Tools for the Adult Cancer Survivor.
- Listen to our podcast, Communicating with Your Health Care Team After Treatment: Making the Most of Your Visit.
- Consider talking to a professional counselor, such as an oncology social worker at CancerCare who can suggest ways to manage your anxiety and help you process your feelings.
- Many cancer survivors also find support groups very helpful, as they can talk to other survivors with similar worries and fears and learn new coping skills. View support groups at CancerCare.
- Listen to our podcast Fear of Recurrence and Late Effects: Living with Uncertainty.
- Talk to your trusted friends or family members about your concerns. Even if there are just one or two people with whom you feel comfortable sharing your fears, this can be a powerful way to get some relief from your anxiety.
- Make sure you continue to engage in hobbies and socialize with your friends is an essential and healthy form of distraction.
- Listen to our podcast Survivors Too: Communicating With and Among Family, Friends and Loved Ones.
- Reflect on what makes your life meaningful, both before and after cancer. What values and activities are important to you? How can you continue to honor those things you hold dear? Focusing on the bigger picture can help minimize the anxiety and remind you what you can do in the here-and-now to live a full life.
- Read our publication Strengthening the Spirit.
- Listen to our podcast Finding Hope and Meaning After Treatment.
Q. I will have a new MRI this week and find out if the cancer treatment did what they wanted it to do. I know I will have MRIs for the rest of my life which I pray is very long. How do you not worry that it will come back? How do I just let it go and live my life?
Anxiety about recurrence is a natural and common part of cancer survivorship, but it does not have to take over your life. There are strategies you can use to manage and minimize your worries so that you can live your daily life and still do the things you enjoy.
For example, before each test, scan or follow-up visit with your doctor, write down all of your questions and concerns. The simple act of writing it all out in one place can be helpful in containing your anxiety, and you’re less likely to forget something that you wanted to ask your doctor. Take notes when you’re with the doctor: becoming more informed about your diagnosis can help you control your fears about things that might not be realistic or likely. Make sure to ask about ongoing steps you can take to improve your overall health or to reduce the likelihood that the cancer might return: are there certain foods you can add to your diet? Ways to increase your physical activity? Other activities to help lower your overall stress? Physical signs or symptoms you can look for to stay on top of possible recurrence?
Another way to minimize your anxiety is to schedule time for it each day (until you no longer need to do so as frequently). If you intentionally set aside a half-hour of your time to think and worry about a recurrence, you may find yourself thinking less about it during the rest of the day. Just make sure you stop thinking about it when your time is up (set an alarm if you need to)! If your worries and negative thoughts do spill over into the rest of your schedule, try not to judge them. Instead, ask yourself how they are helping you in that moment: Is it helpful to jump ahead to the future and imagine the worst? It might be more helpful to observe that you are feeling anxious but cannot know for certain what will happen, and then gently turn your thoughts toward the things you can control in your life. What can you still do and enjoy now?
Try visualization or imagery exercises to increase your mindfulness and awareness of the present moment. You can also increase the number of pleasant activities in your daily life. Make more time for play, rest, exercise, humor, music, art, nature, etc. Doing more of what you love will leave less time to worry. Even if your concerns about cancer recurrence remain in the background, they do not have to consume your life.
Q. I am a newly diagnosed cancer patient. Needless to say, I'm on an emotional roller coaster as my life has changed drastically. The side effects have cause multiple issues, many not directly treatable and as a result I worry and experience anxiety on a number of issues: relationships, fertility, reoccurring cancer, finances and life expectancy. My question is how does a cancer patient find a therapist/psychiatrist (particularly one with experience with cancer patients)? Secondly, should cancer patients see a therapist or a psychiatrist?
I’m sorry that you are under so much stress and dealing with so much. It is perfectly understandable that you would have a lot of anxiety around these important issues. Because the mind and body are so connected, side effects from treatment often impact one’s state of mind as well. Getting emotional support as you face this experience is wise.
Here at CancerCare, we are oncology social workers and offer in-person counseling for people in New York City, Long Island, and some parts of New Jersey and Connecticut. If you live outside of those areas, we offer short-term telephone counseling to help you cope with your cancer experience.
To find a longer-term therapist in your area who is skilled in working with people affected by cancer, try:
American Psychosocial Oncology Society (APOS), which offers a free referral service to help you find a mental health professional (psychiatrists, psychologists, clinical social workers and other counselors) in your area: 866-276-7443.
Help Starts Here, through the National Association of Social Workers offers an online directory of clinical social workers, psychologists, psychiatrists, and other licensed professionals. You can search each database for clinicians who have experience in cancer issues.
Most therapists are social workers and psychologists, but some psychiatrists also provide therapy in private practice. Because of their medical training, psychiatrists are the only mental health professionals who can prescribe psychotropic medications. Many people see social workers, psychologists or other types of counselors for talk therapy while also seeing a psychiatrist for medication evaluation and monitoring, on a less frequent basis.
When choosing a therapist, one of the most important criteria to keep in mind is the rapport you have with him or her. You may have to shop around and it might take several tries. After each initial visit, ask yourself: How did I connect with that person? Does it seem like he/she “got” me? Can I talk freely with that person? Only you can decide which therapist is right for you. Pick someone with whom you can be open and honest, and who can support you through this challenging journey.
For Breast Cancer
Q. I've just started treatment for breast cancer and I need to talk about my fears and concerns with the people who are closest to me. But my family just says, "Oh, you'll be fine" and to stay positive. How I can I get them to listen?
It’s often frustrating to hear our loved ones tell us that everything will be okay and to just think positively. It can feel dismissive and uncaring. However, our friends and family often do not intend to sound unsupportive, but may find it difficult to hear that you are struggling because they care about you so much. Or they might rush to comfort you, thinking that it’s helpful to tell you that things will be fine.
It’s absolutely okay to see things from a more optimistic perspective, or to have hope that things will get better, but trying to force yourself to think positively all the time adds more pressure and stress and can make you feel worse. It’s preferable to let yourself feel the negative emotions, as well as embracing the positive ones. If you try to shut off your fears and worries, it can make you hold onto them longer.
Try telling your friends and family that you appreciate their concern and realize that they’re just trying to be helpful, but that it is in fact more supportive if they just lend you an ear and a moment. Let them know that you are not asking them to solve your problems, that you just need to express your feelings. Sometimes you’ll have bad days and need to vent.
Ask them if they can shoulder some of your burden, just by listening, knowing that you would do the same for them. If they cannot, consider talking to an outside professional instead, like a CancerCare social worker. Sometimes you need a more objective person to create a safe space for all your feelings, positive and negative.
Our Connect Education Workshop Helping Cancer Patients and Their Families Cope with the Stresses of Caregiving might be helpful for you and your loved ones to listen to.
Remember, not all families can respond in ways that will be helpful. A support group might be useful to you as a way to connect with others who understand how you are feeling. CancerCare offers groups in-person, over the telephone, or online. You can also contact us at 800-813-HOPE (4673) and speak with an oncology social worker.
For Lung Cancer
Q. I'm in remission after having chemotherapy and radiation for small cell lung cancer. I've recently started having a shortness of breath when I'm at rest (doesn't seem to happen at work). Is there anything I can do?
The shortness of breath, or dyspnea, you are experiencing can be uncomfortable and frightening. The more you struggle for air, the harder your lungs work to get oxygen, and the more distressed you feel. It is extremely important to consult a medical professional to find out what might be setting this cycle in motion. Possible causes could be:
- a side effect of chemotherapy or radiation (which may reduce lung capacity)
- anemia, meaning your lungs don’t have enough red blood cells to deliver oxygen throughout your body
- a non-cancer lung condition, like asthma, COPD, or an allergy
- anxiety caused by fears of recurrence, the lasting emotional effects of having had cancer, or other types of stress
Contact the American Lung Association (1-800-LUNGUSA) for information on other possible causes of dyspnea. Depending on its source, a doctor may prescribe a steroidal or anti-anxiety medication, supplements, oxygen, or special exercises. The Lung Cancer Alliance has a very helpful video demonstration of breathing techniques to relieve dyspnea. Progressive relaxation, meditation, and guided imagery can all help reduce stress and anxiety. CancerCare has several Connect Education Workshops that address stress management in cancer survivors including Fear of Recurrence and Late Effects: Living with Uncertainty and Managing the Stress of Survivorship.
To prepare for your doctor’s appointment, keep a record of your breathing problems, with these questions in mind:
- When do you experience shortness of breath?
- When does it feel worst?
- How long does each episode last?
- What is going on around you before, during, and after each episode?
- Does anything make it feel better?
Take your record with you to your appointment. It is very important that a medical professional review your symptoms, especially if you’re also feeling faint and dizzy, if your heart is pounding, or if it’s difficult to breathe even at rest.
CancerCare has information on creating a survivorship care plan that can be used to personalize your post-treatment needs and communicate them to your health care provider.
Don’t be afraid to advocate for yourself so that your medical, emotional, and practical needs are addressed, and your quality of life is maximized.
For Ovarian Cancer
Q. I was diagnosed a few years ago with ovarian cancer and have finished my treatment, but now I'm afraid of recurrence. Is this normal?
After a diagnosis of ovarian cancer, a woman can feel vulnerable and experience a lot of uncertainty. The emotional, social and physical experience of having ovarian cancer can be overwhelming and living with this experience often leaves one with a fear of this happening again.
While your fears are typical, at times they many vary. For example, around the time of your check-up, blood tests, or when a milestones or anniversary is approaching you may feel sad, irritable, or anxious. Allowing yourself to acknowledge and accept your feelings is the first step. Developing ways to manage these feelings is extremely important and a way to be kind to yourself. An important act of kindness to yourself is to live in the now and find ways to balance your fear of recurrence with enjoying your life, and the hope for continued wellness.
Ways to manage fear of recurrence:
- Get support. Many women find comfort in a support group. Share your feelings and learn how others are coping with challenging and common fears, which can provide you with a community of strength and understanding. You can also speak with a CancerCare oncology social worker about your concerns.
- Take good care of yourself. Get enough sleep and reduce stress. Find things to do that are comforting such as meditation, yoga class, writing in a journal, or spending time with your pet. We all have activities we find soothing and it is important to develop these and do them when you need to.
- Communicate. Share your feelings with the people who are important to you. Let them know how you are, and what they can do to help. Set limits if you need to by deciding what you can commit to and what you can do another day.