What does being diagnosed with cancer mean on a psychosocial level?
A diagnosis of cancer is still an enormous blow for the person being diagnosed and their family. Even though more and more people are being cured, the stigma of the word cancer remains in the subconscious of the population, as it is associated with pain, suffering, death, and in some cases, an undeserved punishment.
In general, the most frequent symptoms in patients with cancer are anxiety and depression, disruption of daily life, insomnia, and difficulties at work, and with social and sexual relations.
What is anxiety?
Anxiety is a normal physical reaction to stressful events, frightening situations, or danger. However, when the reaction is excessive, it becomes a problem, and sometimes a serious disorder requiring treatment. It is intense fear, a general nervousness, which can be accompanied by physical symptoms such as palpitations, digestive problems, sweating, and tension in the neck. Cancer patients experience anxiety as a response to the diagnosis, to the meaning of the word cancer, and to fear of unfamiliar and presumably disagreeable situations. Thus, feelings of anxiety are normal in the following periods of time: between the detection of the first symptoms and the results of the analysis, before the diagnosis, and between the diagnosis and the first treatments (before surgery, before starting chemotherapy). The patient can also experience anxiety in the time between the end of treatment the first follow-up visit, and after this, before tests and checkups.
During the course of the illness, in general, there should be a decline in the patient’s level of anxiety, except in certain situations, such as medical tests or suspected relapses. If this is not the case, and the anxiety continues, thus becoming a problem for the patient, she should seek professional help. She should also talk to her doctor if her anxiety becomes acute, as in anxiety attacks, avoidance of certain situations, or phobias (for example, of needles).
Depression is a state of generalized sadness with varying intensities. It can be accompanied by loss of appetite and energy, alterations in sleeping habits (too much or too little), an inability to enjoy pleasurable activities, loss of libido, an urge to cry, and depressing thoughts (related to death) and a lack of motivation. Patients with cancer often go through depressions, above all after the diagnosis, in the middle of treatment, and if there is a relapse.
The treatments for breast cancer can have effects (fatigue, tiredness, weakness) that can be confused with depression, .making the diagnosis more difficult. If necessary, a skilled health service provider should be consulted..
If depression causes the patient to want to stay at home and not go out, if she doesn’t respond to proposals to do things she used to like doing, if she has very negative thoughts related to the meaning of life, a strong urge to die, or even if she stops taking care of herself as far as her appearance or hygiene goes, professional help should be sought, especially if the situation drags on.
REMEMBER: WOMEN HAVE A HIGHER RISK OF SUFFERING FROM ANXIETY AND DEPRESSION.. FEFOC OFFERS A BREAST CANCER SUPPORT GROUP OR INDIVIDUALIZED PSYCHOLOGICAL ATTENTION.
What other sorts of problems can a breast cancer patient have?
In the case of breast cancer the psychological effects are mainly related to a woman’s self-image and self-esteem, given that the tumor appears in such an essential organ.. The patient can feel less attractive and less desirable. The patient can have problems leading a normal life because she wants to hide the scar, something that can cause her to restrict her leisure activities, such as going to the gym or the swimming pool…. But there are also more serious problems, such as changes in the patient’s relationship with her partner.
Relations with your family and partner.
Breast cancer has a direct effect on personal relationships, with the family as well as socially. At the family level, it especially effects your relation with your partner. Cancer can be an obstacle to communication between the couple. Sometimes the patient doesn‘t feel she is getting enough support, or the support she gets doesn’t meet her expectations. She can feel alone, or on the other hand, overprotected, when she wants to begin to be autonomous once her treatment is over. Furthermore, in some cases, the partner in particular, and sometimes the family in general consider the disease to no longer be an issue once the treatment has finished and the results of the first follow-up analysis are positive. But it must be remembered that on a psychological level the patient might still be frightened and need to talk about her fears. She must be given time and space to do so.. If not, her recovery will be incomplete, lacking in the emotional aspect. If it seems to her that her partner or the people around her don’t want to listen to her talk about her cancer, she needs to seek professional help.
REMEMBER: Familiarity and trust sometimes means that the patient’s fears and anxieties are transmitted in the form of irritability towards the people closest to her. It’s nothing personal, its just her way of letting off steam!!! FEFOC HAS A SUPPORT GROUP FOR RELATIVES OF CANCER PATIENTS MEMBERS OF YOUR FAMILY MIGHT NEED TO TAKE PART IN ONE OF THESE GROUPS TO SHARE EXPERIENCES AND RECEIVE PROFESSIONAL COUNSELING.
Breast cancer patients often feel less attractive, and sometimes can be afraid their partner will leave them. On the other hand, the patient’s partner sometimes feels uncomfortable, since often they don’t know what is expected of them. He can try to be supportive, but he doesn’t know much about how to go about doing this, and also he finds his wife observing him closely to see how he reacts to the situation. The sensitivity of the patient to the reactions of others increases with cancer, and she makes no exception for her partner. She can feel bad if her husband looks at her when she is naked, in case he has an adverse reaction, but also if he doesn’t look at her, since this makes her feel rejected. All of this hinders communication, and can cause misunderstandings if things are not clarified in time.
REMEMBER: It is important to give yourself time, and the opportunity to talk calmly, without feeling anxious or under pressure.
What happens if you were single, and after recovering from cancer you want to begin a new relationship? What do you do?
Once you have overcome your illness, you should try to live as normal a life as possible. You don’t have to label yourself as a sick person, but as someone who has had a problem, like so many others in life. You should be the one who decides what you want to talk about, and to whom. Your instinct will tell you if the person is the right one to talk to, and can understand your situation. You shouldn’t feel you have to talk about your illness immediately. You are not guilty of anything, and don’t have to apologise to anyone. However, we don’t recommending waiting until the last moment, for example, just before having sex. Not telling your new partner anything beforehand might lead to embarrassing or even disagreeable moments. Be that as it may, as we said, we recommend that you be yourself, and that you say what you want to whom you want when you feel it is the right moment.
Is there a relation between these psychological reactions with the type of therapy received?
Yes, without a doubt. All the treatments against cancer have their side effects:
– Surgery: the anxiety felt when faced with an operation is universal, and difficult to overcome. Regarding breast cancer, fortunately it is becoming increasingly possible to avoid having to remove the entire breast, but even so, there are still psychological consequences. Lumpectomy makes it less likely for there to be problems of physical self-image, but this has been found to produce higher levels of anxiety since having opted for a less radical form of surgery increases the fear that the cancer will return. The fears produced by the surgery itself are: fear of the general anesthesia (fear of not waking up, fear of not being able to tolerate it), of losing control of the situation, of what will happen later, especially when the patient isn’t sure exactly what type of procedure will be carried out. Despite all this, from a psychological perspective, surgery can be the most easily accepted treatment, since the patient sees it as a “necessary evil” to remove her tumor.
– Radiation therapy: although it appears to be a harmless treatment, it has side effects, such as fatigue. Patients also feel more invaded by the sensation of being ill, because they have to go to the hospital each day, they can be afraid of the radiation, and in very rare occasions they can develop a phobia about the treatment (fear of being alone, fear of the machinery needed to carry out the therapy).
– Chemotherapy: its psychological repercussions are due to firstly that this treatment is in general the most widely-feared among all cancer patients. As you know, there are several kinds of chemotherapy, with greater or less effect on your quality of life, but it is almost impossible for it not to have an impact on you. The period of treatment is perhaps the most difficult to endure. It can start with high levels of anxiety and then, halfway through the treatment, symptoms of depression can start to appear. Remember that the treatment is an obstacle you must overcome in order to reach your goal: recovery.
– Hormone therapy: can cause changes in physical appearance and mood swings. Also, in some patients it reduces libido and vaginal lubrication. The patient can feel afflicted by all this, and sometimes it is difficult for her to accept that she needs such a long treatment. On the other hand, there are patients who feel safer because they are receiving continual treatment.
-When treatment ends, some patient’s reaction can be that of a certain feeling of fear at not being under the close medical supervision they received while they were being treated. The checkups begin, and with them, another stage of the disease.
When can I start leading a normal life?
The sooner, the better. Perhaps you have lost touch with your social life or your job. You should try to recover them as far as possible. If you carry out your normal daily activities, it will help you feel normal. You must start feeling like a woman and a person again. Perhaps you have lost interest in some of the things you did before, but you will feel interested in new things. Sometimes patients change their scale of values. Don’ be surprised by this change.
What is sword of Damocles syndrome?
It is the most typical syndrome of a cancer survivor, common to all kinds of cancer. It is the person who even though they try to lead a normal life, feels an ever-present threat hanging as if by a string over their head, and could come lose at any moment and fall on top of them again. This disagreeable sensation is most clearly revealed in happy moments, where it seems as if something were preventing them from fully enjoying things. The sword of Damocles syndrome can also be seen when the time for medical analysis and follow-up visits is approaching, along with the anxiety of waiting for the results.
What other problems can I have returning to normal life?
A breast cancer survivor can suffer some kinds of discrimination, also common with survivors of other kinds of cancer. One of them is problems at work. Women didn’t use to work outside the home, and because of this they didn’t experience these sorts of problems. But now with woman having joined the workforce, and with the increase in the number of victims cured, a problem has been caused for women who have had breast cancer. There are many types of job discrimination, such as a reduction in position, difficulties to get time off, such as sick leave, or difficulties obtaining compensation from the government, in those cases where the disease has caused lasting physical effects…..
There are also other types of discrimination, for example, when trying to obtain medical insurance. There is usually reluctance on the part of the insurance provider to the cancer survivor (refusal to include her in the policy, or increase her fees).
When faced with any type of discrimination find out what your rights are.
Should I talk about my illness with friends or acquaintances?
You should be the one who decides what to say about your illness, when, and to whom. Feel free to talk about it to the people you feel like it makes sense to do so. Don’t feel obliged, because later you might feel uncomfortable around this person, especially if they ask questions you would rather not answer. Besides, the moment to talk about things might be after six months or a year, or more, when the worst is over. You might only want to talk about certain aspects of the disease.
Sometimes its helpful to join a self-help group made up of people who have had the same illness. They could become your best friends!
Is it a good idea to tell the children?
When the patient has small children, things are more complicated. Children realize when there are changes about, and they sometimes suffer as a result. Logically everything depends on the age of each child. There are no rules, although it seems logical that small children feel frightened if their mothers are ill, since sometimes their imagination can give rise to catastrophic fantasies. We don’t think it is necessary to tell them more than is necessary; let their questions be your guide. And above all, talk with their teacher to explain the situation, or at least warn them of the possibility that the child might behave differently.
AND ABOVE ALL REMEMBER: FEFOC PUTS AT YOUR DISPOSAL A TELEPHONE HELP LINE, A VIRTUAL DOCTOR’S OFFICE (THROUGH THIS WEB PAGE) AND PSYCHOLOGICAL COUNSELING. YOU CAN CHOSE BETWEEN INDIVIDUAL ATTENTION OR JOIN OUR SUPPORT GROUP. IF YOU AREN’T SURE WHAT YOU NEED, ASK US. WE ARE HERE TO HELP YOU.