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Life After Cancer A Roadmap for Cancer Survivors

Surviving the Emotional Impact of Cancer
David Spiegel, MD, Pat Fobair, LCSW, MPH, and Ernest H. Rosenbaum, MD

Emotional Supportive Care
Difficulties of Engaging in Emotionally Supportive Programs

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When you are told the frightening words, Your diagnosis is cancer, a sequence of events occurs, sometimes overwhelming both patient and family. Feelings of hopelessness and helplessness and the inability to cope are common after hearing the shocking news. Often, patients are so overwhelmed and distressed that they become non-functional and may not hear or comprehend many of the explanations given to them - explanations that could often put their disease in perspective and help them cope better with the diagnosis.

Much of a survivor's life trajectory through cancer diagnosis, treatment, and survivorship depends on how they have coped with various problems both in the past and in the present, for life and death, and on their personal and family history.

With time, some of the confusion subsides, and patients move onward with life. Survivors begin to deal with the consequences of their illness by working cooperatively with their medical team (doctor, nurse, social workers) and supporters. This requires being informed about medical treatments, disease prognosis, and resolving to make the best of a sometimes difficult situation. Each person has an inner strength, which they must call upon to help them deal with their cancer and all of its associated problems. Support programs have been shown to be very successful in helping survivors develop the coping skills needed to live with and through their cancer.

Emotional Supportive Care
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All cancer patients and survivors experience challenges to their emotional and social wellbeing. Problems with anxiety, depression, and difficulty coping can complicate medical symptoms and aggravate side effects of treatment. The stress of coping with a cancer diagnosis ranges from mild to severe, often depending on the severity of the diagnosis and treatment and the prior mood of the survivor. A third or more of patients report emotional distress (mostly depression and anxiety) during the early months of treatment, and there may be similar levels of distress ongoing into survivorship.

Psychological research during the past 30 years has revealed common problems of cancer survivors following treatment:
Fatigue - 35-80% of survivors Distress - 35-40% Depression - 20-40% Body image - 31-70% Sexual problems - 30-64% Mind and memory losses - 20-45%

Counseling, group therapy, and good supportive care can help patients and survivors effectively deal with these challenges. In addition, effective medications for depression and anxiety can help reduce distress. In particular, antidepressants can improve energy and mood, breaking the cycle of despair and poor self-esteem that can spiral into a worsening depression. It is important to treat depression vigorously with appropriate psychotherapy and medication, since depression is an independent risk factor for shorter survival time with cancer.

Mood usually improves over time for many survivors. Although some survivors have adjusted their lives and actually feel better, others continue to have anxiety, depression, and feelings of isolation, as well as problems interacting with friends and family. Clinical depression affects around 20 - 30% of survivors at various points in time. Cancer survivors who were depressed prior to their diagnosis are at greatest risk for a shortened survival time.

Difficulties of Engaging in Emotionally Supportive Programs
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Stress and anxiety can make it difficult to engage in emotionally supportive programs. There are many reasons why survivors may not comply with lifestyle modification guidance, including:
Poor physician-patient communication
Side effects of medication, cancer, or cancer therapy
Impractical advice
Other problems including job responsibilities, transportation problems, financial problems, childcare costs, poor communications, and cultural barriers

Solutions to these problems need to be worked out with the care-giving team - including physicians, nurses, and social workers along with family and friends. Support groups and supportive community organizations (American Cancer Society [ACS] or Leukemia Society of America [LSA]) can be very helpful in normalizing emotional and social reactions to cancer. Cancer survivors learn how they can be of help to one another as they learn how to master life with cancer, encouraging expression and acceptance of emotions related to cancer, and dealing directly with fears of dying and death. Such group programs can also teach active coping skills, enhance communication with family, friends and physicians, and teach symptom control techniques such as self-hypnosis and relaxation training for pain and anxiety. Emotional stability and a positive attitude are very important for survivors recovering their well being.

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First appeared December 12, 2007; updated August 2, 2008