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Cancer Psychosocial Support
David Spiegel, MD

We have conducted clinical research for two decades on the methods and effects of group support for cancer patients. We have found that seven fundamental issues need attention in the life of a cancer patient:

1. Build bonds of social support.
Cancer can be a very isolating experience. Friends and family may feel awkward about discussing cancer with someone who has the disease. Cancer patients are often removed from the flow of life, spending time getting treatment rather than at work or with family. Find new ways to connect with others: get help from friends, reach out to family, join a good support group.

2. Express emotion.
Cancer inevitably stirs strong feelings: fear, anger, sadness, among others. Allow yourself to deal with these feelings directly. Avoiding them only makes them harder to deal with, although many think that they can control the disease by controlling how they feel about it. There is no evidence that expressing sadness or fear allows cancer to progress. Indeed, if anything the opposite is the case. Those who honestly deal with their feelings about illness seem to do better rather than worse. And they become closer with those who share those feelings with them.

3. Detoxify fears of dying and death.
Death confronts all of us, but for cancer patients it carries a special dread, even though half of all cancer patients will be cured of their disease. Most people fear the process of dying more than death itself: being in pain, being unable to make decisions about their medical care, being separated from loved ones. Each of these serious issues are addressable when faced. Anxiety about death is actually reduced when the possibility of death is faced in a direct and supportive manner. Find someone you trust: a support group, a psychotherapist, a doctor, or a clergyman with whom you can discuss your concerns about dying and death. Whatever happens, you will feel better prepared and stronger for it. One breast cancer patient reflected on her experience in her group in this way: "Talking about death is like looking into the Grand Canyon (I don't like heights). You know that falling down would be a disaster, but you feel better about yourself because you're able to look. That's how I feel about death. I can't say I feel serene, but I can look at it."

4. Reorder life priorities.
Cancer changes your life: your body image, energy, time, future plans. Take the realities of the disease into account in planning your life. Live as fully as you can, while you do what you can to mitigate the damage it does. Trivialize the trivial, get rid of unnecessary obligations, and extract the most joy and satisfaction you can out of what matters to you in your life: important projects, people who matter, helping others. Hope for the best but prepare for the worst.

5. Fortify your family.
One cancer patient said to me: "My life has not been the same since I got cancer, but in many ways it is better. I am so much more honest and caring than I was before." Use the time you have to enrich family relationships, impart life values to children, enjoy the people you love. Discuss problems openly, and be clear with your family about what you need and want from them. At the same time, be prepared to offer help to them in dealing with your illness.

6. Deal better with your doctors.
We find that there are 3 keys to a good relationship with your physicians: communication, control and caring. Be clear with your doctors about what you want from them. Participate in treatment decisions, and become informed about the choices you have. Find doctors you genuinely care about you as a person as well as treating your disease, and let them know how much you appreciate it.

7. Learn methods to control cancer-related symptoms, such as pain and anxiety.
Simple techniques like self-hypnosis can be used to reduce or even eliminate pain and other symptoms. You have to pay attention to pain for it to hurt. You can learn to focus your attention elsewhere, to teach your body to float rather than fight the pain. You can imagine that the part of your body that hurts is warmer or cooler, lighter or heavier, and in this way alter how it feels. The strain in pain lies mainly in the brain. Addressing these seven issues can help you to enrich your life as you cope better with cancer. Cancer is not so much a death sentence as a wake-up call. Heed the call and mobilize your personal and social resources to live beyond the limitations imposed by the illness.

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