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Cancer Psychosocial Support |
Psychosocial Support
David Spiegel, MD
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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.
Regaining Control
Ernest H. Rosenbaum, MD and Isadora R. Rosenbaum, MA
Reprinted with Permission from Coping with Cancer-Published Jan/Feb 1999
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Nobody wants to feel out of control. But if you have recently received a cancer diagnosis or are undergoing treatment for cancer, you know that your cherished feeling of autonomy was the first thing to go. In a single moment, you were overwhelmed by the negative feelings associated with the word cancer and are now preoccupied with therapeutic alternatives, six-syllable drug names, and treatment schedules. At worst, you may feel that coping dehumanizes you. At best, you yearn for a semblance of life as it was before your diagnosis. However, you needn't play victim to cancer. You can regain control of your life by following some simple guidelines. In the process, you will not only strengthen your will to live, but increase your chances for improvement, remission, or cure.
1. Choose a knowledgeable physician who projects confidence, someone you can talk to.
Establish a partnership with your physician and the rest of the medical support team, stressing your need for honesty and open communication. Then, find out everything you can about the nature of your cancer, therapeutic options, and the rehabilitation process by asking questions of your physician and performing your own research on the internet, in medical libraries, and at hospital resource centers. Bring a list of questions to each appointment to make sure you don't forget anything. If you have doubts about any medical decisions, don't be afraid to tell your physician that you want a second opinion.
2. Seek psychological support from a group or an individual.
A support group with a skilled leader can usually provide a safe atmosphere in which to express your concerns as well as learn from the experiences of others. The best way to judge whether a support group is right for you is to attend a meeting. If you don't like it, don't go back. You may have to visit several groups before you find one that meets your needs. Alternatively, you may decide you prefer a one-on-one support relationship with a medical social worker, psychologist, or a person who has recently undergone therapy for a similar cancer. Such a person can be invaluable in allaying your fears and giving you the confidence that you can endure treatment.
3. Learn how to reduce stress.
Experiment with one of the stress reduction techniques such as meditation, visualization, yoga, biofeedback, tai chi, or acupressure. Relaxing may temporarily enhance your immune system and even have a beneficial effect on the course of your illness.
4. Find ways to bring joy back into your life.
Pleasurable pursuits such as walking, painting or other artistic endeavors, reading and writing poetry or stories, watching funny movies, getting a massage, gardening, helping others, or other activities that you enjoy can stimulate the production of endorphins, natural morphine-like chemicals in your brain that decrease depression.
5. Avoid isolation.
Solitude breeds serenity and creativity, but too much solitude can lead to feelings of isolation and depression. Anything you can do to maintain your friendships or create new ones by sharing your feelings and being a good listener will help ward off a sense of isolation.
6. Put your family, friends, and colleagues at ease
by being open about your cancer.
You have everything to do with how others perceive you and treat you. If you can discuss your disease and medical therapy in a matter-of-fact manner, people will respond in kind, without fear or awkwardness. Remember- You are in charge!
7. Make plans for the future.
You won't plan for a future if you don't believe there will be one. Therefore, you may find it helpful to come up with a list of short- and long-term goals. Making plans can be a pleasant and positive experience!
In summary, anger, depression, loss of self-esteem, and feelings of isolation and loneliness are natural reactions to a cancer diagnosis, Allowed to fester, however, they can destroy hope and lead to a wish to die. Knowledge of treatment options, a carefully planned nutritional and exercise program, and proper social and psychological support can help you to overcome these debilitating emotions.
Inevitably, you will need to make some changes in your daily routine as you undergo treatment and regain your health. Your ability to make these compromises is key to regaining control. Whatever changes you make, you will find that your intellectual and emotional potential remain intact and need not be diminished. You may even find that this experience presents an opportunity to redirect your life in new and productive ways.
First appeared May 1, 1999; updated March 8, 2010