About your emotions and cancer

This article about is understanding how cancer can affect your emotions. There is information about

·         There's no right or wrong

·         How you may feel when you are diagnosed

·         Your emotions during and after treatment

·         Your feelings when you have advanced cancer

·         Understanding your feelings

·         Asking for help

  

There's no right or wrong

You may find that you have different feelings from other people with cancer. This doesn't mean that you aren't coping with your illness. When you are trying to come to terms with an illness there is no right or wrong way to feel. Everyone is different and you will deal with things in your own way. So you can take what you need to help you from this section. Ignore anything that doesn't seem to apply to you or to help.

How you may feel when you are diagnosed

Being diagnosed with cancer is likely to bring up many emotions. Most people feel shocked when they are told they have cancer, and don't know what to think. You may be confused, upset and worried.

Your feelings may not all be negative 

        "When I was told I had cancer after my operation, I was relieved. 

          I had been under the hospital for 18 months without being diagnosed. 

          Knowing was better than not knowing."

At times, it may feel like an emotional roller coaster. One day you might be quite positive and able to cope. But the next day you could feel so sad and anxious that coping might not seem so easy. All these feelings are completely natural.

Your emotions during and after treatment

People diagnosed with cancer and going through treatment often feel negative. At times, you may think you will never feel well again. Many questions may arise, such as

·     Will I ever feel happy again?

·     Am I going to die?

·     Why has this happened to me?

·     Will I be able to get myself together and enjoy the things that I used to – even my husband or children can't seem to make me feel happy any more

·     People say I must be positive - am I harming myself when I feel so low?

All these thoughts, feelings and questions are very natural and completely understandable. 

Your family and friends may expect you to feel back to normal once your treatment finishes. But many people with cancer find that this is the time when the emotional impact of their diagnosis hits them and they need more support. You may miss the support from the doctors and nurses at the hospital. And some people say they feel a bit abandoned as they no longer belong to their hospital team in the way that they did when they were having the cancer treatment. 

Guilt, blame and anger

This article is about the feelings of guilt, blame and anger you may have if you have cancer. There is information about

Guilt and blame

Anger

How talking can help

Guilt and blame

Sometimes, when you’re trying to find out why you have cancer, you may blame yourself, or other people, for your illness. Knowing why something happened can help you feel better.

Many different factors come together to cause a cancer. Often, chance plays a big part and the cancer is not due to anything that you have done. Some people are more likely to develop a cancer because of the genes they inherited at birth. But most cancers are not due to an inherited gene. Cancers start because of a mistake in copying DNA when normal cells are dividing and growing. Several of these mistakes have to happen before a cell becomes cancerous. 

Although some of our unhealthy behavior can increase the risk of mistakes in our genes, the mistakes can also just happen by chance as our cells divide and grow. Even when people know this they may still wonder if the cancer has been caused by something they did.

Because chance plays its part, and doctors rarely know exactly what has caused a cancer, there's no reason to blame yourself or other people. Even so, sometimes it can be hard to get rid of these feelings. Talking about your feelings does help. There is information about this at the end of this page.

Anger

You might find that your illness makes you feel angry with

The people close to you

The doctors and nurses who are caring for you

Your God, if you are religious

It’s normal to feel angry, and there is no need to feel guilty about angry thoughts or moods. But relatives and friends don't always realise that you are angry about your illness. They may think you are angry with them. It may help to

Tell them how you feel at a time when you are not feeling quite so angry

Ask them to read these pages if talking is difficult

Having cancer can also mean that you feel cross with people who are well. Why should this have happened to you and not to someone else? You may feel

Angry

Sad

Bad tempered

These feelings may crop up from time to time throughout your illness and treatment. Relatives may also be angry that your illness has changed things for them and feel that it has caused trouble in their lives. Often this is not even a conscious thought, but the angry feelings can still be strong.

How talking can help

It may help to express your feelings and discuss them openly. Bottling them up can make everyone feel upset and cross.

About fear, anxiety and panic

This article is about fear, anxiety and panic as a reaction to having cancer. There is information about

·         Fear, anxiety and panic about cancer

·         Symptoms of anxiety, fear and panic

·         What causes these symptoms

·         Panic attacks

·         Worries you may have

Fear, anxiety and panic about cancer

A diagnosis of cancer is difficult to cope with. It is normal to feel anxious, frightened or panicky at times. How you cope with these feelings depends on

·     The kind of person you are

·     How advanced your cancer is

·     The treatment you have

·     How much support you have around you

You might feel frightened, and worry about what will happen to you. You may also worry about the side effects of treatment or whether your treatment will work. Or you may feel that you are coping well and that you just get on with it and deal with any anxiety as it arises.

You may have much more extreme feelings. You might often feel frightened and panicky. For some people, it can be so bad that they have panic attacks. This is very different to just feeling worried.

Firstly, it is important to know that it can be frightening to have such strong feelings and you may feel that you are not coping well. But there is no right or wrong way to feel about having cancer. We all deal with things in our own way and a lot depends on other circumstances in our lives. 

It is important to find ways of helping you to deal with your feelings. Tell your doctors and nurses if you feel anxious or scared about your illness, treatment, work or finances. Just voicing this can help you feel less alone and less helpless.

There will be people at your cancer centre who can help you to manage your anxiety. For example, your doctor or nurse may help you deal with some worries by explaining things in more detail. They may suggest that you see a counsellor or psychologist for further help and support. Or they could put you in touch with someone who can help you learn relaxation techniques to manage anxiety and panic attacks.

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Symptoms of anxiety, fear and panic

If you feel very frightened, panicky or anxious, you may have problems with

·     Sleeping

·     Lack of appetite

·     Going out and seeing others socially

·     Being short tempered

·     Concentration

If your anxiety becomes a long term problem, you may constantly feel that something bad is about to happen. You may also

·     Keep asking people close to you about your illness and what they think you should do

·     Feel very negative

·     Feel very upset

·     Feel unable to cope with changes to your routine

Fear and anxiety can also have physical effects on you. This is a bit like feeling very nervous about an exam, job interview or giving a speech. You may have

·     A thumping heart (palpitations)

·     Shortness of breath, or an urge to over breathe (hyperventilating)

·     Sweating

·     Shaking hands or overall body shakes

·     A dry mouth

·     A fluttering feeling in your stomach (like butterflies)

·     Tiredness

·     Dizziness, or light or heavy headedness

·     Diarrhoea

·     An urgent need to pass urine

·     Sickness

·     A sensation of having a lump in your throat

·     Difficulty swallowing

·     A dry cough

·     Tense and aching muscles especially in the neck and shoulder area

·     Chest pain

·     Pins and needles

·     Ringing in your ears

·     Abdominal pain

·     Going red in the face or looking very pale

Being constantly anxious can also affect your relationships and sex life. You may lose interest in sex and have very low self esteem.

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What causes these symptoms

All these symptoms are very real and you may worry that your cancer is causing them. That is possible with some of the symptoms. But stress and anxiety are also likely causes.

When your body is faced with something stressful or frightening, it releases adrenalin (also called epinephrine), which prepares your body to either run, or fight the stress. This is known as the fight or flight response.

The adrenalin speeds up your body functions. Your heart beats faster, your breathing becomes rapid, your muscles contract and your gut movements shut down.

These are natural responses that have evolved in humans over tens of thousands of years. They are there to protect us from danger. For example, if you cross a road and a car comes out of nowhere, the fight or flight response helps you to leap out of the way to avoid being hit. Immediately afterwards, your heart is pounding and your mouth is dry. Soon after the fright has passed, your heart rate will slow down and you will feel normal again.

But you may repeatedly be in stressful situations throughout the day, such as seeing doctors, going through tests and having cancer treatment. Sometimes your body does not have enough time to rest and go back to normal between each stressful event. Sometimes, just the word cancer coming into your mind can trigger the fight or flight response.

The natural response that is supposed to protect you can become the problem. The more you worry, the more likely it is that your fight and flight response starts up and so your symptoms increase. It can become a vicious circle and you may end up feeling as though you have no control over your situation.

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Panic attacks

Sometimes fear or anxiety gets so overwhelming that you may have a panic attack. These can come on very suddenly and for no obvious reason. People describe them as among the most terrifying experiences they have ever had.

You may have the physical symptoms of anxiety described above but they may be far more intense. Some people even feel as if they are going to die or are going mad. Neither of these happens because of a panic attack but it does feel very real at the time.

Panic attacks may feel awful, but they are not generally dangerous to your health. These attacks may only happen once and may have no lasting effects. But frequent panic attacks can begin to seriously affect your quality of life. If this happens to you, do seek medical help.

Let your doctor or nurses know how you are feeling. They will be very understanding and may suggest that you have some treatment for your panic attacks. It is better to get help because if you carry on having panic attacks, other problems, such as phobias or depression can sometimes happen.

In this section there is information about how to help yourself cope when you are feeling anxious.

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Worries you may have

Your anxiety may relate to

·     Worries about treatment

·     Worries about pain

·     Worries about being cured

Worries about treatment

Many people with cancer worry about whether their treatment will work, or that it may be very unpleasant.

There has been a lot of research into improving cancer treatments, and this research will continue. This means that today’s cancer treatments

·     Are easier to cope with than they used to be

·     Have less severe side effects that are often more easily controlled

You may hear stories about people having cancer treatments years ago, but this information will be out of date. Talk to your doctor or nurse about any worries you have about your treatment.

It may help to write a list of questions to ask, and take a close friend or relative with you to visit the doctor or nurse. They can help you remember everything you discussed. While you are with the specialist, don’t be afraid to

·     Ask them to repeat anything you don't understand

·     Have your close friend or relative ask questions for you

·     Ask for time to talk things over and decide on any treatment choices

If you have never been in hospital and are frightened, talk to your own GP or nurse, who should be able to help reassure you.

Worries about pain

Other common fears include 

·     Will I be in pain?

·     Will the pain be more than I can bear?

In fact, many patients with cancer have no pain. For people who do, many modern drugs and other types of treatment can successfully relieve or control it.

We have a whole section about pain and pain control that you may find helpful. Generally the more you understand something, the less scary it seems.

Worries about being cured

The first thing most people ask about having cancer is whether they are going to die.

Remember that many people with cancer are cured and others live for many years. Even when the cancer is not curable, things can be done to help manage pain or discomfort, or to slow the growth of the cancer down.

Unfortunately, it isn't usually possible for doctors to say for certain that cancer has been cured. They can’t definitely say that it will never come back. Living with this uncertainty is one of the most difficult things about having had cancer.

You may find it very worrying, not knowing whether the cancer will come back. Not knowing what is going to happen can be very frightening but you can help yourself by

·     Talking to your specialist or nurses

·     Finding out as much about your illness as you can

·     Talking with your family and friends about how you feel

 

·     Why do I feel so sad and anxious all the time?

·     I feel as if I have lost control over my life, what can I do?

·     Is my cancer or treatment causing these feelings?

·     How can I make myself feel better?

·     Who can I talk to about how I feel?

·     Are there any medicines that can help with depression?

·     What are the side effects of these drugs?

·     How do I talk to my children about how I feel?

·     Do other people with cancer feel like this?

·     How long am I going to feel like this?

·     What can I do to help myself get through these feelings?

·     Will seeing a counsellor or psychiatrist help me?

Coping with sadness

This page is about coping with sadness when you have cancer. There is information about

·         Why you may feel sad

·         The pressure to be positive

·         Wanting to be left alone

·         Talking about your sadness

·         If your sadness doesn’t go away

Why you may feel sad

It’s completely natural to feel sad after you have lost something or been disappointed by something. So after you have been diagnosed with cancer, it’s normal to feel sadness. It may be there all the time. Or the sadness may come and go, depending on what else is happening in your life.

You may feel sad that you have lost your good health and ability to do some things that you enjoy. It may be the uncertainty of the future that upsets you most. People often say they are depressed instead of sad. But sadness is different from depression. Sadness is a natural part of any loss, grief, change or disappointment.

The pressure to be positive

Some people feel as though they should not feel sad, and try to hide it. You may feel as if you should be positive and make it easier on the people around you by acting as though you feel happy. Friends and family may want you to be like this because they find it hard to cope with their own sadness about your illness. But remember that how you feel is most important right now.

Pretending that you are fine all the time uses a lot of energy and will make you feel very tired. It can also create distance between you and the people close to you. If everyone is trying too hard to act as if all is well, they can’t express how they really feel.

It is important that you don’t always try to hide your sadness. This can be difficult at times, especially if you have children or grandchildren around and don’t want to upset them. It isn’t easy to decide what to tell them, especially if they are very young.

But it's a good idea to explain simply why someone close to them is feeling ill or sad today. Ourinformation about talking to children may help you.

Wanting to be left alone

There may be times during your illness when you want to be left alone to sort out your own feelings. This can be hard for family and friends who may not understand how you feel, and want to share this difficult time with you. You can make it easier for them by telling them that

·     You appreciate their support, but you need some time to yourself

·     You don't feel like talking about your illness now

·     You will talk to them when you feel more like talking

·     You still care about them even if you don’t want to talk now

Talking about your sadness

You may be surprised that others are happy to support and listen to you once they know how sad you feel. People can support you by just letting you feel sad, letting you cry if you feel like it, and not trying to change how you feel.

If you would like to share your feelings with someone, but don’t feel you’re able to talk to your friends and family, it may help to talk to a counsellor.

We have a list of counselling organisations and information about what counselling is and how it can help you.

If your sadness doesn’t go away

If you have feelings of sadness that won’t go away for longer than two weeks and you’re finding it hard to feel good about anything, then you may be depressed. It is important to recognise this difference between normal levels of sadness and clinical depression. But it’s hard to do this when you are in the middle of it. Other people close to you may recognise signs of depression before you do. If someone close to you is worried that you may be depressed, it is sensible to listen and get a professional opinion.

If you are finding it hard to talk to your family, it may help to talk to a trained counselor or psychologist. We have a list of counselling organisations and information about what counselling is.

RISK REDUCTION OPTIONS FOR WOMAN

What are the cancer risk reduction options for women who are at increased risk of breast cancer but not at the highest risk?

Risk-reducing surgery is not considered an appropriate cancer prevention option for women who are not at the highest risk of breast cancer (that is, for those who do not carry a high-penetrancegene mutation that is associated with breast cancer or who do not have a clinical or medical history that puts them at very high risk). However, some women who are not at very high risk of breast cancer but are, nonetheless, considered as being at increased risk of the disease may choose to use drugs to reduce their risk.

Health care providers use several types of tools, called risk assessment models, to estimate the risk of breast cancer for women who do not have a deleterious mutation in BRCA1, BRCA2, or another gene associated with breast cancer risk. One widely used tool is the Breast Cancer Risk Assessment Tool (BRCAT), a computer model that takes a number of factors into account in estimating the risks of breast cancer over the next 5 years and up to age 90 years (lifetime risk). Women who have an estimated 5-year risk of 1.67 percent or higher are classified as "high-risk," which means that they have a higher than average risk of developing breast cancer. This high-risk cutoff (that is, an estimated 5-year risk of 1.67 percent or higher) is widely used in research studies and in clinical counseling.

Two drugs, tamoxifen and raloxifene, are approved by the U.S. Food and Drug Administration (FDA) to reduce the risk of breast cancer in women who have a 5-year risk of developing breast cancer of 1.67 percent or more. Tamoxifen is approved for risk reduction in both premenopausal and postmenopausal women, and raloxifene is approved for risk reduction in postmenopausal women only. In large randomized clinical trials, tamoxifen, taken for 5 years, reduced the risk of invasive breast cancer by about 50 percent in high-risk postmenopausal women; raloxifene, taken for 5 years, reduced breast cancer risk by about 38 percent in high-risk postmenopausal women. Both drugs block the activity of estrogen, thereby inhibiting the growth of some breast cancers. The US Preventive Services Task Force (USPSTF) recommends that women at increased risk of breast cancer talk with their health care professional about the potential benefits and harms of taking tamoxifen or raloxifene to reduce their risk .

Another drug, exemestane, was recently shown to reduce the incidence of breast cancer in postmenopausal women who are at increased risk of the disease by 65 percent. Exemestane belongs to a class of drugs called aromatase inhibitors, which block the production of estrogen by the body. It is not known, however, whether any of these drugs reduces the very high risk of breast cancer for women who carry a known mutation that is strongly associated with an increased risk of breast cancer, such as deleterious mutations in BRCA1 and BRCA2.

Some women who have undergone breast cancer surgery, regardless of their risk of recurrence, may be given drugs to reduce the likelihood that their breast cancer will recur. (This additional treatment is called adjuvant therapy.) Such treatment also reduces the already low risks ofcontralateral and second primary breast cancers. Drugs that are used as adjuvant therapy to reduce the risk of breast cancer after breast cancer surgery include tamoxifen, aromatase inhibitors, traditional chemotherapy agents, and trastuzumab.