Anxiety, Fear and Depression

Virtually all cancer patients, along with their caregivers, experience sadness, grief and fear. This is normal. However, up to 75 percent of cancer patients experience a high level of sustained psychological distress that can negatively affect treatment and recovery.

About 25 percent of cancer patients suffer from severe symptoms that can be diagnosed as major depression or anxiety disorders. These disorders usually require treatment. It is important to understand the difference between normal sadness and grief and actual psychological disorders that can affect your ability to deal with your cancer diagnosis, treatment and recovery.

Coping Strategies

Cancer diagnosis and treatment are physically and emotionally difficult, and it’s fairly common to experience feelings of depression and anxiety. However, psycho-oncologists (psychologists who specialise in the mental health care of cancer patients) recommend keeping a close eye on your emotional state after diagnosis, during treatment and beyond, and getting support and/or treatment if your symptoms become severe or long-term. This is because studies have shown that those who develop positive coping strategies generally have a better quality of life and recovery rate than those who do not.

While your cancer care team’s primary goal is to treat your cancer, an increasing number of oncologists are recognising the importance of emotional support for cancer patients. Coming up with ways to cope with the emotional aspects of head and neck cancer can be very helpful to you and your family.

Positive coping versus negative coping

Coping means finding ways to deal with challenges and intense emotions. How you cope with your cancer diagnosis and treatment can have a profound effect on your quality of life as well as your caregivers’ quality of life. There are negative coping strategies and positive coping strategies.

Negative coping strategies include denial (pretending you do not have cancer or refusing to think or talk about it), withdrawal or avoidance (isolating yourself from others) or a fatalistic attitude (expecting the worst). Negative coping strategies are associated with higher levels of anxiety and depression in head and neck cancer patients.

In contrast, positive coping strategies can help you to have a better quality of life and might even improve the outcome of your treatment. Positive strategies include finding the benefits of your illness, seeking support from others, being informed, talking to others about your cancer, remaining active in daily life, thinking and speaking positively about yourself, being religious/spiritual and maintaining a generally positive outlook throughout your cancer journey. One of the more difficult positive coping strategies to achieve is finding benefits of your illness. Benefits might include discovering a greater sense of purpose in fighting your cancer, helping others in their cancer journeys or strengthening relationships.

Positive coping comes more naturally to some people than to others. If you have visible scars or facial disfigurement as a result of your cancer treatment, it will probably be even more challenging to remain positive. If you find that you tend toward negative coping strategies, you can consciously change to more positive ones. This is not easy, but it can be done with consistent long-term effort. Medication for depression or anxiety combined with counselling or therapy is the most effective way to develop active positive coping skills, followed by maintaining strong family relationships and a large active social network. Twenty-five percent of head and neck cancer patients who receive counselling over 12 months or more can overcome symptoms of anxiety or depression.

Up to 67 percent who receive regular therapy beginning soon after diagnosis no longer have symptoms of depression or anxiety 12 months later. A qualified therapist or counsellor can give you specific coping techniques. They can also provide advice and support to help you maintain your coping skills as your care progresses and your circumstances change.

While positive coping strategies have been shown to improve quality of life for many cancer patients, note that they don’t work for everyone. Some people find that constant positivity does not suit their personalities, or they find that they simply cannot maintain a positive outlook long-term. They may even be annoyed or angered by people constantly telling them that they must stay positive. They find being realistic and having knowledge, even if it makes them less optimistic, to be more comforting for them. If this is the case for you, know that you are not a failure because you are not always optimistic. Just use your best coping strategies, positive or negative, to get you through your cancer journey and ask for help when you feel you need it.

Positive coping strategies

Here are some ideas you can use today to help you cope with your cancer diagnosis, treatment or recovery.

  • Understand Your Cancer Diagnosis
    Learning as much as possible about your cancer type and treatment plan can help you feel more in control of the situation.
  • Maintain Good Communication with Your Family and Cancer Care Team
    While it’s perfectly understandable to want time to yourself, particularly after a diagnosis, maintaining good two-way communication with your loved ones, doctor(s) and nurses is important.
  • Anticipate Possible Physical Changes
    Before beginning cancer treatment, it’s a good idea to plan for possible physical changes, as this can help you cope later. Understanding your treatment plan and speaking to your doctor can give you an idea about what cancer treatment side affects you may experience, such as severe dry mouth. A wide variety of solutions are available to help you through this process.
  • Maintain a Healthy Lifestyle
    Head and neck cancer treatment can create changes to your diet, so you should meet with a dietician before and during treatment to ensure you maintain adequate nutrition. If possible, practice regular exercise during treatment. Exercise has been shown to provide benefits in cancer patients, such as reducing fatigue and preventing muscle loss. Exercise is also effective at reducing stress. You might even try dance or movement therapy, which can help to reconnect you to your body, enhance your ability to express yourself, build muscle strength, and reduce feelings of isolation, fear and depression.
  • Let Family and Friends Help You
    Letting people close to you run errands, provide transportation, help you with household chores and prepare meals can be a huge benefit and reduce stress. Don’t feel guilty about accepting their help, as it can also help them feel more productive in a difficult situation.
  • Learn and Regularly Practice Relaxation Techniques
    A variety of relaxation techniques, such as deep breathing exercises, prayer, meditation and yoga, can help you feel more relaxed and relieve stress.
  • Try to Maintain Your Normal Lifestyle
    Try to maintain your normal lifestyle as much as you are able. This can help you cope with cancer. Cancer treatment side effects can be managed better than ever before, and many cancer patients are able to work full time or part time while undergoing treatment. Even simple activities, such as walks around the neighbourhood with your spouse, may help you feel better.
  • Speak with Other Cancer Patients
    Because people who haven’t experienced a cancer diagnosis may have trouble truly understanding your feelings, it may be helpful to join a cancer support group. Your hospital may have groups available. Online cancer support groups are also available.
  • Find Tools to Help You Communicate
    If you lose your ability to speak, hear or see as a result of your cancer treatment, there are tools that can help you to cope with these difficult changes. Many people who lose their ability to speak find that it is too tiring and frustrating to try to communicate their needs to others at first, so they don’t. Consequently, they end up going through treatment without help and support when they need it most. Look for ways to communicate more easily and delegate tasks to others. For example, tablets and pads can help you to communicate without speaking much more easily than writing on paper or gesturing. Interactive calendar applications can help you communicate days and times for visits, meal deliveries, chores and more and allow friends, family and caregivers to sign up for times and tasks that suit their schedules without having to go back and forth with you. You can also have computers, pads or smart phones “read” text you type out loud to help you “speak” to others or hear text read to you if your sight is impaired. There are many tools available that can reduce your stress level and help you feel more in control. This will in turn help you to cope with your emotions and keep a more positive outlook in general.

When to Seek Help

 Cancer treatment is primarily about survival, but it is also important to maintain the highest quality of life possible during your experience. Psychological disorders, such as major depression and anxiety, can negatively affect your quality of life. Thirty-three percent of cancer patients experience serious psychological distress.

However, less than 10 percent seek professional psychological care. This is unfortunate since regular therapy or counselling can significantly reduce or eliminate the symptoms of depression and anxiety and improve overall quality of life.

Many cancer centres have psycho-oncology specialists on staff. These specialists might include nurses, social workers, psychologists, psychiatrists and chaplains who specialise in the mental well-being of cancer patients and their families and caregivers. You may wish to include such a specialist on your care team to help you learn positive coping strategies and maintain a hopeful outlook.

Normal responses

If you are trying to decide if you need help handling your emotions, it may be helpful to know what are considered “normal” reactions for most cancer patients.

When people first realise, they are being tested for possible cancer, they usually experience fear and anxiety as they wait for results. When they receive a cancer diagnosis, their most common reaction is disbelief and denial. This stage usually lasts just a few days. The new cancer patient then slowly begins to accept the diagnosis and will likely experience emotional turmoil that includes anxiety and depression, poor concentration, loss of appetite, trouble sleeping and an inability to complete tasks.

Thoughts of death may begin to dominate the person’s thoughts. This stage usually lasts one to two weeks. Once treatment begins, many patients become more hopeful because they have a plan and they are taking positive steps to fight their cancer.

Over the next few weeks or months, most patients will continue to adjust to all the emotions and changes that come with cancer treatment, recovery and remission. This period may be punctuated by new emotional crises if there are facial disfigurements, treatment failures or cancer recurrence.

All these reactions are “normal” in the sense that they are the most common or typical emotions experienced by head and neck cancer patients. It doesn’t mean that if your reactions are different that there is something wrong with you. There are a wide variety of emotional reactions that may be normal for you and are not a reason to be overly concerned or seek professional help. Any time that you feel you need help, though, you should not hesitate to seek it. What is tolerable for one person, even if it is considered normal, may not be tolerable for you. There is no shame in seeking help when you need it.

Signs you may need to seek help

While periods of sadness, grief, fear and anxiety are common throughout the cancer experience, if you’re finding yourself unable to adjust to your diagnosis after weeks or months, you may be suffering from a serious psychological disorder that requires treatment.

Some signs that you may need help include:

  • Having a history of depression or anxiety before your cancer diagnosis
  • Having five or more symptoms of depression for two weeks or more
  • Experiencing sustainedanxiety that prevents you from functioning in your daily life and/or getting the cancer treatments you need
  • Denying your diagnosis to the point that you refuse to get treatment
  • Feeling unable to concentrate or function in daily life
  • Feeling “numb” or paralysed, unable to make decisions or act
  • Losing your motivation to go anywhere, do anything or interact with others
  • Experiencing multiple panic attacks
  • Feeling hopeless, helpless or fixated on thoughts of death and dying
  • Having suicidal thoughts or impulses
  • Experiencing any other type of psychological or physical distress not associated with your cancer treatment over a sustained period of time (e.g., shaking, headaches, digestive issues, difficulty thinking, etc.)

If you have any emotional or psychological issue that you want to overcome but can’t, and it is affecting your quality of life or cancer treatment, tell your cancer care team. Ask for a referral to a mental health professional who can help you feel more in control and develop coping strategies that will support you during your cancer journey. Anxiety and depression can be severe and disabling by themselves. In combination with a cancer diagnosis, they can stand in the way of your treatment, survival and recovery. With the help of a professional, you have a two in three chance of eliminating the symptoms of a psychological disorder entirely during a few months. Do not hesitate to seek help and give yourself every advantage you can in your fight against cancer.