Caring for Your Emotional Needs During This Difficult Time

Cancer is the "club" you never thought you'd join.

"Cancer."

"I have cancer."

"Someone I care about has cancer."

"What do I do now?"

PAMF's Cancer Care Clinic has created a program uniquely suited to the multifaceted needs of people who have learned they have cancer. A diagnosis of cancer is a life-changing event, regardless of whether someone has been newly diagnosed, is in the midst of treatment, or is in the post-treatment or aftercare phase of their fight against their illness.

• Psychosocial Care
• Discovering a "New Normal"

Psychosocial Care

Whatever affects us physically also affects us emotionally, intellectually, spiritually, sexually and socially. Our personal relationships and professional life may also be impacted, as well as our relationship with our 'self’. While PAMF's team of physicians and nurses care for the physical needs of our cancer patients, the Cancer Care Clinic's team of providers includes a medical social worker who helps ensure the emotional and psychological needs of our patients, their caregivers and loved ones are met during this difficult time.

What is a medical social worker? Professionally trained medical social workers have earned their master's degree (MSW) and specialize in applying clinical, advocacy and community-based skills to enhance the individual's or family's life experience. The Cancer Care Clinic's medical social worker:

• Listens with compassion, and focuses on building or enhancing the existing strengths of the cancer survivor
  
• Teaches or reinforces coping skills
  
• Provides support to the survivor and his or her caregiver
  
• Identifies and helps arrange community resources, such as support groups, skilled home health care, meal delivery for the homebound, respite care, and much more
  
• Assists in crisis intervention with brief solution-focused sessions
  
• Discusses the emotional challenges of dealing with a potentially life-limiting illness, and when indicated, assesses the patient for clinical depression and anxiety with referrals to licensed clinical social workers (LCSWs), marriage and family therapists (MFTs), psychologists and psychiatrists in the community
  
• Helps the patient create a "Road Map" with tangible tasks so that the individual who has cancer can learn to live with a chronic illness rather than be defined by it
  
• Addresses any concerns, distress or distractions in the individual's work and home life (such as transportation problems, lack of child care during treatment, etc.) so that he or she can focus more on treatment
  
• Helps the survivor to look at lifestyle choices (alcohol use, smoking, etc.) that may seem to initially decrease feelings of anxiety or depression but over time can be detrimental to good health
  
• Discusses Advanced Health Care Directives, a document that states the treatments/procedures that the survivor would or would not want, among other care decisions
  
• Acts as a liaison and advocate for the individual with cancer, including reporting abusive behavior or victimization, or supporting the individual in voicing his or her concerns among the cancer care team

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Discovering a "New Normal"

While many cancers are quite treatable, a cancer diagnosis means that people are confronted with the possibility of death. Because of this, some people reevaluate themselves and their life choices (past, present and future). But a person does not have to be dying in order to benefit from learning the stages of grief, which Elisabeth Kübler-Ross defines as "any emotional reaction to a significant loss." In addition, human beings are the only species on Earth to be able to think about change, and hence, loss in advance. This is known as "anticipatory grief."

Not only can the stages be combined, but people also move back and forth between them all the time (as does their family and friends). There is no right or wrong way to grieve, and the only way "out" is by feeling your feelings. Behaviors such as denying your emotions, being stoic, pretending to be OK or unchanged and minimizing the impact of being in treatment is actually more difficult in the long run. It is important to avoid comparing or judging how you are responding to this tremendous change.

Listed below are descriptions of the five stages of grief:

1. Shock and/or Denial

Several years ago, a humorous public service announcement reported people "lose at least half of their intelligence while dressed in an exam gown." In addition to the well-known stress reactions of "Fight or Flight," a very legitimate response is "Freeze" (sometimes called "deer in the headlights"). Many report not being able to remember anything past the diagnosis, especially the visit in which one receives a diagnosis. This is normal. Our brains can only process such big news a bit at a time.

Examples of these feelings include:

• "I can't believe this is happening (to me)."
  
• "I'm going to wake up and this will have been a bad dream."
  
• "I couldn’t have heard right—it must be a mistake!"
  
• "I feel like I'm surrounded by cotton batting, or a cocoon, far away from everyone."
  
• It's like I'm watching myself go through this like I’m in a movie."

2. Depression and/or Guilt

Depression wears many faces, and while sadness and anguish at such life-changing news is to be expected, not everyone weeps. In fact, many people display irritability, indecisiveness, think about what they "should have, could have or would have" done (a common myth, as if one did something they shouldn’t have, or didn’t do something they should have, that "brought on" the cancer), fatigue and confusion, among other emotions. It is important to seek the support of a professional when these reactions negatively impact one's life.

3. Anger and/or Blaming

Of course you’re angry! Not only is getting cancer "not fair," it has likely never been one of your life goals to have to fight it. Anger is a necessary part of the grieving process; in fact, when frustration gets "bottled up" or unexpressed, depression deepens and/or becomes entrenched. Keep in mind that there is nothing wrong with being angry; it's what one does with it that can be considered right or wrong.

Your health care team understands that you are going through a hard time; learning how to constructively channel your anger towards fighting your illness is one of the ways people adapt and grow.

4. Bargaining

In this stage of grief, individuals begin bargaining. "If I (fill in a new action/behavior), then I (fill in the desired outcome)." This is normal; it's our brain's way of trying to manage what may or may not be within our ability to control. Changing eating habits, improving one’s mood and energy levels through exercise, and similar lifestyle changes are terrific. However, the only thing we can control is our efforts, not outcomes. Minimizing and/or delaying of emotions until the active phase of treatment is completed ("If I don’t think about it until then, it won't be so big a deal") also occurs in this stage.

5. Acceptance

Many individuals experience acceptance (or even tolerance) early on in the treatment process. Acceptance is not resignation; it is allowing life to be on life's terms, one day, hour and minute at a time. Acceptance is fluid and dynamic process, not an event or task to be checked off one’s "to do" list.
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