Dancing with Cancer

What are the Psychological Problems Seen in Cancer Patients?

When the patient applies to the doctor with any suspicion of cancer, the psychological war begins. The uncertainty felt while waiting for the results of the examination creates the feeling that the patient has taken control of his/her own life. This traumatic experience leads to an emotional crisis. Cancer is perceived as threatening because it is associated with death, becomes difficult to control over time, is dominated by uncertainties and causes side effects in the treatment process, and socially label the individual.

What Psychological Stages Does a Person Go Through During the Disease Process?

The patient goes through several emotional stages after being diagnosed with cancer. ‘Shock Stage‘ begins after the patient hears the diagnosis
First Stage ‘Shock Stage': Most of the patients state that they do not remember any words that their doctors say later, from the moment they hear the diagnosis of 'cancer'.
The second stage is the ‘Denial Stage': This is the period when the patient denies his/her disease, thinks that this will not happen to them, such a thing cannot happen to them, and the defense mechanisms developed to protect the patient's self-emerge.
The third stage is the ‘ Anger Stage': During this period, patients can express their real feelings and anger to themselves, the doctor, the health workers, their families, and even healthy people. In addition, this period is the period when patients question themselves ''why me?'', ''why did this happen to me?''.
Fourth stage ‘Negotiation Stage': During this period, it is seen that patients are trying to postpone the truth. It is seen that they pray for their own lives and even say things like  ''at least, do not make me suffer God’.
The fifth stage is the ‘Depression Stage': This is the period when the patients associate the disease with death and fall into feelings of helplessness and hopelessness.

The final stage is the ‘Acceptance Stage’ This is the period when patients accept their disease and try to adapt to the treatment plan and process. It is seen that there are changes in the mood of the patients from the moment they are diagnosed.

We can list them as follows:

• Loneliness
• Hopelessness
• Decreased interest
• Crying
• Pessimism
• Sleep disorders
• Irritability
• Autism
• Difficulty concentrating
• Fear of Death
• Fear of living dependent on others
• Fear of losing body organs
• Uncertainty about the future
• Feeling sexually deficient
• Emotional fluctuations, such as the fear that the disease will recur, may accompany this period.

What Psychological Symptoms are Seen After Chemotherapy and Radiotherapy?

It may cause the patient to feel hopeless, helpless, and exhausted, and even to feel sorry for themselves. Especially as the treatment is prolonged and the desired effects are not fully taken, an increase in the feeling of hopelessness in the patient can be seen. Even if the treatment progresses positively, the patient may underestimate the positive developments in the course of the disease and causing him/her to perceive his/her life in a more pessimistic way.

Hair loss after chemotherapy can cause serious psychological disorders, psychological reactions, and negative changes in body perception, especially in female patients. In patients who require surgical intervention during the treatment process, the fear of whether the tumor can be cleaned and the sadness, fear, and mourning of the organ being lost after the intervention can be seen. Some patients may become alienated from their bodies and themselves by not being able to accept sudden changes in their bodies.

While getting a cancer diagnosis can lead to serious problems such as depression and anxiety in some patients, it can cause them to refuse treatment, withdraw themselves from their families and social environments, and experience family communication problems caused by not knowing how to cope with the moment of crisis. The fact that their families and relatives are more interested in the patient than usual can cause the individual to remember the disease more and become angry with themselves and their environment. Especially the advanced stage of the disease and the inability to control the pain can also increase the risk of depression.

How to Diagnose Cancer?

It is natural for patients to know that they have cancer. Often, the patient's relatives try to hide this fact because they are afraid that the patient will be adversely affected psychologically. Although this person places a very heavy burden on his/her own shoulders, he/she takes away the right to know the negative changes that occur in the patient's own body. It should not be forgotten that; It is the most natural right of every patient to know what is happening in his/her own body. Coincidentally, learning that the individual is sick will damage the sense of trust he/she has developed toward the treatment team and his/her family.

The diagnosis of cancer should be made by questioning how the individual perceives the disease, how much he/she wants to know, and how his/her psychological state is. The diagnosis of cancer should be told to the patient by his/her doctor, and how much information the patient has about his/her disease should be questioned. If it is considered that the individual is not psychologically ready to learn that he/she is sick, the process should be extended. The person who will give the news should empathize, give the news without losing his/her eyes on the patient, and explain the situation as it is with a realistic approach while telling the diagnosis, the information given to the patient should be accurate, clear, and not misunderstood. The patient should be given as much information as s/he wants to know and they should always be promising to adapt to the treatment while talking to the patient.

When telling the patient about the disease, it is also necessary to inform the patient about the treatment plan and process, thus eliminating the uncertainties that may occur in the patient's head. It should not be forgotten that having a relative with the patient at the time of this conversation will facilitate the situation.

When patients first hear the diagnosis, they may experience seizures of anger, helplessness, anger, and crying, which should be treated as normal. When the patient receives bad news, it should be explained to the patient that they may have different emotional reactions. These are normal reactions and the changes experienced by the individual in the mood should be shown as normal. 

How to Treat the Patients?

• The patient must not feel lonely during this process, so during the diagnosis and treatment process, and during the doctor's check-ups, having their family with the individual will help the patient feel loved, valued, and not alone during this challenging process.
• What the patient needs during the diagnosis and treatment process should be questioned and the individual should be treated according to his/her needs, love, attention, and compassion should be shown, empathy should be approached, and family members should try to understand the psychological needs of the patient.
• During the disease and treatment process, it should be realized that there may be changes in the mood of the individual such as tantrums, crying, anxiety, and unresponsiveness, and these changes should be considered normal.
• It is not right to make decisions about the patient and the disease on behalf of the individual. When making decisions about the treatment process and plan, these decisions should be taken not only by family members but also by involving the patient in this process.
• Sometimes patient relatives act as if ‘nothing happened’ and ‘everything is fine’, which causes family members and the patient to suppress their feelings and act out to each other. In this process, family members should accompany the patient's feelings instead of acting as if nothing happened and prepare an environment that will allow the individual to express their feelings. It should be possible to talk about fears and feelings mutually within the family and to communicate as openly as possible.
• When the patient is overwhelmed with negative feelings and thoughts, it should be ensured that he/she shares these feelings with someone he/she feels comfortable with. In this case, it should be explained that it should focus on the present, not the future.
• The mood of the patients varies during the disease process. While patients are open to talking and communication during periods when they feel physical well, they should communicate themselves during periods of pain and side effects. During these periods, patients' desire not to talk and to be alone should be respected.
• Family members should not make uncertain sentences such as ''you will overcome this'' in order to give morale to the patient and should make the individual feel that they will always be with him/her in this process with a realistic approach.
• The individual's life is not just about cancer, so the importance of going to work, seeing relatives, spending time on hobbies, participating in social activities, and doing something good every day should be emphasized as long as his/her health allows him/her to live his/her life close to his/her old life.
• To prevent confusion and information pollution, the patient should be persuaded to stop researching the treatment plan and process on the internet and to get the right information from his/her physician.

What are the Psychological Problems Seen in the Patient's Relatives?

Cancer is a disease that affects not only the patient himself but also his family and relatives. Having a life-threatening illness of one of the family members causes other individuals in the family to be negatively affected psychologically. Lifestyle change, role change, increased economic obligations, uncertainty about the future and fear of losing the patient pose a potential risk for depression and anxiety that may occur in the patient's relatives. According to studies, family members experienced more anxiety, depression, fatigue, role conflict, social isolation, and distress than patients during the disease.

Psychological disorders such as sleep disorders, eating disorders such as loss of appetite, depression, anxiety, and psychosomatic symptoms can be seen in the first degree of the patients. While emotional variations such as anger, helplessness, denial, blaming themselves for whether they did their best and being stuck in the feeling of intense grief and loss, it was determined that their interest in activities that they liked before decreased near the patient.

While the patient's relatives are trying to care for the patient, they are also trying to control their own emotions. While experiencing the fear of losing relatives deeply, they try not to make the individual feel these negative feelings. This behavior can cause serious psychological and psychiatric disorders in the person.

It should not be forgotten that the psychological problems experienced by the relatives of the patient vary according to the stage of the disease, duration, severity of treatment, worsening of prognosis, and the level of communication within the family. The fact that the patient's relatives have to make changes in their lives and accompany the patient during the treatment process may also cause them to experience fluctuations in their emotional states.

Patient relatives may feel inadequate and helpless in the face of the patient's emotional problems, may hesitate to be close to the patient because they do not know how to treat the individual, or may take an overprotective approach to the patient.

Psychological disorders are more likely to occur in the family members who care for these patients. Hence, caregiver family members are defined as‘ hidden patients’. Studies have proven that terminal caregivers have a high risk of anxiety and depression and a low quality of life. Moreover, it was determined that their own care forces were also negatively affected.

What is the Importance of Psychotherapy For Patients and Their Relatives?

Diagnosing a loved one in the family with ''cancer'' is a life-threatening crisis process that affects not only the individual but the whole family. Receiving psychological support from the individual and the patient's relatives helps to overcome this traumatic process that threatens family integrity more easily.

In this process, mental health professionals should be supported to focus on the family as well as the individual and to express negative emotions such as anxiety, fear, and anger in the family. 

Psychotherapy support should be obtained when the individual and his/her family reach the point where they cannot fight the situation brought about by the disease. Psychological support contributes to the development of correct coping mechanisms, increasing the patient's self-confidence again, alleviating communication problems that may occur in the family in this process, and reducing mental distress.

What are the Effects of Psychotherapy on Patients?

Objectives of Psychotherapy:

• Informing patients about the treatment process and the disease and ensuring the compliance of the person with the treatment
• To ensure the development of the right coping mechanisms to cope with the side effects that develop depending on the treatment and the stress and anxiety caused by the disease in patients
• Explaining that it is normal to feel feelings such as anxiety, hopelessness, helplessness, anger, unhappiness, and burnout, which start after learning the diagnosis in patients and increase due to the side effects that occur during the treatment process, that the individual anxious and afraid from time to time, helping him/her to cope with these feelings and gaining awareness that getting rid of these feelings is time-dependent
• Patients often tend to suppress their feelings so as not to upset their relatives. For this reason, helping the individual express his/her feelings and making him/her feel understood
• After being diagnosed with ‘cancer’ and during treatment, patients feel that beating the disease is always associated with keeping their morale high. This is why they always force themselves to think positively. To make individuals feel that they do not always have to think positively and to ensure that they do not postpone the fear, anger, sadness, and grief they experience and express their negative feelings, and to allow them to accept these feelings
• Explaining the importance of treatment and helping the patient to comply with the treatment when the individual is desperate in some cases, refuses or wants to terminate the treatment
• To reduce communication problems caused by the suppression of the feelings of the individual and family members about the disease during the disease and treatment process and to develop correct communication skills
• To help the individual understand that his/her life is not just about cancer and that he/she has a life other than cancer and to help him/her regulate his/her social life
• Ensuring that the disease should not become the focus of life, encouraging the individual to go out as long as his/her physical condition allows, and encouraging him/her to implement the plans he/she has previously postponed, thus enabling the patient to cope with the feeling of uncertainty that he/she cannot control about the disease and the treatment process and helping him/her to regain control of his/her own life
• Explaining that it is normal to experience the fears that the disease will recur and the same process will occur again in the period when the treatment is successful and terminated, that these fears will decrease over time, and emphasizing the importance of the individual returning to his/her old life as quickly as possible

How to Provide Psychological Support to Patient Relatives?

Cancer is a traumatic condition that negatively affects the patient's self and family psychologically. For the disease, which is a vital crisis that deeply affects the whole family, not only the patient but also his/her relatives receive psychological support, which will contribute to the alleviation of this vital crisis.

• The process of caring for someone who is sick is a tiring and exhausting process, in which patient relatives can blame themselves and overexert themselves. It should be emphasized that during the disease and treatment process, it is important that the relatives of the patients do not overexert themselves and do not devote themselves to their patients.
• They try to hide their fears, unhappiness, and feelings about the process by pretending that everything is okay with their patients and each other, therefore, their relatives should be allowed to express their fears and feelings that they cannot express openly, family members should be encouraged not to postpone the anger and sadness experienced, not to hide negative feelings and to talk openly.
• It should be explained that the relatives of the patients have the right to care for themselves, that this is not selfishness, that they have the right to ask for help from other people in order to take better care of the patient, that they have a life other than the patient they care for, and that family members should be encouraged not to put their own needs second and continue their lives as usual.

Spec. Psychologist Zeynep GÖKTUNA
Yeditepe University 
Koşuyolu Hospital 
Department of Psychology