Special report

January 2011

The diagnosis of cancer: an emotional challenge

The verdict is in : “You are diagnosed with cancer”. Reaction: “Why me? How will I announce it? What will happen to me?”. The person affected tries to  cope emotionally in response to the news.

The word “cancer” continues to be dreadful, taboo, synonymous with death. In our society, cancer is generally perceived as the fatal illness of the 21st century.  It is perceived as an invisible enemy which we need to eradicate. In this word, there is the idea of an evil inside, the belief of being responsible for our illness, the  notion of an incurable evil, uncontrollable through medications.

What of it? Humanity has  lived with cancer for many years. Bone lesions have been found in Egyptian mummies and even in dinosaur skeletons. It is inaccurate to talk about cancer, when in fact  we should speak of “cancers”. The term “cancer” refers to the group of  oncological diseases. More than a hundred types of cancers exist, each  presenting its particular characteristics, its progression, and its response to treatments.  Furthermore, despite its complexity, cancer is no longer necessarily fatal. Thanks to  medical breakthroughs in treatments, it is now possible to live with cancer.

However, living with cancer is an emotional challenge.  Throughout the   oncological trajectory  - announcement of the diagnosis, investigation, treatments, side effects, medical follow-up -  varied and intense emotions are completely expected and appropriate. The challenge is principally the result of the complexity and the psychological stress (N.U.T.S.) of the disease. The acronym N.U.T.S.  represents the recipe for stress,  notably due to Novelty, Unpredictability, a Threat to the ego, or a lack of Sense of control1.

The disease is often experienced as a loss of control over one’s body, while the exact etiology of the disease is unknown The success of therapies is unpredictable; there is no certainty  regarding the absence of a recurrence . The oncological trajectory  is filled with many novel elements  - the disease itself, the treatments, side effects, the medical world. Living with cancer forces one to confront the thought of death, and may have a profound impact on  socio-economic factors , modify relationships, decrease self-esteem, affect body image and sexuality, thereby provoking a threat to the ego.

Being informed of a diagnosis is generally perceived as the most distressing moment. Yet,  this is not always the case. For an individual who has been suffering physically  - weight loss, pain, lack of energy-  this announcement might follow a long period of medical investigation and doubts. Paradoxically, receiving the diagnosis leads to a relief, a perception of control. Conversely, for an asymptomatic person who had not imagined the possibility of such a serious disease, this announcement may create an emotional shock.  It isincoherent: the person understands that he / she is affected by an illness that is potentially fatal but yet does not feel ill. It is therefore impossible to assert  that a certain moment of the oncological trajectory is emotionally more difficult than another.  On the one hand, the emotional response will be proportional to the person’s interpretation based on the N.U.T.S. factors, and on the other hand it will depend on his / her resilience and capacity to cope.

Each person has  their way of facing the emotional challenges of living with cancer. Whether for the person affected by the cancer or for individuals surrounding the person, one way of adapting is to identify the source of psychological stress (N.U.T.S.), then, as much as possible, to find a way to soothe and manage it.  An effective strategy is to get well-informed and to  better understand the situation by discussing it with the doctor, to choose the treatment, and to comprehend the different stages. Another strategy entails the idea of cultivating life, by allowing for small projects, pleasures, alone or with others, all of which allow us to feel alive. These two methods allow one to regain a sense of control, to minimize novelty, and decrease the psychological stress associated with cancer. One must stay vigilant: the emotions must regulate the psychological stress without being intrusive or destructive. It is equally possible that the emotions are exacerbated by the secondary neurophysiologic changes due to oncological treatments; it is crucial to talk about it and to be well-informed.

 Cancer is a complex disease, and it is idealistic to try and eradicate the associated stress and emotions. However, it is possible to cope with the uncertainty and to cultivate life.

Written by: Marika Audet-Lapointe, Ph.D. Oncology psychologist at the PSYmedicis Onco-psychology clinic – www.psymedicis.com.