Being diagnosed with the Big C is often a life-changing event. If you think the first thing that comes to a person’s mind upon diagnosis is treatment and cure, think again. In actual fact, the most common reaction is for the patient’s mind to simply go blank.
Then the emotions kick in. Being in a life or death situation such as cancer very often makes a person reorganise their life priorities, hence making it difficult for family members and friends to understand their internal turmoil.
Urban Health gets an insight into the emotional needs of cancer patients in an exclusive interview with Dr Daniel Zainal, a Consultant Psychiatrist at the Prince Court Medical Centre, to help families cope better:
What are the emotional stages a cancer patient goes through upon diagnosis?
Dr Daniel: Usually patients will undergo five main stages:
Stage 1– Shock and denial: They will pretend as if nothing has happened and that the diagnosis was just a nightmare. This is sometimes frustrating for family members or doctors who want to initiate treatment as soon as possible for the best results.
Stage 2- Anger: One fine day they will just realise they cannot run away from the truth and will start to feel sorry for themselves, asking ‘Why me?’ and blaming others for their condition.
Stage 3- Bargaining: Once their emotions have stabilised, they will try to negotiate with their Maker. Some ask for just one more day, month, year, until their child gets married, until they have completed the haj. Others try to negotiate for more time, promising to do more charity, help someone in need, etc in exchange for a cure.
Stage 4- Depression: Most patients will at some point feel despair or depressed.
Stage 5- Acceptance: This is the stage when they come to terms with their disease and move forward to do something about it.
How long does each stage last?
Dr Daniel: There are no hard and fast rules. How long a patient experiences each stage depends on several factors, such as the level of support, his/her personality, previous history of chronic illnesses.
For instance, someone who had been ill before will have a shorter Stage 1 and 2, jumping straight to Stage 3. People who are breadwinners of a family will probably endure a prolonged Stage 1, trying to avoid the problem due to financial consequences of cancer on the family.
Other factors include type and stage of cancer, tolerance and compliance levels and general health status. People who were healthy before their diagnosis will be more hopeful and jump to Stage 5 quickly, while those with very painful types of cancer like bone cancer or those in late stage of diagnosis will linger longer at the anger, bargaining and depression stages.
How serious is the depression in cancer patients?
Dr Daniel: Statistics show that about 70-75% of cancer patients will experience clinical depression. The main reason for depression is deep-seated anxiety, of not understanding what is happening to their bodies and what to expect.
Better informed patients tend to cope with their emotions better especially when they have supporting family and friends to talk it over with. The problem is that Asians are very concerned about ‘face’ and are not used to expressing their feelings. Being depressed affects healing as the body is put under constant stress.
How is depression diagnosed?
Dr Daniel: Patients are given a questionnaire to fill up where they rate their levels of anxiety, depression and other symptoms. The doctor will also assess physical signs of depression. The most common sign of clinical depression is losing interest in the things they used to enjoy, whether music, gardening, travelling or food. They don’t want to get out of bed and just cocoon themselves in their own worlds to try fight their internal demons.
Do men and women have different emotional reactions to cancer?
Dr Daniel: Both men and women react the same way, although women tend to bounce back faster because of their inherent ability to express themselves better. Men tend to hold back their anxiety, which bottles up and can potentially explode in the form of subtle suicide through not taking treatment and medications. It’s an indication that they have given up fighting their cancer.
What can be done to help a cancer patient manage his/her emotions?
Dr Daniel: Just being there to give moral support is a great help. Allow the patient to go through his/her emotional turmoil in the stages mentioned above, but showing your concern and support will help prevent or reduce the depression that can affect their treatment success.
Encourage them to exercise, take lots of antioxidants, sleep well to avoid daytime fatigue and take their medications as advised. Basically, you’ll be helping them accept an unavoidable fact – that they have cancer – and move on to seek actively treatment instead of mulling longer than necessary in an emotional state of mind.
When should the patient or caregivers seek help?
Dr Daniel: The problem is that most patients don’t think that psycho-therapeutic support is important in cancer treatment. It may not be covered by insurance too. But counselling by a professional can help the patient get a better insight into their feelings, so that they understand their anger better and can move on. It also helps for the entire family or the caregiver to be counselled so that they can better understand what is going on.
Group therapy in the form of support groups for cancer is slowly gaining acceptance here. Find out from your cancer care provider whether there is a support group you can join. Knowing people in the same situation is very helpful because you know you are not alone and can share your worries with someone who has been through it or is going through the same journey with cancer.
How long should the counselling last?
Dr Daniel: The thing with cancer is that the treatment is a long-drawn process. Even after treatment, the cancer may return after a few years. Hence patients’ emotional needs will sometimes be on a roller-coaster, as they always harbour the fear of their cancer recurring.
Continous support for the patient is necessary in order to keep him/her confident, positive and motivated to continue with treatment. Suicide among cancer patients stands at 10%, more so in developed countries where inter-personal relations are poor.
Don’t miss next month’s topic on “Colorectal Cancer: Don’t Ignore Bloody Stools”