The Coping Mechanism During Cancer
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Discovering that one or someone close has cancer can be a shock. It may be difficult totake it all on. One hears the words, but somehow one doesn’t believe it. This is normal. One may be tearful and flat for some weeks. It is normal to be afraid of many things, such as the cancer itself, treatment, pain, the effect the cancer has on family and even death. It may be difficult to make decisions about treatment, what one wants to tell family and friends or what to do at home and at work. It is important to remember that over half the people who get cancer will be cured and, for many others, cancer and its symptoms can be controlled so they can live comfortably for months or years. There is always something that can be done for someone with cancer.[1]
Coping With Cancer
Coping refers to the attitudes and behaviors that one uses to maintain his/her emotional well-being and to adjust to the stresses caused by cancer. Different people cope in different ways, and some ways of coping are more successful in promoting a person’s emotional well-being and psychological adjustment than others. Currently, one might be coping with treatments and their side effects. One may also be coping with a recurrence of cancer or with pain and disability. One’s life has been disrupted and altered by illness, and they are dealing with the effect on their loved ones of all that is happening to them.
Those who feel supported report better quality of life and wellbeing. If cancer comes, having friends and family capable of supporting will provide “resources” to cope with stress, emotional turmoil, and all that comes with receiving cancer treatment and the lengthy recovery thereafter. Talking, listening, and just being there are some of the most important things one can do. During this time, the natural response of most caregivers is to put their own feelings and needs aside. They try to focus on the person with cancer and the many tasks of caregiving.[2]
Psychological Characteristics Of Cancer Patients
The mental state of the patient can have a big impact on the treatment process, so understanding the psychological characteristics of cancer patients plays an important role in cancer treatment. When facing cancer, patients will experience psychological crises such as fear and worries of:[2]
· Treatment or side effects
· Cancer recurrence or metastasis
· Uncertainty
· Losing self-control
· Changing relationships
· Death
Anxiety and fear can make coping with cancer treatment more difficult. It can also interfere with decision-making regarding care and treatment. Therefore, recognizing and treating anxiety is an important part of cancer treatment.
Many patients only think of cancer, and when they mention cancer, they panic and lose sleep and eat. Reading literature on cancer and then acting on mentioned symptoms, develops a vicious cycle of worry. The stage of diagnosis of mental illness when knowing that they have cancer is common in patients. This reaction is sometimes so severe that nothing more can be said about the treatment plan. The patient may present with autonomic symptoms: Anorexia, insomnia, and psychotic symptoms such as frustration, loss of concentration, paranoia and guilt indicate deep frustration. In addition, patients may refuse treatment if they think death cannot be avoided. In this case, the patient needs to consult a psychiatrist for timely psychological counseling and treatment. At the initial stage of treatment each cancer treatment regimen presents its own psychological challenges. Patients often worry because of fear of pain during surgery, fear of whether chemotherapy and radiation therapy will cause hair loss, and less commonly, the change in body shape after surgery. Patients may also experience post-operative disappointment, prolonged and severe post-operative torment. A detailed discussion of the side effects will ease the patient's fear. Many times, patients are afraid that the doctor, family or medical facility will leave "full responsibility", or be abandoned in the middle of treatment stages. Attention should be paid to timely treatment of complications because many patients drop out of treatment due to severe side effects. Often patients who worry about cancer in the late stages will not receive special attention from medical staff. When the patient is terminal, the physician's positive and supportive attitude alleviates the grief of the patient and family. The mental and physical effects of the dying person cause a variety of concerns. Fear of leaving work unfinished is a concern which includes both practical and psychological issues. For example, a young father and mother take care of their young children, while some patients worry about unresolved family and economic problems. The psychology of cancer patients has many negative stages, it is important to have a timely psychological intervention team to help cancer patients overcome their fear, depression, and tormented feelings.
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Emotional Support
Some people may have particular concerns – they may be worried about the change in their appearance after surgery and how it will affect their lives and relationships. Younger people may be worried about fertility following treatment (this should be discussed with the specialist). Other people may feel that they are not getting enough personal support to help them deal with their cancer. It may be helpful to talk about one’s feelings with partner, family members, friends or with a cancer nurse, local Cancer Society, counsellor, social worker, psychologist or religious/spiritual adviser. One may wish to talk to someone else who has had a similar experience.
Cancer’s Impact on Relationships
A cancer diagnosis can be isolating, especially for any age group. One may feel that the diagnosis is one’s alone to cope with, and perhaps feel the need to withdraw from others. This is normal; however, finding one’s support network is important. Allowing open communication with family, friends and loved ones may help one feel more supported in the long-term.[3]
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· Spouses And Partners: Most young adults do not expect their spouse or significant others to be diagnosed with cancer. The thought and fear of losing a loved one can be overwhelming. Sometimes this fear can drive an emotional wedge between partners and negatively affect communication. It is important for each to talk openly and honestly about individual thoughts, feelings and fears. Remember, one does not need to always talk about cancer. Discussing day-to-day topics can help bring back a sense of normalcy to their lives. If one finds oneself needing further support, some NGOs or philanthropic organizations can help by offering individual case management and counseling to patients and to caregivers. Be honest about the feelings and encourage the partner to be open about their feelings as well. Communication will become increasingly important as relationship grows.
· Parents: After a cancer diagnosis, young adults who have previously lived on their own sometimes choose to move back into their parents’ home temporarily. While this may feel like one is giving up independence, remember that it is temporary. One will want to make sure that his/her emotional, practical and financial needs are being met during this time period. Be honest about the need for privacy and share feelings and emotions with parents. One may find them to be a strong source of emotional and practical support.
· Siblings: Watching a brother or sister face a cancer diagnosis is difficult for siblings of any age. They may want to help in practical ways such as providing transportation to and from treatment or helping with household tasks. Encourage the siblings to talk openly. Let them know that they can support by just taking the time to listen. Spend time together talking about subjects other than cancer.
· Children: Young adults who have children may be concerned about how much information they should share with them about their diagnosis. Parents often do not want to share information as a way to protect their children from worrying; however, speaking honestly with one’s children can help them to feel safe and secure. Give children accurate, age-appropriate information. Explain the treatment plan and how it may affect their lives. Encourage children to share their feelings, even those that are uncomfortable. One may also want to speak with an oncology social worker about support groups or events for children who have a parent diagnosed with cancer.
· Friends: Oftentimes, one will find that friends and peers will not know how to respond to the news of one’s cancer diagnosis. While this may feel discouraging, do not be afraid to take the lead in reaching out to them. Be honest about what one needs and what one feels like discussing. If one’s friends want to help, ask them to help in specific ways such as running errands, providing transportation or preparing meals. Although some friendships may change during this time in one’s life, focus on the friends who are able to listen to and support.
Psychological Characteristics Of Cancer Patients Caregivers
Family members are the most important physical and emotional care providers. Caregiving family members help the patient perform activities such as self-care, movement, transport, communication, household chores, shopping, cooking, financing, organization of appointments and social activities. In addition, they need to perform various other activities such as helping the patient cope with symptoms and coordination of medical care. As well as physical care, they also take on emotional care such as enabling social support, helping them make decisions and searching for/obtaining information. As a result, those who provide care suffer from numerous difficulties such as physical issues, social issues and financial difficulties.[4]
Family member caregivers have no idea how to carry out their carer role, how much care the patient needs and how to use current resources as they usually feel unprepared, have inadequate information regarding the disease and the care required and have limited support from health care givers. As a result, they neglect their own health and portray inadequate coping reactions. Simultaneously, family members are challenged because many dimensions of their lives are affected. The burden and strain for families arises from numerous sources, including the physical strain of direct care, financial burdens, work adjustments, emotional adjustments, and managing uncertainty. Coping is the ability of patients and family members to adapt functionally to either the immediate distress of diagnosis and treatment or to longer term adjustments of life changes. Helping patients and family members to cope includes a wide range of supportive strategies, including assisting patients through difficult procedures or therapies to ensure optimum treatment and helping patients and family members to make adjustments to the losses and changes that affect the future quality of their lives.[4]
The caregiver's psychological morbidity is generally equal to or greater than the individual patient's. A large proportion of caregivers suffered from both anxiety and depression suggests that there are unmet needs that are measurable at an early stage of the patient's life-limiting illness, and points to the need for early psychological assessment and potential intervention. Although patient's physical and emotional factors predict caregiver distress, perceived burden is the strongest predictor of caregiver anxiety and depression. A majority of caregivers experienced an adverse impact on their employment, particularly during the terminal period. Some caregivers have to quit their job or declined advancement, and a large proportion lost work hours or used special leave or holidays to fulfill their caregiving responsibilities. There is always a significant costs of prescription drugs particularly for those without extended health insurance demands the need for a policy that addresses the growing impact of drug costs on patients and their families.[5]
There are always a substantial psychological, occupational and economic burdens associated with caregiving at the outset of life-limiting illness that increase as patients' functional status declines and death approaches. Caregiver burden has been the most important predictor of both caregiver anxiety and depression. The caregiver's commitment to the patient has primacy over his or her own occupational and health concerns. [6]
Tips for Taking Control of One’s Finances
When one or a loved one has received a cancer diagnosis, money may be the last thing one wants to think about, but taking control of finances from the start may be the best way to prevent a crisis later on. Get a handle on income and expenses. Figure out how much money is coming into one’s household, how much one spends and what one spends it on. Does one have money saved for an emergency? Does one have assets (a home, other property, a retirement plan, life insurance) that can use to obtain cash?
Stay on top are medical bills. The consequences of medical debt are staggering and unfortunately all too common. Medical debt can be major burden and a source of continuing stress for many living with cancer. If one finds oneself behind on paying medical bills, they must look for other resources that can help like NGOs and philanthropic individuals and organizations. Fortunately, there are many financial assistance programs that help young adults affected by cancer. Talk to health care team about financial needs and referrals to resources. Financial help for cancer patients exists in the forms of:
• Insurance reimbursement
• Co-payment relief
• Discounted or free medications
• Grants to cover practical costs such as child care and transportation to and from treatment centres
• Educational grants and scholarships
Financial help may be available through local finance department. The department may have pamphlets and information about financial assistance for people who are unable to work. Currently, in some countries short-term financial help is available through the sickness benefit and longer-term help is provided through the invalid’s benefit. Extra help may be available; for example, accommodation and assistance with medical bills.[7]
Insurance, Legal And Employment Issues
Many employers will be supportive when an employee is diagnosed with cancer. However, if, after a diagnosis of cancer, one feels that the employer treats the patient unfairly or harshly, there are ways to challenge this. Some countries have “The Employment Relations Act” which may protect employees and a person for personal grievance. One may need to seek advice from the Department of Labour Employment Relations Service. Some people living with cancer may be able to claim, or make use of, various benefits from personal insurance policies they hold, such as life insurance, disability income or income replacement insurance. Providing one’s cancer is not excluded as a ‘pre-existing condition’, the medical bills for treatment and operations may be reimbursed. This is dependent on the particular policy one holds.
School and Work
With cancer diagnosis a young adult may require making adjustments to educational or career-related goals. They are often able to continue with work or school by modifying their routines and schedules. The teachers and co-workers may prove to be excellent sources of guidance and support should one choose to disclose his/her diagnosis. Many young adults are able to return to the workplace during or after treatment. However, some may need to limit the number of hours they work per week or choose to leave their job entirely. The patient must talk to supervisor or human resources department and discuss assistance that may help ease one’s transition, including a flexible work schedule or a re-evaluation of job’s responsibilities and duties. Some countries have introduced special Disabilities Act (DA) which helps protect the civil rights of people with a disability, which includes facing a cancer diagnosis.
Cancer Society Information And Supportive Care Services
One’s local cancer society provides confidential information and support. The public or private Cancer Information Helpline established by the Cancer Society service where one can talk about his/her concerns and needs with trained nurses. The Local Cancer Society centres offer a range of support services for people with cancer and their families which may include:
· Volunteer support including drivers providing transport to treatment
· Accommodation while one is having treatment
· Support and education groups
· Contact with other people with cancer
Cancer support and education groups offer support and information to people with cancer and their families. It can help to talk to others who have gone through the same experience. Support groups can also offer many practical suggestions and ways of coping.
The coping mechanism is family-based interventions for management of cancer patients. The interventions may be proved to be helpful for patients, caregivers, or both. There is strong supporting evidence for the multidimensional intervention success. Cancer patients are the main focus of care to healthcare professionals, but the family members must be included in the care plan as well. When a family member suffers from cancer symptoms and treatment side effects, those surrounding or living with them suffer as well because they are inevitably tied to the patient. For this reason, it is critical that health care professionals incorporate family caregivers in the symptom management of the family member with cancer.
The family caregivers of cancer patients have to choose effective coping methods. However, there are still some caregivers who display ineffective coping attitudes. Therefore, it is important to support the effective coping attitudes of caregivers and intervene in order to change the ineffective coping attitudes.
References
1. Hinds C. The needs of families who care for patients with cancer at home: are we meeting them? J Adv Nurs. 1985; 10:575–81.
2. Cassileth BR, Lusk EJ, Strouse TB, Miller DS, Brown LL, Cross PA. A psychological analysis of cancer patients and their next-of-kin. Cancer 1985;55: 72-6.
3. Carver, C. G. and Scheier, M. F . Assessing coping strategies: A theoreticaly based approach. Journal of Personality and Social Psychology. 1989; 56 (2) 267-183
4. Cameron JI, Shin JL, Williams D, et al. A brief problem-solving intervention for family caregivers to individuals with advanced cancer. J Psychosom Res. 2004; 57:137–43.
5. Girgis A, Johnson C, Aoun S, Currow D. Challenges experienced by informal caregivers in cancer. Cancer Forum 2006;30:21-4.
6. Nijboer C, Tempelaar R, Sanderman R, Trıemstra M, Spruıjt RJ, Van Den Bos GA. Cancer and caregiving: The impact on the caregiver’s health. Psychooncology 1998;7:3
7. Greer JA, Applebaum AJ, Jacobsen JC, Temel JS, Jackson VA. Understanding and Addressing the Role of Coping in Palliative Care for Patients With Advanced Cancer. J Clin Oncol. 2020 Mar 20;38(9):915-925.