Coping with the Emotional Effects of Head & Neck Cancer
Dr. Yvonne Lewis, Clinical Psychologist, Cancer Psychology Service, Deanesly Centre
Emotional impact can vary at different stages:
At the time of diagnosis During treatment (radiotherapy/chemotherapy) Adapting to altered physical appearance and sensations. Coping once active treatment has ended. Impact will vary greatly from one person to another
Emotional Reactions & Process of Adjustment You may feel understandable:
- Fear of uncertain future
- Gradual Acceptance
A 57 year-old woman on learning that she had cancer: “At first I couldn’t take it in, I didn’t believe it….l went all numb, then I thought perhaps the Doctor’s have made a mistake, you read about it all the time, but deep down I knew I had cancer….! was very, very, scared at first, then I felt very low. I went into my shell, didn’t want to see anyone; I couldn’t tell my husband how I felt, I still can’t.”
NICE Guidelines Emotional distress is common among people with cancer. 40% of UK patients experience anxiety or depression. The severity of psychological symptoms may range from understandable sadness and worry to adversely interfering with everyday life. As incidence and survival rates rise psychological support becomes increasingly important in overall care.
Cancer Treatment Cancer and treatment may impact on everyday activities such as: Eating, drinking, socialising, work, hobbies, relationships, roles within family. These activities have a significant social impact, shape our personal identity and therefore can lead to social isolation. Social isolation then limits available emotional and practical support.
Other Issues We Encounter Communication & speech difficulties. Changes in relationships – intimate, family and friendships. Impact of cancer can magnify pre existing issues e.g. – a person who sees illness as a weakness will find accepting help from their partner or others much harder. Can reawaken reactions to previous threats, traumas, or losses
- Common but not always spoken about.
- Can be a consequence of anxiety/depression relating to cancer.
- Can be the result of certain treatments.
- Surgery resulting in changes in appearance and sensations.
- Surgical nerve damage.
- Cause will determine treatment.
- This can be a very important part of a person’s life therefore seeking advice is appropriate.
What Can We Do? To improve emotional adjustment to cancer by building resilience and allowing emotions to be expressed. Improve quality of life – re-engage in everyday meaningful activities. Patient becomes a person again.
4 Main Aspects of Building Resilience
- Communicate openly about feelings – it can help to let our feelings out safely.
- Develop a sense of personal control in general life (and as far as possible in treatment)
- Build on existing coping resources.
- Look at assumptions/ personal values/ beliefs in relation to SMART short-term and long-term valued goals.
Specific, Measurable, Achievable, Realistic & Rewarding & Time framed
Making Sense of Feelings
It is not the symptoms or the effects of treatment which produce the emotion, but the meanings for that individual. E.g. if cancer means loss we are likely to feel sadness and depressed If cancer means threat to survival likely to feel anxious If cancer is seen as unfair/intrusion likely to feel anger
Cognitive Behavioural Therapy – (Beck 1976) What is CBT and how does it relate to Cancer?
- Cancer forces us to make changes in our lives.
- CBT is an approach of understanding our thoughts and behaviours and exploring how these are leaving us feeling trapped.
- Changing unhelpful thought patterns and behaviours can reduce distress and help control physical symptoms and improve our mood.
- CBT can help us gain more control over our lives and cope with adversity.
- CBT is only one of the many therapy approaches that we use in our work.
Issues We Can Help You With: Managing physical symptoms or side effects (pain, nausea, fatigue). Dealing with a sense that your future is uncertain. Coping with visible changes and people’s reactions. Loss of self-confidence. Relationship difficulties arising out of cancer diagnosis and treatment. Managing demands of home, work and family life while looking after yourself. Feelings of depression and anxiety particularly to social situations. Anxiety and phobias relating to aspects of medical treatment or surgery. Coping with grief and loss. Emotional reactions of trauma.
Cancer Rehabilitation -How We Work
- Sessions offer support and a confidential space to people affected by cancer.
- Appointments are also available for families.
- We work together to explore your main concerns and their impact on everyday life.
- Enable emotional and social adjustment.
- Consider alternative helpful thinking patterns
- Relaxation skills- mindfulness and visualisation
- Managing difficult symptoms (stress, pain, fatigue)
- Improve quality of life.
- Rebuild confidence in social situations
Family Reactions Anxiety is often high in the family as they experience feelings of helplessness. Family may limit conversation as they worry about causing more pain should the person speak for too long. This may contribute to the individual feeling isolated and frustrated. Often support from family and friends is sufficient. However sometimes people feel talking to someone independent can be a helpful additional support.
Further Information Should you wish to find out more about the Cancer Psychology Service then please discuss this with your Specialist Cancer Nurse, Medical Consultant or GP.