Mental health becomes the center stage for clients and their families dealing with cancer. The person with cancer feels their whole life has been turned upside down; they experience many emotions, including inevitability, loss, shock, anxiety and depression. Their family members, on the other hand, feel desperate to help and “fix” them, and they feel anxious because they do not understand what is happening other than the fact that their world has suddenly changed and not for the better.
The medical treatments for cancer often feel worse than the cure. The physiological effects can be intense because treatments can have side effects such as itching, burning, sores in the mouth, skin scarring, hair loss and blood clots, and these changes may lead to feelings of anxiety. Other conditions include diarrhea and constipation from the multiple medications the person takes, including opioids, blood thinners, steroids such as Dexamethasone, and benzodiazepines such as Xanax, antidepressants medications, antipsychotics medications such as Olanzapine, or other drugs. Some treatments cause people to lose the hair on their head or all over their body. Because people sometimes consider their hair to a part of their identity, losing their hair may feel like their entire identity has been taken away. They will experience this reminder every time they look in the mirror because it takes up to a year to discover what kind of “chemo hair” will grow back.
Loss and uncertainty
People going through cancer treatments feel uncertain about their future, and every slight ache or pain makes them fear the cancer is returning, which causes some form of anxiety. They also feel a sense of loss because they feel they cannot accomplish the things they had hoped or they envision not seeing their loved ones anymore.
Clients can also experience a loss of control because they feel everything in their world has suddenly been taken away from them. Cancer leaves the person feeling stripped of their choices, including how they will wear their hair and what foods they choose for their nightly meal. Clients with cancer, for example, tend to eat the same thing every day because if they find one food that agrees with them, they will stick with it.
I once worked with a 62-year-old white woman who had been diagnosed with bilateral lung cancer that she later discovered had also spread to her liver, brain and spine. Understandably, this client was depressed, anxious and angry at the world. She wondered why this had happened to her, and she felt helpless because she didn’t have any control over what was happening to her body.
Using psychotherapy with this client allowed her to see that her life has meaning and that she still has control over some choices. She could decide whether to continue with radiation on her brain or chemotherapy treatments for her body. She could also decide how she chooses to look at her diagnosis. Does she see her diagnosis as the end or as something she has to contend with? Does she want to let the cancer diagnosis control her life or does she want to live like she wants? Counseling can help this client process these different thoughts and outlooks on life. With a counselor’s guidance, she can begin to realize that she has choices and learn to enjoy the little things in life rather than focus on the things she does not have power over.
Humanistic psychology and cognitive behavior therapy (CBT) are helpful clinical approaches for clients with cancer who feel a sense of loss. Humanistic psychology can help clients see that they are holistic individuals capable of determining their behaviors and goals, and CBT helps them challenge their irrational “ought,” “should” and “would” statements that clients often tell themselves.
Evidence also suggests that mindfulness-based treatments yield benefits for clients who are dealing with cancer treatment. In addition to being cost-effective when compared to other more conventional and contemporary management methods, mindfulness approaches help clients manage the adverse effects of treatment and symptoms from the cancer progression such as a sense of loss. Several of my clients dealing with cancer have remarked on how they have lost control over their lives and actions, and in Western cultures and health systems, mindfulness is a way to stay aware and in control. A mindful approach, when used effectively, can also reduce stress, improve physical health and help clients reach a state of heightened consciousness and awareness.
I worked with a 69-year-old white man who had non-small cell lung cancer. He underwent a left upper lobectomy (surgeons removed the upper lobe in the left lung) and three months of chemotherapy to treat the cancer. After being in remission for nine years, he developed a chronic cough and discovered he had another tumor — this time on the right lung. The doctors told him that they thought this was a second, new form of cancer and not a metastasized form. He then underwent 68 rounds of radiation therapy and three months of chemotherapy.
Despite being officially in remission again, this client is not overly optimistic because he has been down this road before. In addition to the two lung cancers, he has had melanoma on his nose and was exposed to Agent Orange, a chemical herbicide, during the Vietnam War. This client is always waiting for the other shoe to drop.
Counselors can help clients find positive aspects to their life rather than waiting for something bad to happen. Clinicians can provide clients with tools and interventions to help them cope with their illness and alleviate their anxiety, depression and feelings of hopelessness by teaching them to practice positive affirmations and mindfulness techniques. Supportive-expressive therapy is one evidence-based treatment that allows clients to express their emotions and helps increase their social support; this therapy can also improve the client’s capacity to cope with their cancer.
Resentment and anger
A female client who was going through cancer treatments told me she had feelings of resentment because despite being a healthy person, she was the one who had been diagnosed with stage 4 lung cancer, while her sister who was not as healthy had not. The client was very conscientious about eating only nutritious foods (those high in antioxidants) and maintaining good physical health. She didn’t understand why she was diagnosed with stage 4 lung cancer and had tumors in both lungs, one on the aorta and one close to the esophagus. Her sister, on the other hand, smoked cigarettes, drank alcohol, and for most of her adult life struggled with an addiction to cocaine, but she was in perfect health.
Anger is another emotion clients with cancer may experience. For example, I knew a 19-year-old white man who had been diagnosed with lung cancer that had spread to his liver and intestines. He needed a colostomy bag for his intestines, so he was angry at the world. He was mad that his cancer diagnosis determined how he ran his life, who and how he dated, and what he did in general. His chemotherapy and pharmacological intervention schedule were once a week for three hours, and the treatment left him tired and worn out. A client such as this would benefit from counseling because a clinician could help them see that their life does have positive aspects, they do have choice in life and that not everything is wrong and hopeless.
Admitting feelings of resentfulness and anger can be challenging for clients. Clients rarely share their true feelings with those close to them for fear of worrying or upsetting a family member or friend. Instead, they often bottle up their feelings of depression, anxiety, resentment and anger, which causes the client even more stress, worry and anxiety.
Many clients who are dealing with cancer diagnoses need to talk or vent to someone who is not their family or close friend. Thus, one of the most important and beneficial things a counselor can offer these clients is empathetic and nonjudgmental listening, caring and genuineness. Having space to talk about what they are going through and struggling with and what they need without feeling like a burden to family and friends can make a world of difference for clients with cancer. Counselors can be a reliable source of comfort and a valuable resource for clients. They can use different theories, including mindfulness, humanistic, person-centered, feminist and CBT, to normalize and ground the client’s worries, fears and anxieties. Counselors can also use Carl Rogers’s tenets of unconditional positive regard, empathetic listening and congruence to connect with clients genuinely.
Because dealing with cancer can cause clients to feel uncertain, anxious or angry, it’s also important to teach and model effective self-care strategies and techniques. Self-care can be anything the client chooses to do that makes them feel less stressed, anxious or depressed and more in control of their situation. Strategies can include going for walks, taking a bubble bath, or scheduling downtime to relax. Self-care can also consist of spending more time with family, getting a pedicure, hunting, fishing, bird-watching, sleeping in on Saturday mornings or enjoying a cup of coffee. Undergoing cancer treatment can make clients feel all their choice and control has been taken away, and self-care can give them some semblance of control in their lives.
Donna Degrasse is a licensed mental health counselor in Florida, a trained trauma professional, a marriage and family therapist, and cognitive behavioral therapist who specializes in working with clients and families dealing with a cancer diagnosis. She has been counseling clients since 2016, and she has been working with clients and families dealing with a cancer diagnosis for over a year. She brings compassion, empathy and caring to each family member and client she sees. She is also a doctoral candidate in the counselor education and supervision program at Capella University. Contact her at firstname.lastname@example.org.
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