PSYCHE

Cancer is one of those life crises that can provide new meaning and purpose in life. But that comes later. Awaiting the diagnosis and hearing the news can be the most emotionally difficult period of the entire cancer experience. Here are some suggestions and resources that can help you gather information and make decisions with presence of mind.

Know yourself
There's no "right" way to cope with cancer. Each person handles the emotional challenges differently. Think about how you usually function in an emergency and expect to react the same way. It may help to understand the strengths that brought you through adversity before. Ask yourself whose support you usually count on in trying times, including family, friends, spiritual advisors and mental health professionals. Do what works for you. But if your reactions to crises generally interfere with your ability to function at home or at work, and you are unable to make treatment, family or workplace decisions, reach out to traditional or new support systems now.

What does cancer mean to you?
Cancer triggers a terror different from most other diseases, even though they may have worse consequences. Any sense of doom you may have probably comes more from this historic dread than from the current realities concerning your type of cancer and its treatment. Cancer is not a death sentence for most people. It does not necessarily lead to helplessness, pain, disfigurement, disability or the end of your career. Accept that these exaggerated fears are normal, but do not let them prevent you from having a worrisome lump or symptom checked out or from deciding to undergo recommended treatment. And do not conclude that you will not have the energy or focus to pursue life goals. Most people find that their anxiety diminishes greatly once treatment begins and they are taking active steps to combat the disease.

Let it out
Express your feelings, no matter how awful or embarrassing they may seem to you. Keeping them bottled up may prevent you from moving beyond the distress. However, at work or at home, you may need to promote the image that you are in greater control than you may feel. In that case, you need to find a person you can trust or a safe place -- at a support group, in a therapy session with someone who has had cancer -- where you can vent your anger, fear, sadness and even those alternating hopeful and hopeless feelings. It may also help to find a quiet place to become aware of the full range of your emotions -- by meditating or writing in a journal, for example -- and to appreciate that you can get through this.

It's a control problem
Uncertainty and lack of control over your body and your future often underlie the anxiety that people experience at the time of diagnosis. People who have always felt in control of their futures, their careers and their families may have particular difficulty, as will those who find it difficult to deal with change. Becoming a medical patient and enduring the the passive waiting that tests and treatments entail can provoke a feeling of loss of autonomy. Distinguishing between what you can and cannot control will help restore confidence and competence. For example, although you can't control the outcome of tests or treatments, you can collect information to understand the illness, choose doctors whom you trust, and participate in all decisions. On a smaller, day-to-day scale, although you can't always control waiting time, you can make it more comfortable by bringing a CD player and listening to your favorite music. Delegating essential daily chores to people you trust will also help you understand that you remain in charge of your life. At work, delegating tasks to trusted colleagues will help you -- and them -- to appreciate that you are managing your responsibilities during this personal crisis.

It's not your fault
Resist blaming your personality, attitude, coping style, emotions, lifestyle or personal habits for your cancer. Cancer experts repeatedly emphasize that there is absolutely no scientific basis for these conclusions. The more you blame yourself, the less empowered you will feel to combat the disease.

Find your inner warrior
Thinking of cancer as a battle to be won can help restore your self-confidence and self-esteem. People with a fighting spirit demand the best possible care for themselves. (More on how to be a Powerful Patient)When confronted with a rigid bureaucracy, they insist on their rights. They don't take no for an answer. They are not necessarily "good" or "nice" patients. But if that's not your style, deputize someone to fight on your behalf.

Be positive, but be real
Hopefulness and a positive outlook can be very motivating, but don't fake it or feel guilty when your spirits sink. Setting short-term goals can help to shore up your confidence. You have every right to feel lousy or dispirited even if other people pressure you to be more positive; there is no scientific research that links a positive attitude to recovery from cancer. But quality of life is directly affected by how you feel, and although it is normal to feel grief , loss, sadness and fear from time to time, persistent anxiety and depression are not part-and-parcel of having cancer. Tell your doctor. Ask for help. You need your emotional energy to tackle the disease, not to mention all the other responsibilities that are important to your life.

Reach out
Research shows that people who have strong ties to others deal with crisis best. Reach out to loved ones and close friends. Although some people may disappoint you -- because of their own fear of cancer -- be open to others who may unexpectedly offer concern and assistance. At home and at work, ask those you trust to help out with essential responsibilities and chores. During the period of uncertainty before treatment begins, cancer education programs and support groups can be sources of information as well as safe havens for emotional expression and understanding. Hospitals, the American Cancer Society, your church or synagogue, and Cancer Care can provide information about cancer support groups. Cancer support chat rooms on the Internet can also help. Groups vary; if you don't feel comfortable in one, look for another.

Meeting one-on-one with someone with your type of cancer can help to validate your concerns. The American Cancer Society (www.cancer.org), for example, pairs breast cancer patients with long-term survivors. Cancer Care (www.cancercare.org; click on "Helping Hand Resource Guide") has a patient-to-patient network.

Psychologists, social workers, nurses and psychiatrists trained in psychosocial oncology can be a godsend to people who are trying to manage the distresses associated with a cancer diagnosis. A previous history of depression or emotional problems may trigger a recurrence during this crisis. Your oncologist's office or any cancer treatment center can provide information.

Distract Yourself
Hard as it may be in the beginning of this journey, schedule some time off from thinking about your illness. Keep doing things you enjoy, including exercise, if you are up to it, and remember that there's life -- plenty of it -- beyond cancer. For some people, the workplace is where they best concentrate on their continuing competence and enjoy time away from the sick role.

Other Resources

The Human Side of Cancer: Living with Hope, Coping with Uncertainty
by Jimmie C. Holland, M.D., and Sheldon Lewis.

The National Coalition for Cancer Survivorship's A Cancer Survivor's Almanac: Charting Your Journey
(See Part Two, "Taking Care of Your Emotional, Spiritual, and Social Needs")
by Barbara Hoffman (ed.)
(www.canceradvocacy.org)

The American Cancer Society's Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment, and Recovery
(See Chapter 31, "Coping Strategies") by Gerald P. Murphy, M.D., Lois B. Morris, and Dianne Partie Lange

The American Cancer Society's "I Can Cope" program