The “F” Word of Cancer Patients

It is unlikely to be anything else that warrants a big “F*** You” than CANCER. 

Hearing “you have cancer” is the most Frightening experience and Fraught with Fury and Fear. 

I want to deal with FEAR as part of my reflections and CANCER CARE CONVERSATIONS series. 

People #livingwithcancer can experience anxiety and depression that is haunting. 

Fear no doubt affects the quality of life. We explore a few of the fears often experienced by cancer patients.

Fear and the emotional impact of the diagnosis

Patients, caregivers, and families experience significant emotional distress after a cancer diagnosis. These feelings can affect roles at home, school, and work, our role as a parent, spouses or breadwinners. These fears are valid, especially with so many changes happening. Seeking help to discuss your sense of being overwhelmed is helpful. 

Fear of the treatment processes and the physical pain associated with it

Even though cancer or cancer treatments don’t automatically cause pain, all the stories you have heard lead you to think that’s the case and can be effectively managed when it does. Most cancer patients experience pain at some point, and those with advanced disease are adversely affected by pain. 

The quality of life is significantly impacted by cancer pain, resulting in discomfort and suffering spilling over to a patient’s social, psychological, and physical functioning. For example, it is hard to maintain relationships with others socially, and caregivers face demands that are hard to bear when in pain. 

Cancer patients don’t need to suffer from pain, though; they should expect and ask their health care providers to help them manage their pain effectively.

Fear of burdening family and friends

Being diagnosed with cancer frequently requires the direct support of a caregiver, including assisting with activities of daily living, administering medications, providing transportation, preparing meals, managing finances, and providing emotional support.

We know those who care for cancer patients can spend more than 40 hours a week providing these services. It does sound like a full-time job. However, in some situations, we must acknowledge that caregivers who give higher levels of support are more likely to neglect their own health needs. 

Those who provide care do so because they want to. Often, caregivers feel helpless and don’t know what to do to help. We also know it is hard to predict what a patient wants or needs, or will appreciate. Patients often don’t always show appreciation when they are feeling really ill.

I often advise: just to give each other a break because there is no right way to be a patient or caregiver. As Goldilocks mused,  it can be too wrong, just a little irritating, but sometimes it is just right!

Fear of partner abandonment

After a cancer diagnosis, a couple may experience sadness, anxiety, anger, or hopelessness. Both partners may need extra reassurance that they are still loved. Couples need to be sensitive to the changing emotional needs of a cancer diagnosis.

Sexual problems often develop because of cancer and cancer treatments’ physical and psychological side effects. As a result, a person’s sexuality, sexual desire, and sexual function are not the same. 

Let’s take treatments, e.g. surgeries; that can affect how a specific body part works, chemotherapy; which can change hormone levels addition, certain types of treatments have side effects such as fatigue, nausea, bowel or bladder problems, pain, skin problems or other changes in appearance that might cause issues with sexuality. 

Some sexual problems get better or go away over time, but some are long-lasting and can be lifelong.

Fear of Recurrence

After treatment ends, one of the most common concerns is that cancer will come back. Having a fear of recurrence is very normal. It does not go away; it always lurks in the background. Having a good follow-up care plan with a trusted health care team is important because knowing your health is being closely monitored can certainly help reduce your fear of recurrence. 

Fear during the COVID-19 pandemic

During the pandemic, our mental health suffered and intensified because we were worried about being infected ourselves, being isolated and the possible loss of our loved ones was overbearing. 

During the pandemic, cancer screening, diagnosis, post-treatment monitoring, and concerns with the COVID-19 vaccination impacted uninfected patients.

Given the competing risks of cancer care versus infection and the higher lethality of SARS-CoV-2 infection in immunocompromised patients, providing cancer care during COVID-19 has been challenging. As the pandemic progressed, clinicians had to weigh the risks of delaying cancer treatments against the likelihood of SARS CoV-2 susceptibility and the potentially unfavorable outcomes from COVID-19 while dealing with physical distancing and inadequate healthcare resources.

The reassurance that things are back to normal may be misleading; there are still rural areas in the world and specifically South Africa with high transmission rates and a lack of vaccines.

As a result of early 2020 lockdowns, in the United States, cancer screenings dropped between January and June 2020 by around 60 to 99 percent. We won’t be able to quantify South Africa’s screening deficit. The challenge is to figure out to what extent the rebound delayed screening led to a diagnosis of an advanced illness. It is also unclear how long-term effects will influence physical well-being, stress, and anxiety among survivors. Many of them are age 65 or older with comorbidities or chronically immunocompromised.  

Consider these approaches to manage your fears:

First, do not ignore your fears. 

Telling yourself not to worry or criticising yourself for being afraid will not make these feelings disappear. Instead, feel wiser for knowing that you will experience some fear and focus on ways to manage the anxiety. Also, be aware that your anxiety may temporarily increase at specific times. 

Try talking 

There is discomfort when we hate what one is most afraid of and do it with somebody who can hold their fears. They should get help to shoulder the burden of not knowing. It can be empowering and provides the confidence needed to feel like you can get through the tribulations. 

Join a Fraternity 

A support group is highly recommended. Support groups offer the chance to share feelings and fears with others who understand. It’s not for everyone, but it’s like real life; you will find a friend or group of friends who fit perfectly.

Be well informed. 

Despite the difficulties delivering cancer care during the COVID-19 pandemic and the fear that will live with us still, we must remember that both COVID-19 infections and cancer are a risk for us all. We must remain vigilant.

There is some research about the recurrence pattern for many types of cancer. But no one can tell you precisely what will happen in the future. Your oncologist or another health care professional who knows your medical history can tell you about the chances of cancer returning. They can also tell you what symptoms to look for. Knowing what to expect may help you stop worrying that every ache or pain means the cancer has returned. 

Delving into the science of the disease is also good to feel in control. It’s your body after all! 

Manage  stress 

Ok, this is not so easy. Finding ways to manage your fears and stress will help lower your overall level of anxiety. Try different ways of reducing stress to find out what works best for you. Tips to reduce stress include:

• Spend time with family and friends
• Focus on hobbies and other activities you enjoy
• Take a walk, meditate, or enjoy a bath
• Exercise regularly
• Read a funny book or watch a funny show

I have my own ways, and they are not so ‘healthy’:

• I say to myself “ ‘This too shall pass” – the good, bad and the ugly. BUT seriously, that doesn’t always work; admittedly, it does in some situations. So what other tools do I have? 
• Exercise apparently works. Damn, right, I know that because when I do it, I feel better. But I just can’t get off my bum to do it. Seriously I know it’s good for me, but still… So I don’t exercise regularly.
• Another is reading, but for me, only when reading with my right brain, i.e. letting go while not thinking about anything else and being extremely concentrated. Trust me, when you get this right, it works. It’s like meditation but with a book friend.
• Binge eating for sure…. after eating something sweet, needing something spicy, then salty and then sweet again. There is much said about eating healthy – seriously, it is good for you; but if you don’t accept that food holds so much comfort and embrace how it also makes us live longer because we are happy. 
• Getting out of bed and having a shower is grossly underestimated and is a really good way to get through the day. 
• Dark humour and laughing…

There is no “one size fits all” approach.

Dr. Prinitha Pillay is a Specialist Radiation Oncologist in Gauteng. She is practicing in Johannesburg, offering radiation cancer treatments, comprehensive palliative care and psycho-social support. She offers a variety of treatments including Breast Cancer Treatment, Gynaecological, Gastrointestinal, Lung Cancer Treatment, Paediatric, Head and Neck, Prostate Cancer Treatment, Brain Cancer Treatment, Dermatological and Musculoskeletal Cancer Treatment.

This article was first published at https://treatingcancer.co.za/1317-2/

This article was first published at https://topclickblogs.co.za/dr-prinitha-pillay-radiation-oncologist/

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