Cancer and mental health: Coping with the burden of your diagnosis

By Jessica Saenz

Thousands of people are diagnosed with cancer every day. And while nearly everyone knows — or will know — someone who's been diagnosed with cancer, there's no playbook that teaches people how to deal with the mental and emotional weight of a cancer diagnosis.

Though the cancer experience is different for every person, it's important for people to know that regardless of the mix or intensity of the emotions they experience, all emotions are valid and important.

In recognition of Mental Health Awareness Month in May, here's what you should know about coping with your cancer diagnosis:

It's normal to feel emotional about your cancer diagnosis, but you don't have to tolerate depression.

Depression can creep in slowly and often under the best of circumstances, so traumatic or stressful life events, like a cancer diagnosis, can be depression triggers for anyone. "It's completely normal to be stressed, anxious and sad," says Shawna Ehlers, Ph.D, a Mayo Clinic psychologist and psycho-oncology expert.

Feelings of fear, anger, sadness and anxiety are common for people living with cancer, but these feelings often dissipate. When they don't, you should talk to your health care professional and seek out support. "This is a normal part of cancer — it's even expected — and it's treatable, so it's not something that you have to sit and suffer with alone," says Dr. Ehlers.

If you aren't familiar with the signs and symptoms of depression, it's worth mentioning any concerning thoughts, feelings or behaviors to your health care professional.

Depression looks different for everyone, and it's not always easy to recognize. The sooner you address it and begin treatment, the sooner you can focus your energy on your cancer recovery and healing.

Understand the toll stress can have on cancer, and how it can affect cancer recurrence and recovery.

Stress can wreak havoc on your body in many ways. The body's natural stress response, which is designed to protect you from perceived threats, can stay "on" when it shouldn't. This can happen for many reasons, including traumatic life events and other stressors.

The long-term activation of the stress response system and the overexposure to stress hormones can disrupt almost all your body's processes, and some research suggests there could be a link between stress hormones and cancer progression and recurrence.

Cancer researchers are also exploring how stress, and behaviors linked to stress, including smoking, alcohol consumption and overeating, can contribute to an increased risk of cancer.

Dr. Ehlers says that stress can also influence your recovery, but there are ways to manage it with help from your health care professional.

"Stress has been associated with cancer progression once somebody is diagnosed," she says. "That's why managing stress is really important. That doesn't mean avoiding stress at all costs, it means making sure every day there's some downtime where your physiology gets to calm down."

Along with working with a mental health professional, Dr. Ehlers adds that balance and acceptance are key to managing stress. "It's important to separate the controllable factors from the uncontrollable ones. When someone is diagnosed with cancer, they can feel shocked, lost and overwhelmed — like their whole life is out of control," she says. "But after they have time to think about it, they realize there are things that they can control. They realize it's their life and their story, and they get to share it with whomever they want. They're in control of that narrative."

It's healthy to talk with others about your cancer.

It's not always easy or instinctual to talk about something as serious or upsetting as a cancer diagnosis. While some people may lean on close friends and family, others may choose to cope by avoiding the subject. "One of the things that people naturally do when they're diagnosed with cancer, is they tend to shut down emotions to try not to worry or think about it," says Dr. Ehlers.

But this can have an opposite effect.

"Avoidance takes a lot of energy that could be used for healing," she adds. "One of the things we work on with patients is letting go of that avoidance — which can be scary — so that you're actually talking about the full experience of cancer, including the emotions that are a natural part of it. That processing of emotions helps people manage stress and feel less anxious and depressed in the long run."

It's also healthy to prioritize your boundaries.

Talking to a mental health professional, family and close friends about your diagnosis can help some people feel lighter and more at ease. But when that's not the case, answering questions from curious acquaintances and strangers can be draining and a stressor of its own.

"Sometimes people avoid going out of their house because they don't want anybody to ask them about cancer," says Dr. Ehlers. "What I tell people is that they know the full experience like nobody else can — the big, thick novel experience of their cancer. The people closest to them know the abridged version, people further away might get a few bullet points, and so on."

But when a conversation becomes too involved or lengthy for your comfort, Dr. Ehlers says redirection can be a helpful tool to steer the conversation back to the other person and away from the topic of your diagnosis.

Some phrases that might help you redirect include:

• "I appreciate you asking about me. I'd really like to hear about …"
• "Thanks for letting me catch you up. What about that new car/hobby/job?"
• "Thanks for asking about me. So how is your family/spouse/child?"

If you prefer to be sincere about how you feel about the conversation and politely ask to change the subject, Dr. Ehlers says that's OK, too.

"Part of what I do as a cancer psychologist is empower patients to understand that it is their life. It's their care. It's their story. And they're in control of all of that and who knows what."

Accepting help from your support network can help you and them.

It's not uncommon for people with cancer and other serious illnesses to worry about the stress their loved ones are experiencing because of their diagnosis. Moreover, sometimes this worry can evolve into the belief that they have become a burden.

When this is the case, putting yourself in each other's shoes can help. "I ask patients to think about how that worry about being a burden contrasts with the other person's feeling of helplessness," says Dr. Ehlers. "If you love somebody who has cancer and there's nothing you can do, it's like watching them through a glass wall, and you feel helpless."

The stress and emotions that accompany a diagnosis of cancer can make reframing these thoughts difficult for both sides, so communicating your needs to each other is important. "If you can think of a way that this family member or friend can be genuinely helpful to you, it can help them feel less powerless."

Simple favors that can help you both include:

• Meal prepping for a week or helping with groceries
• Agreeing to water your plants/take care of pets if you are unable
• Helping you with chores, like laundry, dishes, etc.
• Distracting you when things become too stressful

"These are the things that families and communities are made of," says Dr. Ehlers. "Those connections, those networks — that's what makes us strong."

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There are no bright sides to a cancer diagnosis, but there is hope, reassurance and control in deciding how you will take on the challenge. Whether that's with mental health, comfort or your future front and center, is up to you.

"You, as the patient, are the captain of the team. The only thing that matters is what your goals are, and your care needs to be built around those goals," says Dr. Ehlers. "Every part of your care should support what's important to you in life. That's why you're fighting cancer."

Learn more

Join the Cancer and Depression & Anxiety Groups on Mayo Clinic Connect.

Also read these articles:

• "Treating the emotional side of cancer"
• "Cancer diagnosis: 11 tips for coping"
• "Cancer survivors: Managing your emotions after cancer treatment"