The effects of cancer on social and emotional wellbeing
Download: Cancer treatment side effects booklet
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Common reactions to cancer
People with cancer (and those close to them) can experience a range of feelings during their cancer journey. These can include:
- feeling out of control
- feeling that there is nothing they can do to help themselves or their situation.
These feelings are very common around the time of diagnosis, or when there are changes in the course of cancer treatment.
Negative feelings related to cancer often come and go. They usually improve with time as the person gets used to their cancer diagnosis and treatment, and learns to cope with the stress of having cancer.
Why do they happen?
There are certain things that may make people more likely to have social and emotional issues during cancer treatment.
These include the following.
- Younger age
- Being female
- Single, divorced, widowed
- Living alone
- Having young children
- Money problems
- Having relationship problems
- Lots of previous stressful life events or past trauma
- History of problems with alcohol or other drugs
- Having cancer that has spread to other parts of the body (advanced disease).
- Having a limited life-expectancy (poor prognosis).
- Experiencing a number of treatmentrelated side effects.
- Having multiple side effects which affect their ability to do things they would normally do.
- Lymphoedema (swelling from having lymph nodes removed or treated).
- Frequent or severe pain.
- Extreme or long-lasting tiredness (fatigue).
- Issues relating to body image—a person’s thoughts and/or feelings about his or her body.
Cancer treatments, such as chemotherapy, radiotherapy and hormonal treatments can have direct physical effects on the patient. Some of these can cause psychological problems or make them worse.
Physical side-effects that can make social and emotional problems worse can include:
- feeling exhausted (fatigue)
- feeling sick in the stomach (nausea) and vomiting
- fertility problems (e.g. being unable to have children)
- sexual problems
- hormonal changes and menopausal symptoms
- problems with sleep.
Why are social and emotional issues a problem?
Social and emotional issues can be difficult for patients to understand and talk about. They can also lead to other problems, like depression and anxiety.
Signs that a patient may have anxiety:
- Feeling fearful, scared or on edge a lot of the time.
- Avoiding certain people or places due to fears.
- Needing constant reassurance from others.
- Sweating, shaking, or tingling.*
- Breathing difficulties or tightness in the chest.*
- Increased use of grog (alcohol) or other drugs.
Signs that a patient may be depressed:
- Feeling sad, empty, hopeless or tearful most of the day on most days.
- Losing interest or pleasure in things that usually make the person happy.
- Appetite and/or weight changes.*
- Avoiding friends, family or going out
- Sleep problems.*
- Feeling very tired and not wanting to get out of bed.*
- Feeling worthless, guilty or like they are being a burden to others.
- Feeling that life is not worth living.
- Being very critical of themselves.
- Having thoughts or plans of hurting themselves or ending their life.
- Increased use of grog (alcohol) or other drugs.
Researchers from the Menzies School of Health Research have developed a short questionnaire designed to help cancer health professionals identify and meet the needs of Aboriginal cancer patients.
This tested (validated) questionnaire has been developed together with Aboriginal cancer patients. It is available free of charge for health professionals to use.
For further information about this questionnaire, go to:
* Note: There may also be physical reasons directly related to cancer or its treatment for these symptoms.
What to do if you think your patient needs help
When to seek professional help
Depression and anxiety are different from normal feelings of sadness and fear because, these feelings are very strong and/or they happen a lot of the time for a long time (usually more than two weeks).
It is common for depression and anxiety to happen at the same time and your patient may need referral to an appropriate service or healthcare professional for treatment.
Who can help your patient?
The types of health professionals that can help cancer patients with social and emotional issues are:
- health workers
- social workers
- psychologists or psychiatrists
- doctors (GP, oncologist)
- specialist cancer care nurses (such as clinical nurse specialist)
- cancer care coordinator.
Find out what services are available in your local area and how to refer to them.
Discussing referral with your patient
If you, the patient, or their carers, are concerned about psychological issues, it is worthwhile encouraging them to seek specialist help.
You can simply begin a conversation with the patient, to find out how they are feeling.
Educate your patient*
Things that can help people to cope with feelings associated with cancer include:
- talking to supportive friends, family and health professionals
- gathering information from health professionals to understand their cancer better
- planning enjoyable activities
- trying to keep doing normal activities
- taking care of themselves by eating and sleeping well
- doing little things that might make them feel better (e.g. having a bath, dressing nicely or wearing makeup)
- faith, prayer or spirituality
- getting involved in a support group, or meeting other Aboriginal people who are also living with cancer.
Ways to find help and healing
- Seek help to strengthen their spirit.
- Keep in touch with people.
- See a doctor, health worker or counsellor.
- Talk kindly to themselves.
- Talk to someone they know and trust.
- Avoid using alcohol and drugs to feel better.
There are other people that can provide help and support too, like family, friends and the community.
Family and friends can:
- listen and provide support
- keep the family spirit strong
- help the person to find healing
- spend time together
- organise family activities.
Communities can provide:
- traditional or spiritual healing
- links and support with other families
- community education and activities
- cultural and traditional activities.
*Information provided in this section has been sourced from www.beyondblue.org.au.
Other things you can talk to your patient about
Tips for getting active
Physical exercise, such as walking, swimming, dancing, playing golf or going to the gym can help social and emotional wellbeing by:
- relieving the tension in muscles
- relaxing the mind
- providing distraction from negative thoughts and worries.
Do some physical exercise every day, even if it’s just going for a walk.
- Keep it simple and enjoyable.
- Increase activity levels gradually.
- Start by planning simple daily activities, such as shopping, driving, gardening, writing emails or completing simple household tasks.
- Completing these activities can increase self-confidence and build the motivation needed to take on more energetic activities.
- Plan activities that are enjoyable, interesting, relaxing or satisfying.
- These activities are important in helping to overcome depression and anxiety.
- At first, they may not feel as enjoyable as before, but with persistence, the pleasure should eventually return.
Take part in activities with family members and close friends.
- Accept social invitations.
- Keeping connected with people helps increase levels of wellbeing, confidence and opportunities to participate in activities.
- Planning a routine can help.
- Make sure some form of exercise is scheduled in for each day.
- Try to stick to the plan as closely as possible, but be flexible.
Download the Keeping Active fact sheet from www.beyondblue.org.au.
Tips for getting a good night’s sleep
- Depression and anxiety can disrupt sleep patterns. It is important to try to restore a regular sleep pattern to make a full recovery.
- Try to get up at about the same time each morning.
- To prevent worrying about things during the night, set aside some time for problem-solving during the day.
- Avoid drinking caffeine after 4pm and try not to drink more than two cups of caffeine-type drinks each day (e.g. coffee, strong tea, cola or energy drinks).
- Avoid using alcohol to help with sleep. When alcohol is broken down in the body, it causes people to sleep less deeply and to wake more frequently.
- Allow time to wind down before going to bed. Stop any activities at least 30 minutes before bedtime and do something relaxing.
Download the Sleeping Well fact sheet from www.beyondblue.org.au.
Reducing alcohol and other drugs
- It’s a good move to reduce the use of alcohol and other drugs as these can cause long-term problems and make it much harder to recover.
- It’s also a good idea to avoid stimulants, including:
- excessive amounts of caffeine
- any kind of amphetamine (speed, ecstasy, ice)—these can worsen symptoms of depression and anxiety.
Download the Reducing alcohol and other drugs fact sheet from www.beyondblue.org.au.
Cultural, social and practical issues associated with cancer
Cancer is also associated with many social and practical issues, such as:
- money problems related to the cost of treatment
- travel and accommodation issues
- access to practical support
- Aboriginal people with cancer have many social and practical needs that they might need support with.
- They may find it helpful to speak with and Aboriginal Health Worker about their cancer treatment.
Body image and sexuality
Cancer can affect a person’s ability to be intimate in both physical and emotional ways.
Changes to body image
Body image is how a person feels about their body. Having cancer and cancer treatment can affect a person’s body image. This can be because of:
- cancer symptoms
- scarring or body changes after surgery
- treatment side effects (like weight changes)
- hair loss or skin changes
- fertility problems (that make it hard to get pregnant or father a child).
Every person having cancer treatment changes in different ways. Some changes, like hair loss, can be seen by other people. Other changes only the patient will notice.
When a person’s body image changes, it can affect how they relate to other people. This can sometimes put a strain on relationships with people close to them, particularly their partner.
Changes to sex life
It is common for people to have problems with sex during cancer treatment. This can be because of:
- physical changes from the cancer or its treatment
- feeling tired and unwell during treatment
- changes in body image.
These problems often improve when the cancer treatment is finished.
Your patient and their partner may need to find new ways to show that they care about each other. This can include touching, holding, hugging and cuddling.
How to support your patient
Encourage your patient to tell the doctor or nurse if they are having problems with their body image or sex life. There may be
treatments that can help.