This article is written in partnership with the War On Cancer app, a community here to improve the life of anyone impacted by cancer.
Cancer is a group of diseases characterised by the cells in the body having lost their ability to control cell division. They grow and divide uncontrollably and eventually form a clump of cells – a tumour. In advanced cancer, individual cells from the tumour can break away and spread to other parts of the body and form metastatic tumours. Of the body’s over 30 billion cells, cancer can start from almost any cell.
Despite strict regulation and all the failsafes that exist in the development of new cells, cell division can go wrong. For example, the repair system may not work properly or cell division may not be paused. In these cases, damaged and defective cells are then allowed to grow and divide when they are not normally able to do so. Cells that divide uncontrollably eventually form a lump called a tumour. There are two types of tumours, benign tumour and malignant tumour, the latter is cancerous.
It’s important to remember that not all tumours are dangerous. For example, a harmless lump of fat can form. These are called benign tumours. A benign tumour can’t grow into other tissues or spread to other organs. Benign tumours can be removed if desired or needed and rarely return.
A malignant tumour consists of cells that have changes in the DNA that allow them to grow uncontrollably. Malignant tumours can become so large that they grow in and crowd out surrounding tissue and organs. Cells from the tumour can spread and form new tumours (metastases) in other tissues and organs. Malignant tumours are classified as cancer.
What causes cancer?
The common denominator to all cancers is that the cells have accumulated several gene changes that make them divide uncontrollably. These cells have lost the ability to control cell division and continue to divide when they shouldn’t. The most common reasons why cancer cells have lost this ability are because of lifestyle, heredity, environmental factors or bacterial and viral infections. Of course, sometimes it’s not possible to know what exactly causes cancer.
Mental health during and after cancer
According to a survey conducted in 2021, 92% of people who experience cancer express a need for mental health support and 72% experience a decline in mental health. Going through cancer is an individual experience and impacts everyone’s mental health differently. It’s common to experience low mood, anxiety, fear, guilt, or identity crises.
Anxiety and cancer
Considering the changes that cancer can bring to your life, it’s common to experience feelings of anxiety and stress. The disruption of the every-day and fearing the unknown can lead to feelings of worry. Being able to spot the signs of anxiety or a panic attack allows us to take control of and manage what’s going on.
Symptoms of anxiety
Signs and symptoms of anxiety include:
- a sense of dread
- feeling constantly “on edge”
- difficulty concentrating
- a noticeably strong, fast or irregular heartbeat (palpitations)
- muscle aches and tension
- trembling or shaking
- dry mouth
- excessive sweating
- shortness of breath
- stomach ache
- feeling sick
- pins and needles
- difficulty falling or staying asleep (insomnia)
Anxiety can range from mild to severe. The most severe is what we call ‘panic’.
Experiencing anxiety, worry, or fear regularly tends to make us avoid things or situations that we know can trigger these emotions. However, this can be hard to do when experiencing cancer. Fear of the unknown, going to tests and scans and waiting for results may be a part of having cancer, and oftentimes are unavoidable. It’s completely normal that going through cancer may lead to increased levels of anxiety.
How to cope with anxiety during and after cancer
Allow yourself to feel
If you feel anxious, sit with how you’re feeling and work out where the anxiety is coming from. Fighting it can lead to ‘worrying about worrying’. Instead, give yourself the time to reflect and process how you’re feeling and keep reminding yourself that it will pass, even if it doesn’t feel like it.
Focus on your breath
Taking a moment to stop what you’re doing and breathe can be helpful when you start to feel anxious. Slow, deep breaths are a physical tool that signals your nervous system to calm down, which helps you regain control. Try this: Breathe in for four beats, hold for four beats, and then breathe out for four beats. While you do this, picture places, people, and things you love. Close your eyes.
Reach out to someone you can trust
It can be hard to open up and be vulnerable about how you’re feeling, but remember that it’s a sign of courage, not weakness. Reach out to someone you trust and talk to them about how you’re feeling. Allow them to listen and support you.
If you think your anxiety or panic is due to cancer, it can help to be part of a place where you can share what you’re feeling with others who understand what cancer can be like. The War On Cancer app is a place for anyone impacted by cancer to connect with others in a similar situation and share experiences and stories with people who understand. Learn more about why connecting with others is paramount to our health and download the War On Cancer app here.
Do what makes you happy. Blast your favourite song, watch your favourite movie or get outside, anything that makes you feel good. Shifting focus to something that makes you feel good can help you move through anxious moments without letting them overpower you.
Tell your doctor
If anxiety is starting to impact your daily life, talk to your healthcare team. Your doctor will be able to offer you sound, practical advice and get a better understanding of how cancer is impacting your life. Perhaps they can adjust their approach to help you.
Lack of control during and after cancer
When life throws curve balls, we experience a loss of control over what’s happening in our lives. A cancer diagnosis introduces foreign terms, unclear prognoses, treatments, drugs, surgeries, new priorities and routines that affect all areas of our lives – physical, relational, and emotional – and our sense of self and agency.
How to gain a sense of control during and after cancer
1. Ask your doctor or healthcare team to ask you about your mental health
At your checkup or appointment or after they’ve run through the checklist, ask your healthcare team “What about my mental health?” If you make it clear that you need or desire support, the more likely you’ll get your hands on the resources to help you get there.
2. Educate yourself about what your options are and take action
From new vocabulary to getting to know your body and mind, there’s a lot to learn when it comes to cancer, and it’s easy to feel lost without knowledge.
Take the position of a learner. Learn everything you can. Knowledge makes you feel less threatened by what you’re facing, the unknown becomes less unknown. The more you can understand, the more informed and independent you are in making decisions.
For example, ask when you don’t know what something means. Ask about side effects of your treatment options. Ask about clinical trials that could be relevant for you. Journal about what you’re experiencing, physically and emotionally. When you’re feeling low, ask yourself why and what you can do in order to offset those feelings.
3. Control what you can in tangible ways
However much we want to take action in our lives, sometimes it’s hard to find the energy or discipline. That’s okay.
Be understanding of yourself, and allow yourself to feel this way. Then, do one small thing that is within your control that can counteract your low feelings.
For example, focus on your breath. Journal or express your thoughts in a medium that works for you. Play a song or call a friend. Engage in a hobby, go for a walk or eat a healthy meal. Smile at a nurse. There are micro-moments in your every day that you can choose to control, and however big or small the action may seem.
Take care of yourself physically
Make sure to get enough sleep, eat nutritional food, and move in a way that works for you. By taking care of yourself physically, you also take care of yourself mentally. Here are some tips to keep in mind about nutrition before, during, and after cancer.
Depression and cancer
25% of people who go through cancer experience depression. Many more experience temporary signs of depression – low mood, sadness, and other symptoms that have a negative impact on mental health.
The common denominator of a cancer diagnosis lies in loss. It can be a loss of mobility, opportunity, income, physical ability or strength, future plans, freedom, or energy. Or, the loss can be intangible – inner calm or peace, feeling that things will be alright, or losing the feeling of a care-free life.
Depression is completely natural to experience when grieving. In order to accept a new reality, we need to give ourselves the space to feel what it’s like to live without what we’ve lost. Like all stages of grief, depression can impact you whether you’re a loved one or have been diagnosed with cancer. Symptoms of depression vary; perhaps you experience a loss or increase of appetite. Maybe something that used to spark joy doesn’t do so anymore. It can be tricky to differentiate between symptoms of depression or side effects of cancer because they both affect your body and mind.
Everyone is different which makes depression highly individual. Maybe you experience it temporarily or for a long time. According to the Five Stages of Grief, grief-induced depression is not an illness. Instead, it’s an “appropriate response to a great loss.”
Share your grief with others
Depression can make you feel that everything loses meaning in comparison to the loss you’re experiencing. This mindset separates us from others and the world around and is why many people who experience depression retreat into themselves.
To deal with this, have the courage to share your grief with others with people you trust. Or, share with people who have experienced something similar and understand what cancer is like through the War On Cancer app.
Get in touch with your spiritual side – try out mindfulness, prayer, meditation, or other types of activities that help you reconnect with yourself and the world around you. This may take the shape of breathing exercises, meditation, or prayer.
Connect with nature
We are beings built for nature. Going on a walk or finding a park to rest in nearby can help. Or, spending time in your garden, making a flower bouquet, or taking care of your house plants can all be small ways to connect with nature.
Do something that usually brings you joy
Take time to do something you enjoy, even if it doesn’t elicit joy as it used to. At least, it can help express your thoughts through an activity instead of ruminating, or give you a break from your thoughts.
Remember that this is part of the process
Feeling loss, sadness, and depression, can help you in the long run (as long as you feel you can gain control of it). By allowing yourself to feel, you also allow the process of grief to do its job. Experiencing situations for the heaviness they can be allows us to be freed from that weight too. It’s part of the process of acceptance.
Guilt and cancer
Guilt is defined as “the fact of having committed a specified or implied offence or crime, or a feeling of having committed wrong or failed in an obligation.” So why do we sometimes struggle with coping with guilt when going through cancer?
Cancer is completely unrelated to our failures or wrong-doings. Yet, cancer can still cause us to feel guilty. This can be for various reasons.
Guilty for being a “burden” to those around us
A cancer diagnosis can change your life from one day to the next. Checkups, hospital visits, medication at various times a day. You may feel fatigue, scanxiety (anxious when going for check ups or scans), low mood, or physical changes. These practical changes impact our energy levels and psychological, emotional, and social wellbeing. We may retreat into ourselves when we don’t know how to handle them or feel alone, and may not have the energy for daily tasks.
Because of this, we feel guilty about changes in dynamics in our relationship and to the world around us, especially when we feel that we’re not delivering on our responsibilities and expectations we’re not living up to. This is called existential guilt, where we feel guilty for the negative impact we have on others. The source of this type of guilt varies, but can be informed by societal, familial, cultural, or moral expectations.
Feeling guilty for getting cancer
Some people feel guilty for getting cancer. This is a classic example of maladaptive guilt – feeling guilty about things outside of your control. This kind of guilt stems from feeling like there was something that you could’ve done to prevent the outcome. You can feel this way, even when there’s nothing you could’ve done to prevent cancer.
Though not all forms of guilt are bad (like adaptive or pro-social guilt, where you feel guilty for hurting someone, for example), maladaptive guilt often has a negative impact on your mental health and life.
Guilt for not being who you were or who people want you to be
Cancer can change you, just like any life experience. However, our own or others’ expectations may not align with the way we’re changing. Similarly to feeling like a burden on others, this kind of guilt can stem from a complex mix of cultural, societal, familial, or moral expectations. It is a combination of maladaptive and existential guilt.
Survival guilt is a guilt complex that can develop in people who experience a life-threatening situation, including cancer. It’s existential guilt that is experienced when you survive something life-threatening and others don’t.
According to the DSM-5, survival guilt can be a symptom of PTSD, though you can experience survivor’s guilt without having PTSD.
Two key areas to be aware of when experiencing survival guilt are rumination and regret. Rumination causes us to feel regret and guilt because it is skewed by hindsight bias – looking back, we overestimate our ability to have known or changed the outcome of an event. There are some things that we will never know the answer to. Rumination is not productive because we cannot change the past. Some things are beyond our understanding, just like some things are beyond our control. We need to learn how to cope with, live, and learn from it.
How to cope with guilt for getting cancer
Explore where the guilt comes from
To move past negative thought loops, shift your focus from negative to more realistic, constructive thoughts about your situation. Rather than trying to shed guilt by thinking “positive,” let yourself feel the guilt and explore where it comes from.
Let go of expectations that negatively impact you
Life experiences are meant to impact you and you’re doing something right when you let yourself evolve through life. Some expectations you or others set may be informed by outside factors rather than in the context of your situation. Let go of expectations that negatively impact your mental health and approach your growth with curiosity, grace, and realistic goals. This will help you shed the guilt for not being who you once were, and celebrate who you are becoming.
View your situation from a new perspective
Move past maladaptive guilt by learning to see your situation from a new lens. What are ways in which cancer has helped develop or grow you? Is there something you’re aware of or appreciate now that you took for granted before?
You are more of a burden when you feel like a burden
When we feel guilty, we tend to isolate ourselves and those around us feel unappreciated or that they’re doing something wrong. Embrace being surrounded and supported by others. In that way, you show appreciation of their efforts and love them back.
Adopt a grateful mindset
Remind yourself that being surrounded by loved ones during cancer is a blessing, not something to feel guilty about. Appreciate the good things. Awareness and gratitude are key to free yourself of self-recrimination and allow you to experience the good that life has to offer.
Remember that independence and support can co-exist
It’s normal to sometimes feel humiliated or want to hide because you want to be independent and not need the support of others. Whether or not you have cancer, everyone needs somebody. We are independent in spirit and dependent in love. These realities can co-exist. We are social animals and make it harder on ourselves when we fight that.
Put yourself in others’ shoes
Think about how you’d want to help and support if you had a loved one who was going through cancer. You wouldn’t want the other person to feel guilty about your support. Practice grace and gratitude towards yourself and others.
Grieve, seek wisdom, and live meaningfully
Instead of ruminating, seek wisdom to reach a sense of acceptance. Allow yourself to grieve and then do something positive for yourself or someone else. Doing good counteracts feelings of guilt. Many others experience survivor guilt whether it be from cancer, a natural disaster, war, or other trauma.
Feeling happy about getting a second chance at life and mourning the passing of others are not mutually exclusive events. There can even be a beautiful synergy between the two.
Share what you’re feeling with someone close or a professional
Social support during hard times gives you the strength to persevere and even lead to post-traumatic growth. Speak to your loved ones or someone you trust about your feelings and thoughts. Here’s why it’s important to express your feelings during cancer.
If you’re experiencing consistent feelings of survival guilt, are stuck in the same thought patterns, or feel guilt affects your mental or physical health, seek professional help. They can help you with cognitive behavioural therapy which helps you explore automatic negative thoughts that contribute to your guilt and replace them with realistic thoughts and diminish self-blame. People who find themselves isolated are more likely to experience survivor’s guilt, so don’t try to cope with guilt alone.
Download the War On Cancer app to join a community that understands life with cancer and can help you cope.
Fear of the unknown during and after cancer
We quickly become aware that there’s a beginning and end in life. However, the reality of dying feels abstract if you’ve never had to face it. Then, when you get diagnosed with cancer, this fear becomes more present and acute. You wonder if you can do everything you’ve dreamt for in life. You may also ask yourself bigger questions, like if your partner will stay with you or what will happen to your kids – things that you might not reflect on as much when you’re healthy or not under “threat.”
After cancer and having faced a tangible threat to your life, relapse becomes a tangible fear. This fear heightens our awareness, and people often analyse their body for signs of cancer relapse. These heightened senses create worry or anxiety, also known as scanxiety. Learn more about a mental cancer hangover and how to cope with one.
We also know that people who have a lot of existential thoughts can experience real meaning in life, but they can also be fearful because they haven’t found a “right” answer.
Beyond meaning and death, humans desire to be in control of their own lives. But, life itself will always be, to some extent, beyond our control. Being in control is a way for people to categorise and make life easier. Kids are a prime example; many children want things to be in order and know what happens next because otherwise they’ll feel overwhelmed. Adults can understand complexity and handle more of it. But, too much complexity becomes difficult, even for adults. Thus, control is our mechanism to deal with it.
Historically, people who were more fearful were more prone to survive because they anticipated threats or danger. Fear is an emotion that helps us survive. When we work on being less fearful, we work against the wirings of our brain. We’re programmed to want to be in control, intercepting negative or threatening situations, and be proactive. Our brains deal with the uncontrollable or unknown by getting anxious to try to keep us safe.
How to cope with fear of the unknown
Go back to the basics
Get your sleep and eat well. Being hungry or tired or stressed can trigger anxiety because our brains mix up those feelings. Use your routines to help yourself when you get fearful.
Reflect and enjoy the flip side of fear
The temporariness of life makes it and the experiences within it more meaningful. Reflecting on the fragility of life can bring you to appreciate the present moment more, understand what it is you value, and where you want to spend your time.
Talk to others about your fear
We are social beings and need to share our stories. Joining a community is a great way to handle fear of the unknown. Sharing thoughts and receiving insight from people who’ve been in a similar situation is gold. Do so by downloading the War On Cancer app today.
Journal or express your thoughts
We feel anxious or stressed about the unknown, it can lead to depression if it goes too far. In that situation, many people isolate themselves and avoid these feelings. Instead of closing up, express yourself. Write down your fears. Become aware of what’s happening in your body as you express yourself. By visualising your fears and writing them down, you expose them and they lose some of their power.
Accept that feelings are interlinked
It’s normal that when you’re experiencing joy, you can also experience sadness. For example, if you share a meal with loved ones, you can be joyful and then suddenly be struck with sadness. You enjoy their presence but, at the same time, are afraid to lose them, or that you don’t know what life will be in a week or two when you start cancer treatment. Experiencing joy and sadness together is normal because feelings and thoughts are interlinked – when something is meaningful to you, you fear losing it.
Bring yourself back to the present
By acknowledging that many things are out of our control or unknown to us, we are given the choice to enjoy the moment. Find a balance between dreaming and making things come into fruition, and letting life take you on a journey.
Your feelings are your superpower
Life with cancer makes feelings more intense. When you feel joy, you really feel joy. On the other hand, anxiety may paralyse you. When facing the unknown, we experience a broader range of emotions, which is a new and sometimes scary experience. By learning how to manage these fluctuating feelings, we learn to live life not in neutral, but present and appreciative of it.
Find meaning in adversity
After a cancer diagnosis, many want to live life fully. That’s why a lot of people who go through cancer feel more present and live life more meaningfully, despite experiencing more anxiety.
Learn to appreciate the unknown
By exposing yourself to the unknown, you don’t get rid of it, but learn to live with it. If you want to learn to appreciate the unknown, get to know your feelings and fears, and try not to control them, or let them control you. Let them co-exist with you. Be scared and still do things that matter to you.
Identity and existentialism during cancer
Identity is how you see, perceive, or define who you are. Its scope is broad – from your name to how you enter a room, your values, how you behave, or what drives you. Your identity is how you think about and perceive yourself. When we describe ourselves, it is a reflection of our identity.
There isn’t a clear distinction between how we perceive ourselves and how others perceive us. You can also identify yourself in many ways; roles we have, personality, or achievements. It’s common to describe ourselves in traits (i.e. creative, social, shy) when we’re younger, and add on life achievements as we age.
Oftentimes, our identities are heavily influenced by how we spend our time. This is because we identify ourselves with our thoughts, and our thoughts follow how we spend our time. For example, if you put a lot of time into being a parent or a musician, your thoughts follow that focus. If you do one thing only, that’s where your thoughts lie. If you do many things, you learn to adopt a different mindset.
Losing your identity during cancer
Experiencing cancer can cause us to question ourselves and cause an identity crisis. This is because we question things about our lives, thoughts, capacity, environment and more that we may not have reflected on previously.
Why do we lose a part of our identities when going through cancer?
After a cancer diagnosis, it’s common to experience shock, and going through cancer is a form of crisis. Change causes confusion, and crisis makes us question things; what your life will look like, how long cancer will last, who you can rely on, and who you are. This can be painful and can feel like you’re losing, to some extent, the person you were before you were diagnosed with cancer.
During the initial shock, we ask how cancer will impact our lives in the here and now and think about how the relationships around us may change. In this state, it’s hard to see the potential possibilities.
After the shock subsides, we move on to the question of identity and the loss of identity, depending on how cancer has affected you. For example, if you enjoyed hiking before getting cancer and now you can’t hike anymore, the way you spend your time and identify yourself will change. What will I do with my time now? Who am I now?
The impact of being labelled or treated as a patient
When cancer becomes part of your life, so does a new descriptor: a patient. The word comes from the Latin “patiens,” from “patior,” meaning to suffer or to bear. This perspective tends to victimise people going through cancer and can cause people to treat you differently because the way we’re defined by our surroundings impacts the way others behave towards us, and how we see ourselves. This can end up having a negative effect on your mental health.
Instead of being defined by one diagnosis, we want to be defined by who we are. Feeling empowered and being seen as ordinary people facing extraordinary events, rather than victims, can be beneficial for your mental health.
Tips on how to cope with changes in your identity
If you feel lost or that you’re losing yourself, try to replace it with curiosity. Take time to reflect on things that you haven’t had time to reflect on. What if you don’t have a passion? That’s okay. Most people don’t have a passion. Be curious, try new things, and be aware of what energises you. It’s not easy. But if you connect with something that brings you energy or joy, or sparks a passion, you’ve come a long way. That’s more than a lot of people do in life.
Write down and understand your thoughts
Rumination is common when we’re going through a crisis or have negative thought loops. To break the cycle, it can be helpful to see it by writing things down or visualising what those thoughts are. What usually comes to mind when you ruminate? Is it about how you perceive yourself, or how others perceive you? Is it about what you can or cannot do? Write what you’re thinking to find a new perspective and understand your thoughts and how they affect you.
Are your thoughts making you feel worse? Is there something you can replace a bit of your time with where you can get a bit of a break from that feeling or thought? Which thoughts make you feel better? How do you cultivate more of those?
This will help you spend energy on new ideas or simply get rid of negative thoughts.
Life’s experiences change us, especially crises. It’s unhelpful to think that you can ignore the experience of a crisis. Even if you want to go back to how things were before cancer, you can’t erase the experience and go back to “normal.” Instead, learn to find acceptance in the present moment.
Acceptance isn’t passive, a “just deal with it” mindset. Acceptance is a verb, exploring how change or crisis impacts you and allowing that change to happen. This can be painful and takes courage. As opposed to dealing with it, which is simply saying that an issue is going to be part of your life, acceptance is about diving into the issue, exploring it and what it does to you, how it feels, what thoughts it brings up. Once you can accept what is happening to you, your thoughts, feelings, and behaviours, you’re getting somewhere.
This doesn’t mean that you accept cancer or a changing identity, but allowing yourself to experience what is happening and feel what you’re feeling instead of resisting it. feeliletting yourself to experience what’s happening and allow yourself to feel what you feel instead of resisting it.
Sometimes, you don’t have the courage or energy to explore what you’re feeling, and that’s part of acceptance too. It’s okay to find things too painful and allow yourself not to dive in. Being aware that it’s hard is part of the process too.
Define what is important to you
People who go through a crisis ask existential and meaningful questions. What makes me who I am? What do I enjoy? What do I care about? What about my values? Am I living meaningfully?
Approach questions with curiosity. Explore this within yourself and externally and become aware of what thoughts arise. What feelings do you experience? These experiences aren’t only physical, but emotional, psychological, and spiritual.
If you want to go back to how things were before getting cancer, it’s probably because you valued many aspects of your life pre-cancer. What are the things that you want to go back to and how will the road there look like? Map out your resources and involve others for support.
If you want to start new, contemplate what your values were and how you lived your life before cancer, and what it is you want to change. This can take time, and sometimes it’s easier to go back to the way things were since what we know is concrete. Stepping into the unknown takes courage, and the grey area will be an inevitable part of your life for a while.
If you feel victimised, have a conversation
If you feel victimised by your loved ones or someone you know, talk to them. Make known what it is you need or desire in order to change the dynamic. When people don’t know how to meet you, or treat you, they make up their own ways. For example, they may reach out too much or not at all. This may be because they want to show they’re thinking of you, or feel that they’re in the way. If you help them and tell them what you need, it can help the dynamic in your relationship.
About War On Cancer
War On Cancer is a social impact company that exists to improve the lives of anyone impacted by cancer. We envision a world where a cancer diagnosis does not define who you are. To that end, we address unmet needs by providing a community when cancer causes social isolation, knowledge where there is a lack of resources, and opportunities to help shape cancer care. Today, over 35,000 people have downloaded the War On Cancer app and are part of the community. We have offices in Stockholm and London.
Last updated on: 2022.09.13