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Many people consult a psychooncologist after the illness is over because they need help coping with side effects, dealing with changes and limitations or restructuring parts of their lives

  • Among the main concerns of cancer survivors are getting back to work, physical appearance, pain and the fear of relapse

What goes through the head of someone who has just been diagnosed with cancer? And of someone who has just been told that they have overcome the disease? Although it may seem that the second piece of news could only cause joy, the reality is that "often people do not come to the consultation at the beginning of the oncological process, but later, when they have to return to their normal life and deal with new limitations or restructure some areas of their life", states Marta de la Fuente, head of Psychooncology at MD Anderson Cancer Center Madrid.

"There are more and more cancer survivors and many of them feel resigned or angry about their new situation, so it is very important to work with them through the process of acceptance of their new reality, aspects of quality of life ...", continues the specialist, who states that it is no easier to treat these patients than those who are still in the process of treating the disease itself. "The needs are different - it is not so much where the person is as the symptomatology".

Among the main concerns facing people who have just overcome cancer, in addition to the physical aspects and possible relapse of the disease, are getting back to work and the possible social stigma. "These people have many anxieties and doubts as to whether they will be able to manage their time or be able to continue with their self-care guidelines, as well as many anticipatory anxiety about their abilities, the result of insecurity, or of colleagues and bosses not understanding their illness, the treatments or the side effects", says Ms. de la Fuente.

Addressing social stigma, Ms. de la Fuente speaks of the growing awareness and sensitivity of society, although she acknowledges that "we must continue working, especially on the defense of workers’ rights, or patients’ rights in this case". She also stresses that the stigma comes not only from society, but also from the patients themselves, a less observable problem, but one that generates great emotional impact on patients in the form of insecurities, fears and uncertainties.

As she points out, the key is to "be there when emotions are affected" to accompany the person in making decisions, managing side effects, symptoms, fears ... "Many people acquire a series of routines during the process of the disease and then, afterwards it is stressful to reconnect with their social, family, sentimental and working life”.

Physical changes - protagonists during and after cancer

The side effects that most affect cancer patients during the process of the disease are those related to changes in physical appearance. De la Fuente points out that even today, "hair loss is still one of the most concerning to patients, especially because it is the most obvious and causes most stigma, as it is clearly associated with cancer".

But it is not the only side effect that cancer treatments can cause, which can also result in patients gaining weight, having skin problems (rashes, redness, dryness, color changes ...), wounds, scars, changes in the nails and even amputations. In addition, the tumors themselves, when they cannot be removed due to their location, can cause very visible physical changes as they grow and progress.

"These physical changes are very noticeable and generate feelings of helplessness, frustration, anger, anxiety, sadness, irritability, mood swings or anger that can cause the patient to stop leading their normal life and to cut themselves off from social life," explains Ms. de la Fuente. "There are feelings of great hopelessness and even shame, not wanting people to see these physical changes," she concludes.

The key is to identify and control the emotions patients feel when faced with these physical changes, to then work on accepting them, providing the patient with new, healthier coping strategies. "It's not about helping them not to feel afraid, but to teach them what to do when facing certain emotions”.

Caring for children and feeling guilty

The family unit is often most affected by a diagnosis of cancer. In the case of the couple, there is a change of roles that can overwhelm the non-sick partner, who may feel guilt, anger or irritability. "There are often communication problems, complications at the sexual level, interpersonal conflicts over dealing with the children ...”, explains Ms. de la Fuente, but who also talks of couples becoming closer. "It is very important to know how the couple were before cancer appeared to know whether to act in one way or another", she says.

Regarding the care of children, feelings of guilt, sadness, frustration or helplessness are common in the person undergoing cancer treatment. "The patient wants to spend more time with the children and dedicate more care, but often cannot because they are very tired or are admitted to hospital," Ms. de la Fuente emphasizes. "These are side effects that for patients are really primary effects, since they are the ones that are really affecting them in their daily lives," explains the psychooncologist.