Common Emotions During Cancer Treatment

Fear and Anxiety

woman looking fearful and anxious
Anxiety in people with cancer. photo©petrograd99

"Every time I feel a new pain I wonder if my cancer is back."

It's rare that someone says they are not afraid when they are diagnosed with cancer.  The fear of cancer is very common and this fear can recur with each treatment and beyond—as many survivors cope with the fear of recurrence or progression.

Not only is there fear about the initial diagnosis and treatment, but every ache and pain takes on a new meaning.  Instead of thinking "tension headache" or "caffeine withdrawal," cancer hijacks our imagination to think of "brain metastases."  And instead of thinking your back is sore from any number of activities, even sleeping wrong, we start thinking "bone metastases."  Each follow-up visit brings anxiety to the forefront, to the point where the anxiety associated with follow-up scans has been coined "scanxiety."

First of all, it's important to note that these fears and anxieties are normal, because being diagnosed with cancer and undergoing treatment is a traumatic experience.  Having an awareness about new symptoms you are experiencing, and asking your oncologist about any concerns you have, is not only important, but may alert your doctor to problems that should be addressed.  

Some degree of anxiety can be helpful.  It's what gets us out of bed so that we arrive on time for chemotherapy.  Yet sometimes anxiety is excessive, as in generalized anxiety disorder.  The difference is that with excessive anxiety, people may worry even when worrying isn't warranted, physical symptoms of anxiety can result such as a pounding heart and trembling, and instead of being motivating, excessive anxiety can be paralyzing and leave people feeling helpless and hopeless.  

How can you cope with anxiety related to cancer?  

Fortunately researchers are learning more about stress management for cancer patients.  Several of the integrative cancer treatments such as relaxation and meditation can help reduce anxiety.  Interestingly, a review of several clinical trials found art therapy to be quite beneficial for breast cancer patients living with anxiety.  Check out this article on how to deal with stress and anxiety in 4 easy steps.


man appearing depressed
Depression in people with cancer. photo©manaemedia

"Am I supposed to feel this sad after being diagnosed with cancer?"

Depression is very common in people with cancer but raises an important question.  "How do I know if I'm depressed or if what I'm feeling is normal grief?"  Though there are other distinctions. One questions you may ask yourself is: "Am I feeling overwhelmed or hopeless?"

Though 15 to 25 percent of people with cancer experience depression, understanding the symptoms is very important for a number of reasons.  One is that your doctor may not ask; studies tell us that many physicians do not adequately screen for depression in cancer patients. Another is that it can be dangerous; depression may lower survival in some cancers, lessen your quality of life, and--though we don't like to talk about it--carries the risk of suicide.

People most at risk include those with advanced stage cancers, people with functional limitations due to cancer, symptoms such as pain, a lack of social support, and a personal or family history of depression.

If you are concerned that you or a loved one are depressed, talk to your doctor and don't wait; studies tell us that suicide risk is greatest in the first 3 months after a cancer diagnosis.  Check out the criteria for a major depressive disorder and consider doing an online screening test for depression.

In addition to treatments your doctor may recommend, there are many things you can do yourself to help in your recovery from depression.  Check out this information for coping with depression and tips for living with depression.


man holding his head feeling guilty
It's common to feel guilty with cancer. Photo©Art-Of-Photo

"I wish I'd started eating a healthy diet when my husband did."

"One of the women in my cancer support group passed away and I almost felt guilty for being alive." 

Whether it is guilt about lifestyle habits that predisposed to cancer, or guilt that you can't be the parent you wish to be with cancer, guilt affects many people during their journey.

If you are a parent, or if you tend to be the "helpful friend or family member," a diagnosis of cancer can be particularly hard.  The symptoms of cancer, as well as the time requirements for treatment, are suddenly superimposed on our already-too-busy schedules.

You may feel guilty that you didn't seek out medical treatment sooner--when you first had symptoms.  Or perhaps you feel guilty that you didn't get that second opinion that your friends insisted you get.

If you even ate a single meal that was less than healthy, or ever smoked, or even just breathed air that wasn't 100 percent fresh, you may have felt shame and guilt.  Nobody deserves to have cancer.  Forgive yourself and forgive others for their lack of understanding if you feel like are being blamed for having cancer.  Check out these tips for coping with cancer as a former or current smoker.  You may also wish to check out these articles on the stigma of cancer, and how to handle insensitive remarks when you have cancer.

Another kind of guilt, such as cancer survivor guilt, can surface once you have had cancer, especially if you are in involved in a cancer support group.  Cancer survivor guilt can happen when someone you care about has a progression of their cancer or dies from their disease.  If you are feeling guilty for surviving cancer when your friend died from cancer, remember that this is not a trade-off, and your friend did not die from cancer so that you can survive. If the situation were reversed, your friend would be grateful that you continue to survive, even after she is gone.

Joining a cancer support group, though it increases the chance you will someday need to cope with survivor guilt, is a wonderful way to work through and past guilt - especially with cancers that have a stigma associated with them.


woman on phone looking angry
Cancer can make you angry. Photo©Milenko Bokan

 "I'm so mad that my friend wasn't there for me after I was diagnosed.  I thought she was my best friend."

"If my doctor had only ordered a CT scan earlier..."

Anger is one of the symptoms of death and dying made popular by Elisabeth Kubler-Ross; stages that it's now recognized that these symptoms are common with cancer and other serious health conditions.

You may feel angry that your cancer was first misdiagnosed, or if your diagnosis was delayed.  After you are diagnosed you may feel frustrated and angry with how long it takes before treatment is started.  During treatment, you may feel angry that there is no way to know if the treatment is working--sometimes for several months.

You may feel angry that friends you thought were true friends have disappeared.

You may feel angry at the limitations cancer has placed on you, and frustrated at the way cancer treatment cuts into time that you would have rather spent with your family, or working, or enjoying life.

You may even feel angry at your body--like it has betrayed you--especially if you are one of those people who "seemed to be doing everything right."

Friends and loved ones of people with cancer may also experience anger.  Spouses may resent their partners cancer ,and it can be a challenge when coping with a dying loved one's anger.

Since anger is almost a given with cancer, it's helpful to think of ways to best cope with anger.  To do so,it may help to first understand the meaning of anger.  Much of the time, anger is a sign that you are being hurt or that your needs are not being met.  In other words, when you are angry, you have a reason to be angry and anger is telling you something!

The next step is much harder.  

Express yourself.  If you can talk to the person who has made you angry--do so (only you know who these people are.)  Sometimes people are unaware that a comment or action has made you angry.  If you are angry at your doctors for being misdiagnosed, tell them.  It won't change what happened, but you will have expressed yourself, and given your doctors an opportunity to know your feelings, and hopefully, express caring and regret that your diagnosis was delayed.  There will be times you can't talk to someone who has offended you.  If this is the case consider journaling.  Write down what you are feeling, share it with a good friend, then tear up your sheet of paper.

Don't obsess and don't "over-talk" it.  Not only does ruminating on your anger raise stress hormones in your blood (which may play a role in cancer recurrence) but it allows the event that made you angry in the first place, to continue to hurt you.   

Just because you are angry, does not mean things are going to change, or that someone who has treated you wrong will apologize.  Sometimes you just need to let go to live with cancer, and practice forgiveness.  

Posttraumatic Stress

woman in bed looking stressed
Posttraumatic stress with cancer can interfere with sleep. Photo©KatarzynaBialasiewicz

 You may be familiar with posttraumatic stress disorder (PTSD) from listening to reports of soldiers coming back from war, and survivors of natural disasters.  Yet cancer survivors may also experience PTSD or at least some degree of posttraumatic stress.

Posttraumatic stress is marked by 3 primary symptoms:

  • Re-experiencing the trauma (re-living part of the cancer experience)
  • Persistent avoidance of reminders of the trauma (for example, the cancer center)
  • Persistent increased arousal (for example, becoming frightened easily and having difficulty sleeping)

Full blown PTSD occurs in 3-4 percent of cancer patients at the time of diagnosis, and up to 35 percent of people after treatment.  In contrast, "PTSD-like symptoms" occur in around 20 percent of people newly diagnosed with cancer, and up to 80% of people who have a cancer recurrence.

Talk to your doctor if you are having symptoms of posttraumatic stress related to cancer.  In addition to simple measures you can take to decrease your symptoms, and counseling or medications your doctor may recommend, several integrative cancer treatments such as meditation, massage, and yoga appear to be helpful for many people suffering from posttraumatic stress.

Emotional Distress

woman on the phone looking distressed
Managing distress with cancer. Photo©Feverpitched

"My doctor asked me about my "distress level" and told me that it was as important as my blood pressure and pulse rate."

Emotional distress is important enough for people with cancer, that some investigators say it should be checked as the "6th vital sign," and provides valuable information about your overall well-being.

Distress is defined as unpleasant feelings about your diagnosis and treatment, feelings such as helplessness, sadness, and discouragement.  Just as with anxiety, cancer will always bring some degree of distress.  Distress becomes excessive when it interferes with your daily functioning and lessens your ability to cope with your cancer.

How do you know when your distress level is normal or more serious?  After all, cancer turns your world upside down.

If you are wondering if your distress level is excessive, that National Comprehensive Cancer Network has put together the NCCN Distress Thermometer for Patients, in which you can answer yes/no questions covering things such as practical problems, family problems, emotional problems, physical problems, and spiritual concerns. You can use this tool to help you talk with your doctor, who may recommend a support group, counseling, a chaplain visit, or a number of other resources to help you cope with your distress.

Staying Positive

smiling middle aged woman
Staying positive when you have cancer. Photo©tetmc

"I find that when I think of the ways cancer has made me a better person, I feel a little happier."

 Before going further, it's important to say: "You don't always have to be positive."  If people tell you that "all you need to survive cancer is a positive attitude," you can inform them that research really doesn't back up that theory.  In fact, it important to be able to express your negative emotions when you have cancer, and one sign of a good friendship is someone who allows you to express these feelings.

All of that said, most of us simply feel better when we are more positive.

Think of the positive changes that have happened in your life because of cancer-- the so called "silver linings" or benefits of cancer.

And check out these tips of keeping a positive attitude with cancer.

Good Grief

mother daughter and grandma who look like they are grieving
Grief takes many forms with cancer. Photo©gpointstudio

 "I really like the men in my support group, because they let me talk about what I have lost by having cancer."

Grief is an internal emotional response to loss.  With cancer, these losses can take many forms:

  • You may grieve the loss of a body part.
  • You may grieve the loss of function caused by cancer or cancer treatments.
  • You may grieve your loss of freedom.
  • You may grieve the loss of your sense of immortality.
  • You may grieve the loss of your time, both due to lost time needed for cancer treatments, and the sense of less time to live.
  • You may grieve future activities that you won't be a part of, for example, your child's or grandchild's graduation or wedding.
  • You may grieve for your family, for example, feeling sad that a child or grandchild will not have you present for a graduation or wedding, and will themselves feel a loss.

If you have an advanced cancer, anticipatory grief is common both among those with cancer, and in their loved ones.  Anticipatory grief is a form of grief that occurs before a death (or other great loss) in contrast to after a loss or death (conventional grief,)  and can involve more anger and isolation, as many people do not understand this form of grief.  Check out these tips on coping with anticipatory grief.

Understanding the four phases and tasks of grief may help you begin to cope with some of these feelings.  If you are struggling with a sense of loss due to cancer, check out these 10 tips to help you in times of grief.


American Society of Clinical Oncology (ASCO) Cancer.Net. Coping with Guilt. 08/2013.

Andersen, B. et al. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. Journal of Clinical Oncology. 2014. 32(15):1605-19.

Boehm, K., Cramer, H., Staroszynski, T., and T. Ostermann. Arts therapies for anxiety, depression, and quality of life in breast cancer patients: a systematic review and meta-analysis. Evidence Based Complementary and Alternative Medicine. 2014. 2014:103297.

Grassi, L. et al. Psychosocial screening and assessment in oncology and palliative care settings. Frontiers in Psychology. 2015. 5:1485.

Hamer, M., Chida, Y., and G. Molloy. Psychological distress and cancer mortality. Journal of Psychosomatic Research. 2009. 66(3):255-8.

National Cancer Institute. Adjustment to Cancer: Anxiety and Distress – for health professionals (PDQ). Updated 02/19/15.

National Cancer Institute. Depression. Updated 1203/14.

National Cancer Institute. Cancer-related post-traumatic stress-for health professionals (PDQ). Updated 01/07/15.

National Comprehensive Care Network. NCNN Distress Thermometer for Patients. Accessed 06/25/15.

Pirl, W. et al. Recommendations for the implementation of distress screening programs in cancer centers: report from the American Psychosocial Oncology Society (APOS), Association of Oncology Social Work (AOSW), and Oncology Nursing Society (ONS) joint task force. Cancer. 2014. 120:19):2946-54.

Rouleau, C., Garland, S. and L. Carlson. The impact of mindfulness-based interventions on symptom burden, positive psychological outcomes, and biomarkers in cancer patients. Cancer Management and Research. 2015. 7:121-31.

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