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Speaking at a webinar in partnership with Great Eastern, Chia Hui Erl, Senior Counsellor, Allied Health, explains the forgotten impact of cancer on mental health and the role of psychological resilience.

Cancer is commonly perceived as a life-threatening, potentially traumatic illness. As a result, cancer patients are usually confronted with physical, psychological, social, spiritual and existential challenges that can lead to long-lasting negative psychological outcomes including emotional distress, depression, anxiety, sleep problems, fatigue, and an impaired quality of life.

According to research studies, about 4 in 10 cancer patients experience symptoms of depression and anxiety, while about 1 in 10 report symptoms of post-traumatic stress disorder (PTSD). A good majority also express fear of cancer recurrence (FCR), a common phenomenon experienced by cancer patients that can persist well into survivorhood¹.

Despite the prevalence of mental health issues among cancer patients, it is given little attention because patients are primarily focused on monitoring their physical health.

Furthermore, there is a general lack of awareness on mental health issues, absence of support, a lack of evidence around effective treatment, stigma around cancer (especially for certain cancers such as lung cancer), as well as patients’ personal preference to not seek professional mental health support.

It is therefore important to understand these impacts of cancer on mental health as it can allow patients to be aware of their situation and find strategies to manage their mental well-being effectively.

Impact of cancer on mental health

For many cancer patients, a cancer diagnosis and cancer treatment can cause substantial disruption to everyday life. This disruption can manifest in two themes: (1) loss, and (2) fear and worry.

The range of losses patients might experience include:

• Loss of certainty
• Loss of function and quality of life
• Loss of role and identity
• Loss of bodily integrity

Such losses can feed into symptoms of depression and anxiety, which in turn manifest in feelings of fear and worry about an uncertain future, whether it is death, cancer recurrence, or side effects.

However, while patients may experience these losses, fears, and worries, it may not always lead to negative impact; patients may experience psychological growth with successful adaptation to cancer. This can include a greater appreciation for life, grow a greater capacity to empathise, form better relationships with others, experience spiritual growth, be able to reevaluate their priorities in life, and gain new life experiences.

Building resilience

Psychological growth can be gained during a health crisis through resilience: the ability to adapt and bounce back in the face of adversity.

Resilience can be influenced by internal and external factors.

Internal factors refer to the resources we possess as an individual, such as having a positive view of ourselves and of others, having the ability to manage strong emotions, being optimistic and accepting of reality, being flexible and mindful of changing situations, having creativity and confidence, and having the ability to set realistic goals that can be achieved.

External factors include social and interpersonal resources, such as having strong relationships and social support networks, and the ability to enlist help from others when needed to help regain a sense of control.

Resilience depends on many systems in our lives, from familial systems at home to social support systems, healthcare systems, and emergency systems in our communities. These systems are interdependent and work together to help us adapt to challenges that threaten survival and development.

Coping with the impact of cancer

We all carry different stressors with us. Some of these stressors are controllable for some, but uncontrollable for others.

It is important to acknowledge these stressors and accept the emotions we experience. We should also ask ourselves if the source of our concerns is something we can or cannot control. This can help determine the best course of action to manage our stressors effectively.

Problem-focused coping involves managing stressors by finding ways to resolve a controllable situation. Some steps we can take to address problems are:

• Focusing on what we can control
• Keeping a regular routine
• Setting realistic and achievable goals
• Exercising within our capacity
• Validating our own experiences
• Knowing when to ask for help, and accept help when offered

Emotion-focused coping involves addressing an uncontrollable situation by making ourselves feel better through regulating our emotional and psychological responses to the situation. This can include:

• Acceptance
• Mindfulness
• Spiritual practice e.g. praying
• Journalling
• Practising daily gratitude
• Self-compassion

Both coping strategies have their own benefits, but it is important to understand that different strategies work differently for different individuals and different situations. If you find yourself struggling with the impact of cancer and are not sure how to best manage your situation, it is always helpful to discuss options with your doctor and mental health professional.

For more information on Great Eastern, visit www.greateasternlife.com

¹ ‘Depression and anxiety among people living with and beyond cancer’, Niedzwieds et al., 2019