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Handling Negative Emotions

117148965_8When head and neck cancer patients find out that they will need surgery that is likely to cause visible scarring or disfigurement, or impaired functioning, virtually all react with fear and anxiety.1 Strauss RP. Psychosocial response to oral and maxillofacial surgery for head and neck cancer. Journal of Oral and Maxillofacial Surgery.1989;47:343-348. Seventy-seven percent specifically fear surgical disfigurement and its social consequences.2 Fingeret MC, Vidrine DJ, Reece GP, et al. A multidimensional analysis of body image concerns among newly diagnosed patients with oral cavity cancer. Head Neck.2010 March;32(3):301-309. Other common negative emotions before and after surgery for head and neck cancer include anger, depression and embarrassment. If you are preparing for surgery to remove cancer from your head and neck, you are most likely experiencing strong negative emotions well ahead of your surgery.

Visible facial disfigurement and functional impairment (such as permanent difficulty eating, swallowing, communicating, etc.) are considered to be some of the most emotionally distressing aspects of head and neck cancer and its treatment.3 Katz MR, Irish JC, Devins GM, Rodin GM, Gullane PJ. Reliability and validity of an observer-rated disfigurement scale for head and neck cancer patients. Head Neck. 2000 Mar;22(2):132-141. Some people find the fear of disfigurement, impairment and the associated possibility of social rejection to be even more distressing than the possibility of death. If you think about how negatively some people react to small facial blemishes, such as pimples or wrinkles, you can imagine how upsetting facial disfigurement could seem to them. It is not just a loss of a piece of one’s anatomy; it is a loss of one’s sense of self.4 Millsopp L, Brandom L, Humphris G, Lowe D, Stat C, Rogers S. Facial appearance after operations for oral and oropharyngeal cancer: a comparison of casenotes and patient-completed questionnaire.Br J Oral Maxillofac Surg.2006;44(5):358-363.

How you react to your appearance after surgery will depend a great deal on how severe your disfigurement is, where it is located, whether or not it has been cosmetically or functionally reconstructed, how much it impacts your ability to function and your personality.5 Callahan C. Facial disfigurement and sense of self in head and neck cancer. Soc Work Health Care. 2004;40(2):73-87. The more severe your disfigurement is, the greater its negative impact will be on your quality of life.6 Arunachalam D, Thirumoorthy A, Devi S and Thennarasu. Quality of life in cancer patients with disfigurement due to cancer and its treatments. Indian J Palliat Care.2011 Sep-Dec;17(3):184-190. Those who had a high level of comfort with themselves before surgery sometimes maintain a greater degree of comfort after surgery as well.5 Callahan C. Facial disfigurement and sense of self in head and neck cancer. Soc Work Health Care. 2004;40(2):73-87. In other words, if you did not often worry about what people thought of you before your surgery, you probably still won’t, or you will eventually reach that point again. Others suffer trauma at the loss of their looks and struggle for weeks, months or even years to adjust and find their social confidence again.5 Callahan C. Facial disfigurement and sense of self in head and neck cancer. Soc Work Health Care. 2004;40(2):73-87. Most people’s reactions are somewhere in the middle, and they successfully adjust over a period of time. Chances are good that you will achieve a relatively high quality of life again and will eventually find a new normal. You will not always focus so negatively on your disfigurement.6, Arunachalam D, Thirumoorthy A, Devi S and Thennarasu. Quality of life in cancer patients with disfigurement due to cancer and its treatments. Indian J Palliat Care.2011 Sep-Dec;17(3):184-190.7 Rumsey N, Clarke A, White P, Wyn-Williams M, Garlick W. Altered body image: appearance-related concerns of people with visible disfigurement.J Adv Nurs.2004;48(5):443-453.

Reconstructive surgery or prosthetics may help you to cope long-term. Reconstructive surgery restores anatomy that has been removed or altered, and its purpose is to improve functionality and/or appearance. Your surgeon may perform reconstructive surgery during your tumor removal, or he or she may perform reconstruction during a second, separate procedure. In addition, you may need revision surgery to correct new or lingering issues with your reconstruction or to try to improve your functionality or appearance even more. Finally, when you are cancer-free, you may elect to have purely cosmetic procedures done to improve your appearance if that is a deep concern for you. Discuss your options with your care team. Knowing that there are paths available to improve quality of life helps many patients to handle the negative emotions associated with living with a disfigurement.

Anger

Anger is a demand to reject and fight. It is based on fear. Anger is a common reaction to disfiguring surgery. It seems unfair and supremely unjust that you have cancer, and now you must wear a reminder of it on your face for the rest of your life. You want to rage against the feelings of helplessness and fight back. Unfortunately, your disfigurement is not something you can deny—it’s a fact you must contend with if you are to move past anger and focus on preserving and optimizing your quality of life.

The key to moving past anger is to learn how to accept the truth of your condition and do what you can about it, within your personal limitations. Fortunately, there’s help. Many cancer patients find that learning about coping strategies and talking to others who are living with similar disfigurements are among the best ways to feel more in control. Fear of the unknown and not feeling like you can do anything about your situation are common reasons for feeling anger. When you are well informed and have strong support, you can make decisions that will help preserve your sense of control.

Sadness and depression

The difference between sadness and depression is that sadness is occasional while depression sticks with you over long periods of time. Both are based on a sense of hopelessness and futility. Disfigurement is certainly not a joyful experience, but it does not extinguish the sources of joy in life. Learning how to feel more in control and engaged in your life during cancer treatment and afterwards will help you resist feeling hopeless.

Appreciating the here and now, spending time with friends and loved ones and making every effort to position yourself for recovery are the best ways to relieve depression. But if you find that you are unable to overcome persistent depression, don’t deny it. Whether through talk therapy, group therapy and/or medical treatment, depression is treatable. Better yet, by treating your depression, you will find the physical challenges of coping with cancer or disfigurement less exhausting.

Anxiety and worry

Similar to anger and depression, anxiety and worry can be the result of a sense of loss of control. The enormity and complexity of dealing with cancer or disfigurement can lead to feeling overwhelmed and preoccupied by all the possibilities and unknown factors. Learning to distinguish between the factors you can do something about and the factors that are truly beyond your control can help you to stop worrying. You are only human, as the saying goes, and it is not realistic to expect that you can do everything.

In the case of disfigurement, learning how to function as closely to normal as possible and accepting your appearance can help you to stop making comparisons to others or to your life before cancer. Seek help to establish reasonable expectations of your “new normal” and, if possible, let go of the rest. Appreciating the life you have and accepting your personal limitations are effective strategies to reduce anxiety.

Embarrassment and shame

Embarrassment and shame are two sides of the same emotion. When you are embarrassed, you don’t want people to notice how you are different because you fear rejection or mockery. When you feel ashamed, you feel responsible for being different and reject yourself before anyone else has the chance. Like so many of the steps to recovery, the key to overcoming embarrassment and shame is acceptance of your condition. All individuals are worthy of care and respect. Share your feelings of embarrassment or shame and you may find they are easier to let go.<


References

1 Strauss RP. Psychosocial response to oral and maxillofacial surgery for head and neck cancer. Journal of Oral and Maxillofacial Surgery.1989;47:343-348.

2 Fingeret MC, Vidrine DJ, Reece GP, et al. A multidimensional analysis of body image concerns among newly diagnosed patients with oral cavity cancer. Head Neck.2010 March;32(3):301-309.

3 Katz MR, Irish JC, Devins GM, Rodin GM, Gullane PJ. Reliability and validity of an observer-rated disfigurement scale for head and neck cancer patients. Head Neck. 2000 Mar;22(2):132-141.

4 Millsopp L, Brandom L, Humphris G, Lowe D, Stat C, Rogers S. Facial appearance after operations for oral and oropharyngeal cancer: a comparison of casenotes and patient-completed questionnaire.Br J Oral Maxillofac Surg.2006;44(5):358-363.

5 Callahan C. Facial disfigurement and sense of self in head and neck cancer. Soc Work Health Care. 2004;40(2):73-87.

6 Arunachalam D, Thirumoorthy A, Devi S and Thennarasu. Quality of life in cancer patients with disfigurement due to cancer and its treatments. Indian J Palliat Care.2011 Sep-Dec;17(3):184-190.

7 Rumsey N, Clarke A, White P, Wyn-Williams M, Garlick W. Altered body image: appearance-related concerns of people with visible disfigurement.J Adv Nurs.2004;48(5):443-453.