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Coping Strategies

143175672_8Cancer diagnosis and treatment are physically and emotionally difficult, and it’s fairly common to experience feelings of depression and anxiety. However, psycho-oncologists (psychologists who specialize in the mental health care of cancer patients) recommend keeping a close eye on your emotional state after diagnosis, during treatment and beyond, and getting support and/or treatment if your symptoms become severe or long-term. This is because studies have shown that those who develop positive coping strategies generally have a better quality of life and recovery rate than those who do not.1 Llewellyn CD, Horney DJ, McGurk M, Weinman J, Herold J, Altman K, Smith HE. Assessing the psychological predictors of benefit finding in patients with head and neck cancer. Psycho-Oncology. 2011 Sep 14.

While your cancer care team’s primary goal is to treat your cancer, an increasing number of oncologists are recognizing the importance of emotional support for cancer patients.2 Rosenberger C, Hocker A, Cartus M, et al. Outpatient psycho-oncological care for family members and patients: access, psychological distress and supportive care needs. Psychother Psychosom Med Psychol.2012 May;62(5):185-194. Epub 2012 May 7. Coming up with ways to cope with the emotional aspects of head and neck cancer can be very helpful to you and your family.

Positive coping versus negative coping

Coping means finding ways to deal with challenges and intense emotions. How you cope with your cancer diagnosis and treatment can have a profound effect on your quality of life as well as your caregivers’ quality of life. There are negative coping strategies and positive coping strategies.

Negative coping strategies include denial (pretending you do not have cancer or refusing to think or talk about it), withdrawal or avoidance (isolating yourself from others) or a fatalistic attitude (expecting the worst).3 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/. Negative coping strategies are associated with higher levels of anxiety and depression in head and neck cancer patients.3 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/.

In contrast, positive coping strategies can help you to have a better quality of life and might even improve the outcome of your treatment.3 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/. Positive strategies include finding the benefits of your illness, seeking support from others, being informed, talking to others about your cancer, remaining active in daily life, thinking and speaking positively about yourself, being religious/spiritual and maintaining a generally positive outlook throughout your cancer journey.3 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/. One of the more difficult positive coping strategies to achieve is finding benefits of your illness. Benefits might include discovering a greater sense of purpose in fighting your cancer, helping others in their cancer journeys or strengthening relationships.1 Llewellyn CD, Horney DJ, McGurk M, Weinman J, Herold J, Altman K, Smith HE. Assessing the psychological predictors of benefit finding in patients with head and neck cancer. Psycho-Oncology. 2011 Sep 14.

Positive coping comes more naturally to some people than to others. If you have visible scars or facial disfigurement as a result of your cancer treatment, it will probably be even more challenging to remain positive.4 Luckett T, Britton B, Clover K, Rankin NM. Evidence for interventions to improve psychological outcomes in people with head and neck cancer: a systematic review of the literature.Supportive Care in Cancer.2011;19(7):871-881. If you find that you tend toward negative coping strategies, you can consciously change to more positive ones. This is not easy, but it can be done with consistent long-term effort. Medication for depression or anxiety combined with counseling or therapy is the most effective way to develop active positive coping skills, followed by maintaining strong family relationships and a large active social network.3, Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/.5 Kroenke CH,Quesenberry C,Kwan ML, et al. Social networks, social support, and burden in relationships, and mortality after breast cancerdiagnosis in the Life After BreastCancerEpidemiology (LACE) Study. BreastCancerRes Treat.2012 Nov 10. Twenty-five percent of head and neck cancer patients who receive counseling over 12 months or more are able to overcome symptoms of anxiety or depression.6 Kangas M, Milross C, Taylor A, Bryant RA. A pilot randomized controlled trial of a brief early intervention for reducing posttraumatic stress disorder, anxiety and depressive symptoms in newly diagnosed head and neck cancer patients. Psycho-Oncology. 2012 Oct 8. Up to 67 percent who receive regular therapy beginning soon after diagnosis no longer have symptoms of depression or anxiety 12 months later.6 Kangas M, Milross C, Taylor A, Bryant RA. A pilot randomized controlled trial of a brief early intervention for reducing posttraumatic stress disorder, anxiety and depressive symptoms in newly diagnosed head and neck cancer patients. Psycho-Oncology. 2012 Oct 8. A qualified therapist or counselor can give you specific coping techniques. They can also provide advice and support to help you maintain your coping skills as your care progresses and your circumstances change.

While positive coping strategies have been shown to improve quality of life for many cancer patients, note that they don’t work for everyone.7 Bast RC Jr, Kufe DW, Pollock RE, et al., editors. Principles of psycho-oncology. Cancer Medicine, 6 ed. Hamilton (ON):BC Decker; 2000. Some people find that constant positivity does not suit their personalities, or they find that they simply cannot maintain a positive outlook long-term. They may even be annoyed or angered by people constantly telling them that they have to stay positive. They find being realistic and having knowledge, even if it makes them less optimistic, to be more comforting for them. If this is the case for you, know that you are not a failure because you are not always optimistic. Just use your best coping strategies, positive or negative, to get you through your cancer journey and ask for help when you feel you need it.

Positive coping strategies

Here are some ideas you can use today to help you cope with your cancer diagnosis, treatment or recovery.

  • Understand Your Cancer Diagnosis
    Learning as much as possible about your cancer type and treatment plan can help you feel more in control of the situation.
  • Maintain Good Communication with Your Family and Cancer Care Team
    While it’s perfectly understandable to want time to yourself, particularly after a diagnosis, maintaining good two-way communication with your loved ones, doctor(s) and nurses is important.
  • Anticipate Possible Physical Changes
    Before beginning cancer treatment, it’s a good idea to plan for possible physical changes, as this can help you cope later. Understanding your treatment plan and speaking to your doctor can give you an idea about what cancer treatment side effects you may experience, such as severe dry mouth. A wide variety of solutions are available to help you through this process.
  • Maintain a Healthy Lifestyle
    Head and neck cancer treatment can create changes to your diet, so you should meet with a dietician before and during treatment to ensure you maintain adequate nutrition. If possible, practice regular exercise during treatment. Exercise has been shown to provide benefits in cancer patients, such as reducing fatigue and preventing muscle loss. Exercise is also effective at reducing stress. You might even try dance or movement therapy, which can help to reconnect you to your body, enhance your ability to express yourself, build muscle strength, and reduce feelings of isolation, fear and depression.8 Dance/movement therapy for cancer patients. Cochrane Database of Systematic Reviews: Plain Language Summaries. 2011 Oct 5. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0016207/.
  • Let Family and Friends Help You
    Letting people close to you run errands, provide transportation, help you with household chores and prepare meals can be a huge benefit and reduce stress. Don’t feel guilty about accepting their help, as it can also help them feel more productive in a difficult situation.
  • Learn and Regularly Practice Relaxation Techniques
    A variety of relaxation techniques, such as deep breathing exercises, prayer, meditation and yoga, can help you feel more relaxed and relieve stress.
  • Try to Maintain Your Normal Lifestyle
    Try to maintain your normal lifestyle as much as you are able. This can help you cope with cancer. Cancer treatment side effects can be managed better than ever before, and many cancer patients are able to work full time or part time while undergoing treatment. Even simple activities, such as walks around the neighborhood with your spouse, may help you feel better.
  • Speak with Other Cancer Patients
    Because people who haven’t experienced a cancer diagnosis may have trouble truly understanding your feelings, it may be helpful to join a cancer support group. Your hospital may have groups available. Online cancer support groups are also available.
  • Find Tools to Help You Communicate
    If you lose your ability to speak, hear or see as a result of your cancer treatment, there are tools that can help you to cope with these difficult changes. Many people who lose their ability to speak find that it is too tiring and frustrating to try to communicate their needs to others at first, so they don’t. Consequently, they end up going through treatment without help and support when they need it most. Look for ways to communicate more easily and delegate tasks to others. For example, tablets and pads can help you to communicate without speaking much more easily than writing on paper or gesturing. Interactive calendar applications can help you communicate days and times for visits, meal deliveries, chores and more and allow friends, family and caregivers to sign up for times and tasks that suit their schedules without having to go back and forth with you. You can also have computers, pads or smart phones “read” text you type out loud to help you “speak” to others or hear text read to you if your sight is impaired. There are many tools available that can reduce your stress level and help you feel more in control. This will in turn help you to cope with your emotions and keep a more positive outlook in general.
Listen to your body. Relaxation and visualization are simple things to learn. It will take you 15 or 20 minutes to learn, and it’s something you can use your entire life. It helps you in every situation.Linda K. (maxillary sinus carcinoma survivor)

References

1 Llewellyn CD, Horney DJ, McGurk M, Weinman J, Herold J, Altman K, Smith HE. Assessing the psychological predictors of benefit finding in patients with head and neck cancer. Psycho-Oncology. 2011 Sep 14.

2 Rosenberger C, Hocker A, Cartus M, et al. Outpatient psycho-oncological care for family members and patients: access, psychological distress and supportive care needs. Psychother Psychosom Med Psychol.2012 May;62(5):185-194. Epub 2012 May 7.

3 Depression (PDQ): Health professional version. National Cancer Institute – PDQ Cancer Information Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032529/.

4 Luckett T, Britton B, Clover K, Rankin NM. Evidence for interventions to improve psychological outcomes in people with head and neck cancer: a systematic review of the literature.Supportive Care in Cancer.2011;19(7):871-881.

5 Kroenke CH,Quesenberry C,Kwan ML, et al. Social networks, social support, and burden in relationships, and mortality after breast cancerdiagnosis in the Life After BreastCancerEpidemiology (LACE) Study. BreastCancerRes Treat.2012 Nov 10.

6 Kangas M, Milross C, Taylor A, Bryant RA. A pilot randomized controlled trial of a brief early intervention for reducing posttraumatic stress disorder, anxiety and depressive symptoms in newly diagnosed head and neck cancer patients. Psycho-Oncology. 2012 Oct 8.

7 Bast RC Jr, Kufe DW, Pollock RE, et al., editors. Principles of psycho-oncology. Cancer Medicine, 6 ed. Hamilton (ON):BC Decker; 2000.

8 Dance/movement therapy for cancer patients. Cochrane Database of Systematic Reviews: Plain Language Summaries. 2011 Oct 5. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0016207/.