Hope
Inner Strength
Sadness and Depression
Grief
Denial
Anger
Stress
Fear and Worry
Guilt and Regret
Loneliness
Getting Support
Ways You Can Cope

You've probably felt a range of feelings during your cancer experience. You may have had these feelings at other times in your life, too, but they may be more intense now.

You may relate to all of the feelings below or just a few. You may feel them at different times, with some days being better than others. It may help to know that others have felt the same way that you do. You may also want to read "Ways You Can Cope".

Hope

"I feel it's important to me that I live each day to the fullest, and make peace with my relatives and friends and develop loving relationships with them." - Kate

You can feel a sense of hope, despite your cancer. But what you hope for changes with time. If you have been told that remission may not be possible, you can hope for other things. These may include comfort, peace, acceptance, even joy. Hoping may give you a sense of purpose. This, in itself, may help you feel better.

To build a sense of hope, set goals to look forward to each day. Plan something to get your mind off the cancer. Here are some tips from others with advanced stage cancer:

• Plan your days as you've always done.
• Don't stop doing the things you like to do just because you have cancer.
• Find small things in life to look forward to each day.

You can also set dates and events to look forward to. Don't limit yourself. Look for reasons to hope, while staying aware of what's at hand. See "Ways You Can Cope" for more ideas from other patients.

Inner Strength

"My biggest struggle is that I need help, but I don't want people to give me too much of it. I want to do what I can for myself. If I have to work at something, there's a reason to live." - Will

People with cancer find strength they didn't know they had. You may have felt overwhelmed when you first learned that your doctors couldn't control your cancer. And now you aren't coping as well as you did in the past. But your feelings of helplessness may change. You may find physical and emotional reserves you didn't know you had. Calling on your inner strength can help revive your spirit.

Some people find it helpful to focus on the present instead of the past or future. They start a new daily routine. They accept that it may have to be different from the old routine. Others like to plan ahead and set goals. With places to go and things to do, life stretches out before them. Others focus on the relationships they have with people close to them. Inner strength is different for each person. So draw on the things in your life that are meaningful to you. Look at other sections in this booklet for ways to tap into your inner strength.

Sadness and Depression

It's normal to feel sad. You may have no energy or not want to eat. It's okay to cry or express your sadness in another way. You don't have to be upbeat all the time or pretend to be cheerful in front of others.

Pretending to feel okay when you don't doesn't help you feel better. And it may even create barriers between you and your loved ones. So don't hold it in. Do what feels natural to you.

Depression can happen if sadness or despair seems to take over your life. Some of the signs below are normal during a time like this. Talk to your doctor if they last for more than 2 weeks. Some symptoms could be due to physical problems. It's important to tell someone on your health care team about them.

Signs of Depression

• Feeling helpless or hopeless, or that life has no meaning
• Having no interest in family, friends, hobbies, or things you used to enjoy
• Losing your appetite
• Feeling short-tempered and grouchy
• Not being able to get certain thoughts out of your mind
• Crying for long periods of time or many times each day
• Thinking about hurting or killing yourself
• Feeling "wired," having racing thoughts or panic attacks
• Having sleep problems, such as not being able to sleep, having nightmares, or sleeping too much.

Your doctor can treat depression with medicine. He or she also may suggest that you talk about your feelings. You can do this with a psychologist or counselor. Or you may want to join a support group.

Grief

"I heard the doctor say, 'I'm so sorry, but . . .' and then I heard nothing else. My head was spinning, and I kept saying to myself, 'No, the doctor must be making a mistake.'" - Rosa

We all cope with loss or the threat of loss in different ways. You may feel sadness, loneliness, anger, fear, and guilt. Or you may find the way you think changes from time to time. For example, you may get easily confused or feel lost. Or your thoughts may repeat themselves over and over again. You may also find yourself low in energy. You may not want to do things or see people. These are all normal reactions to grief.

What you grieve for is as varied as how you think and feel. You may be grieving for the loss of your body as it used to be. You may grieve for the things you used to be able to do. You also may grieve losing what you have left: yourself, your family, your friends, your future.

It's okay to take time for yourself and look inward. It's also okay to surround yourself with people who are close to you. Let your loved ones know if you want to talk. Let them know if you just want to sit quietly with them. There is no right or wrong way to grieve.

Often people who go through major change and loss need extra help. You can talk with a member of your health care team, a member of your faith community, or a mental health professional. You don't have to go through this alone.

Denial

"I feel like the reality of this cancer isn't going to go away if I deny it. If I did that, I might miss the comfort I get from sharing fears and concerns. I don't want to miss the sense of well-being I have knowing I have taken care of my loved ones." - Carrie

It's hard to accept the news that your cancer has spread or can no longer be controlled. And it's natural to need some time to adjust. But this can become a serious problem if it lasts longer than a few weeks. It can keep you from getting the care you need or talking about your treatment choices. As time passes, try to keep an open mind. Listen to what others around you suggest for your care.

Anger

The feeling of "No, not me!" often changes to "Why me?" or "What's next?" You have a lot to deal with right now. It's normal and healthy to feel angry. You don't have to pretend that everything is okay. You may be mad at your doctor, family members, neighbors, and even yourself. Some people get angry with God and question their faith.

At first, anger can help by moving you to take action. You may decide to learn more about different treatment options. Or you may become more involved in the care you are getting. But anger doesn't help if you hold it in too long or take it out on others. Often the people closest to us are the ones who have to deal with our anger, whether we want that or not.

It may help to figure out why you are angry. This isn't always easy. Sometimes anger comes from feelings that are hard to show, such as fear, panic, worry, or helplessness. But being open and dealing with your anger may help you let go of it. Anger is also a form of energy. It may help to express this energy through exercise or physical activity, art, or even just hitting the bed with a pillow. (See "Ways You Can Cope".)

Stress

"Just because I love God and know where I'm going, doesn't mean I'm not stressed. I worry all the time about what's to come. I try to focus on the things I can control, but it's not always easy." - David

Everyone has stress, but most likely you're having a lot more now. After all, you're dealing with many changes. Sometimes, you may not even notice that you're stressed. But your family and friends may see a change.

Anything that helps you feel calm or relaxed may help you. Try to think of things that you enjoy. Some people say it helps to:

• Exercise or take a walk.
• Write thoughts and feelings in a journal.
• Meditate, pray, or do relaxation exercises.
• Talk with someone about your stress.
• Do yoga or gentle stretching.
• Listen to soothing music.
• Express yourself through art.

See "Ways You Can Cope" for more ideas to relieve stress.

Fear and Worry

"I have people around all day, but there's nothing worse than waking up alone and upset at 3:00 in the morning in a quiet, dark room. You have to have someone you can call right then." - Jamal

Facing the unknown is very hard. At times, you may feel scared of losing control of your life. You may be afraid of becoming dependent on other people. You may be afraid of dying.

If you struggle with these fears, remember that many others have felt the same way. Some people worry about what will happen to their loved ones in the future. Others worry about money. Many people fear being in pain or feeling sick. All these fears are normal.

Sometimes patients or family members worry that talking about their fears will make the cancer worse. This is not true. Thinking about getting sicker or dying is not going to make your health worse. But it's good to be hopeful and positive. It's better for your health to express your feelings, rather than hold them in.

Some people say it helps if you:

• Know what to expect. Learn more about your illness and treatment options by asking questions of your healthcare team.
• Update your affairs. If you have not already done so, make sure your will and other legal paperwork are in order. Then you won't have to worry about it. (See Advance Planning.)
• Try to work through your feelings. If you can, talk with someone you trust.

If you feel overwhelmed by fear, remember that others have felt this way, too. It's okay to ask for help.

Guilt and Regret

"I couldn't stop thinking about what I could have done to slow down my cancer. Maybe I should have gone to the doctor sooner, maybe I should have given up sweets, maybe I should have done this, maybe I should have done that. After talking about it with my social worker, she helped me see that this is no one's fault, especially mine." - Erika

It's normal for people with cancer to wonder if they did anything to add to their situation. They may blame themselves for lifestyle choices. They may feel guilty because treatment didn't work. They may regret ignoring a symptom and waiting too long to go to the doctor. Others worry that they didn't follow the doctor's orders in the right way.

It's important to remember that the treatment failed you. You didn't fail the treatment. We can't know why cancer happens to some people and not others. In any case, feeling guilty won't help--it can even stop you from taking action and getting the treatment you need. So, it's important for you to:

• Try to let go of any mistakes you think you may have made.
• Focus on things worthy of your time and energy.
• Forgive yourself.

You may want to share these feelings with your loved ones. Some people blame themselves for upsetting the people they love. Others worry that they'll be a burden on their families. If you feel this way too, take comfort in this: many family members have said it is an honor and a privilege to care for their loved one. Many consider it a time when they can share experiences and become closer to one another. Others say that caring for someone else makes them take life more seriously and causes them to rethink their priorities.

Maybe you feel that you can't talk openly about these things with your loved ones. If so, counseling or a support group may be an option for you. Let your health care team know if you would like to talk with someone.

Loneliness

"I know my friends try to understand. It doesn't matter what I say though--they just don't get it. I can't even begin to explain to them how I feel or what's going on. I'm not saying it's their fault or anything. It's just hard." - Jennifer

You may feel alone, even if you have lots of people around you who care. You may feel that no one really understands what you're going through. And as the cancer progresses, you may see family, friends, or coworkers less often. You may find yourself alone more than you would like. Some people may even distance themselves from you because they have a hard time coping with your cancer. This can make you feel really alone.

Although some days may be harder than others, remember that you aren't alone. Keep doing the things you've always done the best you can. If you want to, tell people that you don't want to be alone. Let them know that you welcome their visits.

More than likely, your loved ones are feeling many of the same things you are. They, too, may feel cut off from you if they can't talk with you. You may also want to try joining a support group. There you can talk with others who share your feelings.

Getting Support

Your feelings will come and go, just as they always have in your life. It helps to have some strategies to deal with them.

First, know that you aren't alone. Many people have been in your situation. Some choose to confide in friends and family members. Others do better when they join a support group. It helps them to talk with others who are facing the same challenges. You may prefer to join an online support group, so you can chat with people from your home.

If support groups don't appeal to you, there are many experts who are trained to work in cancer care. These include oncology social workers, health psychologists, or counselors.

Many people also find faith as their source of support. They may seek comfort from the different members of their faith community. Or they may find that talking to a leader in their religious or spiritual community can be helpful. If you need help finding faith-based support, many hospitals have a staff chaplain who can give support to people of all faiths and religions. Your health care team may also be able to tell you about faith-based organizations in the area.

Ways You Can Cope

You may be able to keep doing many of your regular activities, even though some may be harder to do. Just remember to save your strength for the things you really want to do. Don't plan too many events for one day. Also, try to stagger things throughout the day.

On the next page you'll find some ideas that other patients say have helped them cope. As you can see, even little things can help.

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