Emotional Support in Cancer | Oasis Of Hope Cancer Treatment Center
What if a person facing cancer was forced to decide between being cared for by a doctor or a counselor? Whom would he/she choose? Most people recognize that speaking with a counselor would be helpful – but not at the cost of not being able to see their doctor. A person might be thought crazy if they chose to see a psychologist instead of the oncologist. In most hospitals, patients do not encounter this dilemma. The choice has already been made. It is rare to find counseling provided in cancer treatment centers. At best, there may be a social worker who comes for a quick interview. Notes are entered into the medical file and that is it. Two years ago, the Oasis of Hope director of counseling attended the annual convention of the Association of Oncology Social Workers. The director came back very excited about working at Oasis of Hope, explaining during breaks at the conference, other social workers would ask about the program at Oasis of Hope. They all were amazed that Oasis of Hope truly integrates emotional support into its treatment program, and they stated that they could only dream of working in such a place. In most cancer treatment centers, emotional support is a nice thought that happens minimally if at all.
This is not the case at Oasis of Hope. Counseling is an integral part of the treatment program. Why? Cancer, its symptoms, and treatments, will tax the strongest of people. Fear, anxiety, anger and other strong emotions are promoted by cancer, and few people have had to deal with such a difficult situation that stresses them in so many different ways at the same time. The whole experience can affect a person’s sense of self, employment, energy level, sexuality, interpersonal relationships, hopes and dreams, hobbies, and faith. All of these issues, if not managed adequately, can have a negative influence on the treatment outcome of a patient. In fact, depression is fairly common in cancer patients, and this is quite understandable (1).
More than 2000 years ago, the Greeks recognized instinctively that health and emotions always came together. For Hippocrates, the father of medicine, some factors were essential to achieving health, like a healthy diet, pure water, exercise, and support of family and friends. But essential too were the emotions, as well as relaxing activities that soothed them (2).
The Oasis of Hope approach likewise emphasizes the connection between the emotions and physical outcome. An individual’s constitution at birth, which is mainly genetically determined, and his/her coping skills, which depend largely on personality, can lead to the development of disease later in life (3,4). Some decades ago, scientists began to define the ways in which emotional distress can affect our immunity and predispose us to certain illnesses such as cancer (5).
Beginning back in the 1950’s, L. LeShan (4,6) dedicated decades to studying and reviewing the literature on this matter, and concluded that there were four key types of personality characteristics that tended to lead to the beginning of malignancy in cancer patients (7):
- The loss of an important emotional relationship
- An inability to express anger or resentment
- An unusual amount of self-dislike and distress
- Feelings of hopelessness and helplessness
Furthermore, chronic stress affects the body negatively in several other ways. Through imbalance of the autonomic nervous system, it affects the rhythm of the beats of the heart, and may induce abnormal cell division that could potentially promote cancer (8). Also, stress might be able to impair the body’s defenses against cancer by altering the molecular mechanisms responsible for repairing faulty DNA in cells (9).
At Oasis of Hope, there are a number of counselors on staff to help patients learn how to manage the stress of cancer, and to help them transition from a feeling of hopelessness to a feeling of empowerment. The counselors help patients experience and work through the normal emotional stages of a cancer crisis.
The first stage experienced by most people is shock. Imagine being blind-sided so unexpectedly and hard that you had no clue what hit you? That is exactly the feeling that overwhelms a person when a doctor states, “We found cancer.” When a person is in shock, family, friends and a support team are critical.
The next stage is denial. Think of a child falling down hard on the playground during P.E. and hearing the other kids gasp, “ooooohhhh.” The natural instinct is to pop right up and declare, “I’m okay!” only to look down and see the bloody knee. Then, the delayed tears would come. When a patient is diagnosed, he may wish to bounce right back stating, “I’m okay, I’m going to be okay.” He may state, “Those doctors are wrong, I am going to get a second opinion.” He may have even waited days or weeks until he was willing to share the news with loved ones. This is normal.
Fear is the third emotional stage. A flurry of questions and doubts begin to race through when reality sets in. All the unknowns create strong emotions of fear and anxiety. Patients often contemplate many unsettling questions such as, “Am I going to die? Am I going to have lots of pain? Will I suffer much from the treatments? If I die, who is going to take care of my children?” The natural tendency is to keep these fears private. The unnatural thing to do is to externalize and address fears. The healthy thing to do is to share with others exactly what is being experienced.
Grief is a normal part of experiencing a diagnosis of cancer and the ensuing treatment. Few people realized how many feelings of loss a patient goes through. The seeming loss of hopes and dreams for the future can bring on grief. The loss of a normal routine can feel devastating. A person should not go through this process alone.
Feelings of loss are normally followed by the fifth stage, which is anger. Think of a child who has his toy snatched away from him by a bully. At first, he doesn’t know what happened. Then, he can’t believe it. His fear of the bully is paralyzing and then he starts to cry. After a time of crying, he gets angry. It is common for a patient to express anger and frustration. Anger is followed by a stage of guilt. Questions of “Why me?” and “What did I do to deserve this?” are common. With the help of Oasis of Hope counselors, the feelings of anger and grief can be transformed into the seventh stage, which is acceptance and resolve. When a patient is able to accept the situation, she is emotionally ready to hope and believe that healing is possible, and then she can find the courage to take action, knowing all the time that the treatment outcome may not be what is desired.
Sarah Mahoney authored a great guideline for what to do when diagnosed with cancer entitled “This is Your Brain On Illness” (10). In her article, Mahoney acknowledges the emotional stages that a cancer patient experiences, and she specifies actions that can be taken to manage the stress and make effective treatment decisions. Her main points are: 1) The first 5 minutes: You’re in shock, just take it all in; 2) The first 24 hours: You seize control. Don’t commit to treatment yet; 3) The first week: You hit a slump; 4) Identify your feelings; 5) Recruit your “A” team; 6) Investigate “self-management” programs; 7) Embrace your inner grouch; 8) Resist redefining yourself.
There is a close link between the experience of mind and the physiological performance of the body (11). The body is equipped with psychological and biological mechanisms that allow the brain and immune system to communicate with each other. Physical function and the way a person thinks, reacts, copes, and perceives emotions, are all connected and influence each other. All cognitions, feelings and emotions are chemical. They influence the biochemistry and physiology of a person at the cellular level. They can produce changes within the endocrine and immune systems in diverse ways, including modulation of specialized nerve pathways and chemical messengers (11). The renowned pathologist David Felton first discovered that the spleen contains nerve fibers that are intimately associated with the cells of the immune system, such as lymphocytes and natural killer cells. Both the nerve endings and the immune cells produce similar message molecules, such as neuropeptides, referred to by Candace Pert in her book as the Molecules of Emotion (12). Norman Cousins, the great scholar and humanitarian, confirmed this concept in his book Head First: The Biology of Hope with this statement, “The human mind converts ideas and expectations into biochemical realities” (13).
The Oasis of Hope counselors have the insight that when negative emotions and stressors are managed adequately, the patient can leverage his/her emotional energy toward healing. One of the most effective ways to help a patient transition from fear and anxiety to hope and faith is by helping him/her build a social support system. This is unnatural at first. The tendency for people in crisis is to withdraw socially. But isolation increases emotional distress.
Activities that facilitate communication and social interaction help decrease a patient’s anxiety and stress levels. Story telling (14), group therapy, and even cancer support groups through video conferencing (15) are all effective at improving a patient’s outlook. The main point is that cancer is not a journey that should be taken alone. To successfully navigate all of the roadblocks, pitfalls, and sinkholes of cancer, one must reach out to others.
The attitude and will that a patient has can have a big impact on whether or not health will be recovered. At Oasis of Hope patients are active partners in all stages of treatment, rather than a passive recipient of medical intervention. By becoming actively involved in a self-healing process, patients can shift from the feelings of helplessness and hopelessness that increase the impairment of the immune system, to a sense of control. There is evidence that being empowered with knowledge and being part of the decision-making process results in an improved health outcome; whereas passivity and apparent lack of control may be harmful to health (16). Oasis of Hope Emotional Support Team helps each patient participate in her own healing process, develop a passionate involvement with life, and find unique purpose and meaning in illness and in health. This is the principle reason why Oasis of Hope has not reduced emotional support to a single visit from a social worker for a quick assessment. The counseling program has daily activities and is a full part of the treatment program.
Through education sessions, group therapy, individual counseling, laughter therapy, and music and art programs, the counselors at Oasis of Hope support patients as they transform a paradigm of helplessness to a new hope-filled outlook. Patients learn the advantages of taking care of the physical, emotional, and spiritual aspects of their lives. Counselors motivate patients and companions to make positive changes in their thinking style by helping them to understand the big impact that the mind has on health.
If a shift from a perception that a person is dying from cancer can be made toward a renewed sense that a person is dealing with cancer, much of the emotional distress and burdens are alleviated. People need permission to engage in life and enjoy each day whether cancer is present or not. The essence of the Oasis of Hope emotional support program is just that. It is an invitation to live each day to the fullest.