How people cope

Tuesday 31 January, 2012

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On this page: Learning about the cancer and its treatment | Getting support | Urges to make a major change | Looking after your health | Anniversaries and important dates | Understanding how relationships can change | Depression | Creative ways to express grief | Becoming resilient | Finding a 'new normal' | When everyone in the family is grieving | Can you gain from change and loss? | Acknowledgements


Everyone deals with grief and loss differently; there's no ‘one size fits all'. Grief is as unique as each individual. Even two people with the same type of cancer and treatment may respond differently to their losses.
'You fall in love in a thousand ways, and you grieve in a thousand ways...' — Allan Kellehear, professor of palliative care

As difficult as it may seem, there are ways to help your grieving to be a more complete and even sometimes a valuable experience.

How you grieve will vary depending on:

  • what is causing your grief
  • your age and gender
  • your culture
  • the type of person you are
  • past experiences in life
  • the amount of support you have.

Acknowledging your grief is the first step towards finding the best way to deal with it. You can then look at ways to help you work through your grief. Many people say the two most important factors about coping with grief due to any type of major loss are time and support from others.

'I think time does heal, but the pain is still there and you just learn to cope with it. Sometimes I still cry out ‘Why?' Darren was so full of life and never complained about anything; I'm still amazed at how he coped with it all.' — Troy, 36, whose partner died from cancer four years ago

Learning about the cancer and its treatment

Knowing what to expect from cancer and its treatment can help lessen fear and anxiety and give you back some control. Try to get as much basic information as possible about your situation. If possible take someone close to you to appointments and treatment sessions. They will be able to help by asking questions and remembering answers later on. Write down any questions you have and take them with you. You may consider asking:

  • What kind of cancer do I have?
  • What stage is my cancer?
  • Has my cancer spread to other parts of my body?
  • How quickly can my cancer spread?
  • What are my treatment options?
  • How will the treatment help?
  • What can I expect to happen during my treatment?
  • What are the side effects from treatment?
  • Where can I find out more information?
  • Are there any support groups for my type of cancer?
  • What can I do to cope with my cancer and its treatment?
  • How can I talk to someone who has been through a similar experience?
  • What happens when my treatment is finished?
  • If I need extra help where can I go?

Getting support

You cannot make yourself feel better ‘just like that'. However, it can help to talk to people you trust. Not everyone will feel comfortable talking about changes and loss. You may find it hard to express your feelings or worry you are burdening others with your problems. But try to keep the lines of communication open between you and those close to you, including your doctors, nurses and other health care professionals.

There may be times when people try to protect you from bad news about your cancer and its treatment. This may prevent you honestly expressing your emotions. Open and honest communication can help everyone gain strength from each other, helping you work through the situation.

Try not to grieve alone; if support and help is offered, accept it. This may come from:

Sometimes pride and the belief you need to be strong and self-sufficient might stop you asking for help. But most good friends and close family will want to help. They may need guidance. Here are some ideas:

  • Ask for help with cooking meals, shopping or paying bills.
  • Meet regularly with a close friend for a chat, coffee or simply a walk in the park.
  • Ask friends or family members to call you at times you feel most alone – this may be in the evenings or early mornings.
  • If you live alone ask a couple of good friends to agree to being called on at any time of the day or night. Knowing someone will be there to talk or visit you when you feel low or desperate can be a great relief.
  • You may find that writing your thoughts down and sharing them with others may help them understand what you are feeling and what you need.
  • If at any time you feel things are too much and support from friends and family isn't enough, see your GP, speak to other health care professionals or call Cancer Council on 13 11 20.
  • You may want to seek help from outside your circle of friends and family. If necessary your GP can help organise some grief counselling for you.
  • Knowing when to get help is important. Leaving it too long, and believing you can cope alone, may end up making things harder for yourself. Your grief may never completely go away but getting the right help can change the way you view your losses.

Thinking through the urge to make a major change

People sometimes feel they want to make a change to their life, hoping it will help them forget what has happened and move on, for example:

  • choosing not to disclose the diagnosis to avoid dealing with the reactions of others
  • changing jobs after treatment finishes, believing a fresh start will help avoid facing old work colleagues and having to pretend everything is okay.

It is important to think carefully about any changes you might like to make before you put them into action. Other people may encourage change. But the change won't erase what has happened. It may actually make it harder to deal with in the long term. Only you can decide what is right for you.

It is often best to avoid making major decisions in the first 12 to 18 months after a major loss. Circumstances or people may force you to make major changes, taking the choice away. But if you can, take the time to listen to your own feelings. It may be that you are only trying to please others rather than doing something that you think will actually help you. Try to maintain your ‘normal' lifestyle surrounded by people and places you know and feel safe with. You are already facing a major loss because of a change to your life so if possible avoid making major life decisions when you are feeling sad or overwhelmed. This can allow you to maintain some sense of stability and security.

Looking after your health

Grief can affect you both emotionally and physically. People who are grieving sometimes forget about looking after themselves. They neglect their basic needs, such as nutrition, exercise and social activity. They may over-eat or under-eat, causing weight loss or gain. Others may give up regular exercise because they see it as too hard or not enjoyable any more.

It is not uncommon for a grieving person to stop seeing their close friends and family as much as they used to. You may refuse invitations to social occasions so you don't have to talk about your loss or because you think you won't cope with seeing everyone else happy. You may find it difficult to speak to people on the phone as you do not want to repeat to all your friends and family what has happened to you.

Looking after your body and mind is very important after a major loss. As hard as it may be, try to:

  • Exercise each day: exercise is a great way to relieve tension, help improve mood and reduce fatigue.
  • Eat a healthy and well-balanced diet. Eat regular meals and drink lots of water. Poor nutrition can contribute to low mood and may make you more prone to infections.
  • If possible (and affordable) allow yourself some treats now and then, such as naps, going for a drink or bike ride with a mate, relaxing baths, massages or eating your favourite foods. Be kind to yourself and try to make time for ‘you' everyday.
  • Avoid drinking too much alcohol or using other drugs to help you relax. Alcohol can harm your health, dull your emotions and interfere with good sleep. It is likely to make you feel worse and cause new problems.
  • Take things slowly: don't expect miracles and don't move too fast to change things.
  • Recall happy memories of before you had cancer. Remembering good times can be painful but it can also be helpful.

Preparing for anniversaries and important dates

Specific dates can be a reminder of something important, happy or painful in your life. Dates that can be significant if you are grieving a loss due to cancer include the date you:

  • were diagnosed
  • finished treatment
  • found out your cancer had come back
  • have follow-up appointments.

Other special dates affecting how you feel may include birthdays, wedding anniversaries, religious holidays and other holidays or important events.

Every year these dates may have a significant effect on you and those close to you. The events may become more important if you or your family worry about your cancer coming back as you want to enjoy these times more with close family and friends. Many survivors worry that a special event such as a birthday may be their last. Others may feel worried that their feelings will ruin the celebrations for others. It is common for people to feel anxious, fearful and upset a few weeks or days before these dates as you remember how things were before you were diagnosed with cancer.

To help ease anxiety, people who have had a major loss or change say it can help to plan ahead for holidays and anniversaries. Think about what you want to do, where you want to be and who you want to be with.

If you prefer to be alone, you need to let others know this. Sometimes not planning or expecting too much is the best way to be.

'I found the KISS approach helped me the most: Keep It Simple and Special.' — Trish, 50

Talking to someone about your feelings can reduce feelings of distress and isolation. Family and friends can be a good source of support.

Understanding how relationships can change

Relationships can change due to cancer. Someone who before was the main ‘breadwinner' may now be too unwell to maintain this role. You may be disabled or rely heavily on your partner to initiate most things.

Sexual relationships can change.

Some people may no longer feel like having sex, while others may want more as they find it helps them to cope with their feelings.

Couples may withdraw from each other and feel angry or resentful about each other's responses to the cancer and its treatment. A woman who has lost her breast may feel she is no longer sexually attractive to her partner and avoid sex, whereas her partner may continue to want sex because he still loves her and sees her as attractive and sexy.

A man who has had treatment for prostate cancer may feel he can no longer fulfil his partner's needs due to the side effects of treatment. His partner may not see it this way and be happy to try new things to help them enjoy a fulfilling sex life.

People grieving may think they can no longer have a fulfilling sexual relationship or never will again. For some people this can be devastating. However, no matter what the cause of your grief, it does not have to mean the end of your sex life. It may take time for you to feel comfortable about your body and having sex again. And you may have to find new ways of fulfilling your sexual desires, but it can be done. Time can heal many of these situations. It also requires patience, understanding and support from others.

Be open and honest with yourself about your needs. Don't do anything before you feel ready. Tell your partner how you are feeling. That way, they can support you and won't try to do anything that makes you feel uncomfortable or frightened. Good communication is vital for a healthy relationship.

Some people may find professional counselling can help. If you would like further information contact Cancer Council on 13 11 20 and speak with one of our nurses. They can refer you to a counsellor if you feel this may be helpful.

Being aware of depression

Many people who are grieving may say they feel depressed. If you are grieving you may have similar signs to someone who is suffering depression, such as difficulty sleeping, changes in your eating patterns, low mood, frequent crying and severe sadness. Grief is a natural and normal part of loss. It isn't an illness. The signs of grief may be as painful and disturbing as depression but they help the person adapt and cope with the change the loss has caused in their life.

About one in five people who are grieving the death of someone close to them develop major depression. It can also happen to some people after they finish their cancer treatment.

You may be more at risk of depression if you:

  • have had previous major stresses in your life
  • have a history of depression
  • have little or no support from others
  • have problems with alcohol or drug abuse.

The beyondblue website is a useful resource and offers a checklist of symptoms of depression. If you think you may be depressed, you need to talk to your GP. You may need treatment with counselling or medication, which can be helpful and effective.

Using creative ways to express grief

There may be times when you cannot explain your feelings in words. You may feel too tired to speak or no longer feel you can describe the intensity of what you are going through.

There are other ways of expressing feelings. For example, someone who has lost the ability to be as active as they used to be prior to their cancer treatment may find it helps to paint or draw how they are feeling. The loss of or change to part of your body may also be best expressed creatively through music, writing, painting or drawing. 

Below is a list of some other things that you may find helpful to deal with your grief. What helps will depend on why you are grieving.

  • Write letters, a journal or memoirs.
  • Read or write poetry.
  • Make something to remember the time before and after your loss: build something, create a garden, sew a quilt or fill a photo album.
  • Use the Internet: create a blog, email or join online support groups. Be aware that some information on the Internet may not be helpful and may even be disturbing for someone who is grieving. Call Cancer Council on 13 11 20 for information about how to search the Internet safely.
'I go down to the workshop after breakfast and it is lunchtime before I know it. I find I have not thought about my cancer for a couple of hours. Doing something you love is a great way to give your mind a rest from the worry! ' — Tim, 69

Becoming resilient and helping yourself

Resilience means being able to recover quickly from illness, change or misfortune in your life. It means ‘bouncing back' from hard times. Hardiness is being capable of lasting through or carrying on through a hard time. Having resilience and hardiness can potentially help someone get through tough times.

Understandably, you may ask, ‘How can you expect me to become "resilient and hardy" after what I have been through? I am doing my best, I can't possibly be stronger.'

We include this discussion of resilience because research shows people can learn to become resilient. People can ride hard times and find hope again. We hope you will read the information and take from it what may help you in your situation.

Resilience and hardiness are not necessarily inbuilt. They can be learned, even late in life. People often show resilience without really knowing it. You may hear people discussing someone going through a hard time and saying, ‘They are so strong, they cope so well under such stress, and I would never cope that way'. The truth is you may cope just as well, but you don't know that until you are in a difficult situation.

A good example is the strength people show in disasters such as a terrorist attack or a natural disaster such as the 2004 Indian Ocean tsunami, or the Victorian bushfires in 2009. Many people involved in these events have rebuilt their lives, despite great hardship and sadness.

Being resilient will enable you to ‘make it' even in the most traumatic times. You can turn difficult times into times of personal growth. This does not mean resilient people don't feel stress, pain, sadness or find their situation difficult. They do, but they are able to work with their troubles and find a positive way forward.

'It is the stiff old tree that snaps in the strong wind while the blade of grass bends and lives to see another day.' — Ancient Taoist sage Lao Tzu

Building resilience is a personal journey. Not everyone will react in the same way to a stressful, life-changing event. You need to find out what works for you. Having a lot of caring support within and outside your family will go a long way to helping you build resilience. But other strategies can help. People who have been through hard times mention the following strategies:

  • Accept change as part of life. Focus on things you can change.
  • Seek support from family, friends and other sources such as support groups.
  • Try to face your fears daily: say things out loud like, ‘This is what is happening to me right now. I can find a way to cope with it'.
  • If you have had changes in your body appearance try not to avoid looking at them or dealing with them. Becoming familiar with your changes will help them to become part of you.
  • Keep your problems in perspective. Try looking at a more long-term outcome from your situation to help realise it won't be this bad forever.
  • Try not to see your loss as impossible to cope with. You cannot change what has happened but you can change how you think about it.
  • Go slow, don't let people push you too hard (a little may be good but too much may be damaging). 
  • Don't expect miracles: try to notice small, positive changes and accomplishments – this is better than no change at all.
  • Be kind to yourself, think well of yourself (as you would a good friend), try to develop confidence in your ability to cope and build resilience.
  • Set some realistic goals. Try to do something every day that will help you move towards these goals.
  • Try to visualise what you want rather than worrying about the worst that could happen.
  • Don't try to deal with the big picture all at once: deal with what is happening now, not what might happen in the future.
  • Try to let go of your fears: they may never happen, so use your energy elsewhere in more positive ways.
  • Try to be decisive with your actions. Don't shy away from your problems.
  • Maintain a hopeful outlook. Being hopeful will help you expect good things to happen in your life again. But remember it is okay to have down time too!
  • Eat well, get regular exercise and find time to relax and do things you enjoy. Keeping your mind and body healthy will help you be ready to deal with situations that need resilience.
  • You may find a massage, meditation, reflexology or other complementary therapies help you cope better and build up some resilience.
  • Keep up or take up hobbies such as gardening, reading, woodwork or sewing. Many people say this gives them less time to ponder on negative thoughts.

Look for ways to help you adjust to your ‘new normal' life (e.g. wearing clothing to help hide scars or being prepared to let scars be seen, resting when you are tired, trying out new ways of being intimate with your partner).

Remember it's okay to say ‘no'! Set yourself limits.

'My new speech method required that I use my left hand to seal the stoma in my neck. This meant that I couldn't hold a briefcase, shake hands, and say g'day at the same time, which I believed I had to be able to do in my usual work as a consultant. I developed another way of sealing off my stoma by inclining my head so that my double chin would do the job for me. I then went back to work!' — Lesley, 69

Finding a ‘new normal'

There was a time when bereavement counsellors talked about ‘closure and resolution of your grief', meaning forgetting the past and starting anew. But forgetting your past isn't usually possible or helpful. Now a much more popular and realistic view is to encourage people to weave their loss into their ‘new and different' life. After a major loss there is no ‘normal' world to return to. This is because the loss alters everything in some way: socially, personally, spiritually and sometimes physically.

Cancer survivors often say they had to find a new way of living their life. They had to find a ‘new normal'. Some survivors find they deal with more than one ‘new normal' as their cancer journey continues.

Comparisons with others won't help. Most people find no consolation in hearing someone say, ‘You need to move on, it could be worse' or ‘There are others who have lost more than you'. Your pain is real and relevant. Grief is a healthy and normal response to a loss. 

Tips for helping someone who is grieving

It can be hard to know how to best help someone who is grieving. You may become stuck for words, or avoid doing anything practical to help. This is often not because you don't want to help but you fear saying or doing the wrong thing. You are right to be cautious. It is easy to upset someone who is grieving a major loss in their life. However, if you feel you can help, offer. Be honest right from the start. You may need to say ‘I want to help but I'm not sure what to do'. Or ‘I don't know what to say but I want you to know I do care and I am here if you need a shoulder to cry on'. Or ‘Given this bad news, what do you hope for now?' Your honesty will always be appreciated.

Try not to say that you know how they feel. Each person grieves in their own way. You cannot know exactly how they feel, even if you have been through a similar experience. This doesn't mean that your experiences won't give you a better understanding of someone's situation, but remember that they may not react in the same way as you would or did.

The following tips may help:

  • Acknowledge the situation by saying something like, ‘I am sorry to hear you have cancer'. Using the words ‘cancer' shows that you are more open to talking about how the person truly feels.
  • Be patient. Don't expect them to feel or behave in a certain way by a certain time. Allow them to do things in their own time.
  • Be aware that the person's feelings may change often. Grieving involves a roller coaster of emotions. One day you may feel hopeful, the next day all you feel is sadness and despair.
  • Be a good listener but don't force someone to talk. Just being by their side may be enough. They will talk when they are ready.
  • Give reassurance where you can. Empathise without making out you know exactly how they feel. Say things like, ‘That must be very difficult to cope with', ‘I imagine you must feel very uncertain about what to do next'.
  • Don't withdraw your support once you feel the person is coping better. Grief from a major loss can take a long time. Your support may be more helpful six to 12 months down the track than when the event first happened.
  • Offer to help with practical chores such as shopping, cleaning, gardening, picking the kids up from school, helping care for elderly parents, paying bills, cooking and driving. Knowing someone else can do these things can be a great relief to someone who is struggling with grief.

You could suggest the person grieving seeks professional help if they:

  • begin to rely on alcohol or drugs
  • stop eating regularly
  • begin to neglect their personal hygiene
  • appear to be sleeping too much
  • become aggressive or show signs of other anti-social behaviour
  • talk about taking their own life.

If they do not listen to you and continue to have difficulties then you may need to talk to a health professional to get some advice on how you can cope with the situation.

When everyone in the family is grieving

Cancer affects the whole family, not just the person with cancer. It can be very difficult to support other family members when you are going through your own grief. However, if everyone can be aware of each other's feelings it will go a long way to making things easier for you all.

Communicating with each other regularly about how you feel is helpful. Recognise that each person's needs and feelings may be different, even though you are all grieving about the same loss. For example, a father with lung cancer may be grieving that he can no longer run around kicking a ball with his 10-year-old son. This may bring up feelings of guilt and sadness for him, while the son may be feeling angry toward his Dad for not coming out to play footy with him.

The person with cancer may feel anger towards their partner for not showing signs of wanting to be with them. The partner may want to be with them but is dealing with their own anger because of lack of intimacy. Each person is grieving their own losses.

Siblings of a child with cancer can sometimes feel abandoned and alone. As their parents focus is on the sick child, with regular hospital visits, they may be left with friends and relatives. This means they may see very little of their parents. And when they do see them the talk may be all about their sick brother or sister. This can build up sadness, resentment and anger towards their parents and the sick child. They are likely to grieve not having time with their parents, seeing their other sibling or just being the focus of attention. Parents are likely to be grieving a loss of time with them too, but feel they have to keep focused on the sick child.

Different people of different ages will need different types of support. Try to be patient and kind with each other. Look at what each other is dealing with and try to understand each person's grief. Some children may be too young to be able to do this. However, regular chats to let them know you do care but you also have a lot on your plate right now may help them understand that everyone is feeling the changes. But this doesn't mean they can't come to you for support and love. If you would like more information on how children of different ages cope with cancer, call Cancer Council on 13 11 20 and speak with a cancer nurse.

Can you gain from change and loss due to cancer?

It may seem unlikely that anything good could come from cancer. But many people say their experience of cancer and the grief ends with positive changes. Of course you would prefer to turn time back to avoid your loss. But it is not uncommon for people who have suffered major losses in their life to say things like, ‘I am a better person for it'.

Finding positives can help you feel better and cope with the bad days. As one person so eloquently said about a major loss in life, ‘It was the worst and the best thing that happened in my life'.

'I still have days when I feel very low and wonder what it is all about. I wish I did not have to change this bloody urine bag on my side. But when I have those days I am able to remember the love and support that I have had from my family during this difficult time. It has made me realise just how important family really are and that at the end of the day they are all that matter. ' — Bill, 72

Acknowledgements: Written by Annie Angle, cancer nurse (Dip. Oncology Nursing, Royal Marsden, London). Reviewed by Voula Kallianis, Social Worker, St Vincent's Palliative Care Unit; Eugenia Georopoulos, Project Officer, Centre for Culture Ethnicity and Health; Wendy Thurling, Senior Bereavement Counsellor, Australian Centre for Grief and Bereavement; Jane Fletcher, Deputy Head, Cabrini Monash Psycho-oncology Research Unit and Director Melbourne Psycho-oncology Service; Associate Professor Michael Jefford, Medical Oncologist, Peter MacCallum Cancer Centre; Marie Craw; Nadia Montibellar; Neil O'Loghlen; Lesley Bawden; Meg Rynderman, Cancer Connect and Australian Cancer Survivorship Centre Volunteer; Majella Franklin.

Updated: 31 Jan, 2012