At any stage after a cancer diagnosis, you may experience times of distress and feel a range of strong emotions, such as disbelief, fear, sadness, anxiety and anger. These can be seen as a type of grief - cancer often involves a series of losses, such as the loss of good health, temporary or permanent changes to your appearance, not being able to work or do your normal activities, changed financial plans, a loss of independence, changed relationships, and a shift in how you see yourself. It usually takes time to adjust to these changes.
When your mental health needs are met, you are in the best position to manage the demands of treatment. Let your treatment team know if you have a history of anxiety or depression, as this could make you more vulnerable now. It is important to manage emotional distress and seek professional support if it is ongoing.
Many people say that their experience after a cancer diagnosis also includes feelings of hope and connection. For some, it can be a time of reflection and lead to new goals and priorities.
Shock and disbelief
The first reaction to a diagnosis is often shock – you may feel numb, as if you aren't feeling any emotion. It may take time to accept that you have cancer, especially if you don't feel sick. This numbness can protect you as you gradually come to terms with the diagnosis.
However, some people may never fully accept the diagnosis. Over time, denial can make it difficult to accept the demands of treatment, so always discuss your views with your cancer specialist.
Fear and anxiety
Cancer treatments and outcomes have dramatically improved in recent years, but it can still be very frightening to hear the word "cancer". It's natural to worry about the treatment, side effects, test results and the long-term outcome, as well as the impact that the diagnosis will have on your family, work and other responsibilities.
Most people cope better when they learn more about the diagnosis and treatment options and when they develop a plan for how they will manage the practical issues. The period before each new treatment begins may be particularly stressful, but many people find that they feel calmer once treatment is underway.
In times of stress, your body releases adrenaline, your heart beats faster, your blood pressure goes up, your breathing is shallow and rapid, your hands get sweaty, and your mouth gets dry. These natural reactions are part of the "fight or flight" response to danger, allowing people to react quickly to a sudden threat. For most people, these feelings settle, but for others they can cause panic attacks (see below) or they may be ongoing. This can lead to anxiety that affects your thoughts and may make you irritable and short-tempered. See ways to reduce stress and anxiety.
For more insights on emotions and cancer, you can listen to The Thing About Cancer, a podcast from Cancer Council. Hear experts discuss all things cancer, including how to cope with the diagnosis and manage fear.
For some people, severe anxiety or fear can lead to panic attacks. These might happen in a particular situation, such as having a test in an enclosed space or before a medical procedure, but sometimes there is no clear single trigger.
A panic attack can happen suddenly and be very alarming. It can include symptoms such as shortness of breath, racing heartbeat, dizziness, sweating, shaking, chest pain, a choking feeling and overwhelming fear. In a panic attack, these sensations may be intense, but will normally peak and pass within a few minutes. However, they can also be symptoms of heart attack and other serious health conditions, so call 000 if they occur unexpectedly, do not pass quickly, or if you are unsure. If you experience panic attacks, it is important to talk to your doctor about ways to manage them.
Anger, guilt and blame
It is common to ask "why me?" You may feel angry with your family or friends, health professionals, the world, or even yourself if you think you may have contributed to the cancer or a delay in diagnosis. Perhaps you're angry that you did everything right and still got cancer.
Cancer often does not cause any symptoms in the early stages, or it may cause symptoms that are more likely to be explained by other conditions. This means it can take some time to get a diagnosis. It is natural to try to work out why the cancer started. However, even though we know the risk factors for some cancers, not everyone with risk factors will get cancer, so there is an element of chance. If you are blaming yourself, try to remember that no-one deserves cancer.
People diagnosed with cancer often say that their greatest concern is for the people they love, that they feel guilty about putting them through such a stressful experience. It may be helpful to share your feelings with someone neutral, such as a counsellor.
Feeling sad after a cancer diagnosis is common. It is a natural response to loss and disappointment. You may be sad about the way cancer has changed your day-to-day life, your body, or your plans for the future. If you have continued feelings of sadness, have trouble getting up in the morning, or have lost motivation to do things that previously gave you pleasure, you may be experiencing depression.
Cancer can be isolating, even with many people to support you. You might feel lonely if your family and friends have trouble dealing with your diagnosis, or if you are too sick to work or socialise with others and enjoy your usual activities. This might be the time to connect with other people going through a similar experience.
Loss of control
Being told you have cancer can be overwhelming and you may feel that your emotions are out of control. It may also seem that you are losing control of your life - some people say they feel helpless or powerless. This can be very difficult, especially if you are used to being independent or being the one who takes care of everyone else.
Physical side effects and emotions
The physical and emotional effects of cancer and cancer treatment can interact with each other. Let your team know if you have any new or ongoing side effects.
Pain and fatigue
Cancer does not always cause pain, but if it does, there are now many treatments available to relieve it. The most common treatment side effect is fatigue, feeling exhausted and lacking energy for day-to-day activities. Fatigue differs from normal tiredness as it often doesn't go away with rest or sleep. This feeling can also be a symptom of depression. See Overcoming Cancer Pain and listen to our "Managing Cancer Pain" and "Managing Cancer Fatigue" podcasts.
Your appetite might change if you feel unwell, anxious or depressed, or because of the physical effects of cancer treatment. Some people lose their appetite, while others find they eat more. A change in your appetite or weight can make you feel distressed. See Nutrition and Cancer and our fact sheets on mouth health and on taste and smell changes, and listen to our "Appetite Loss and Nausea" podcast.
Cancer treatments can cause changes to your appearance, such as hair loss or loss of a body part. Whether these changes are temporary or permanent, they can change the way you feel about yourself (your self-esteem) and make you feel self-conscious and less confident. See our Hair Loss fact sheet, and call 13 11 20 to find out about wig services. You can also contact Look Good Feel Better on 1800 650 960 or at lgfb.org.au for a free workshop on appearance-related side effects.
Certain cancer treatments directly affect the body's sexual organs or hormone balance. However, any cancer treatment can reduce your interest in sex. You may feel tired and unwell, or you may be too worried to think about sex. You might also feel less confident about your body. A low sex drive (libido) can also be a symptom of depression. Libido often improves after treatment finishes, but for some people the effect is ongoing. See Sexuality, Intimacy and Cancer and listen to our "Sex and Cancer" podcast.
Some cancer treatments affect the reproductive organs, which may lead to temporary or permanent infertility. This means it may no longer be possible to conceive a child. You may feel devastated if you are unable to have children, and may worry about the impact of this on your relationship or future relationships. Even if your family is complete or you were not planning to have children, you may feel distress. See Fertility and Cancer.
Thinking and memory changes
Some people diagnosed with cancer notice changes in the way they think and remember information. This is often called "chemo brain", but it can happen even if you don't have chemotherapy. It is also known as "cancer fog" or "cancerrelated cognitive impairment". These changes are usually temporary and get better with time, but can have a big impact on your emotional wellbeing. See our Understanding Changes in Thinking and Memory fact sheet or listen to our "Brain Fog and Cancer" podcast.
Does thinking positively help?
A common belief is that people with cancer need to stay positive. While it can help to be hopeful, this doesn't mean denying the reality that cancer is serious or frightening. Trying to put on a brave face all the time drains energy, and generally doesn't work well because the negative thoughts just keep coming back. Pressure to be positive can lead to people being afraid to discuss fears and feelings, which can make problems worse.
Try to be realistic about what is happening, and talk to someone about your fears and concerns and how you feel you are coping. Explaining how you feel to those around you may also help you get the support you need.
In Australia, the rates of cancer survival have increased significantly over time, but it can be hard to feel hopeful when you have just been diagnosed with cancer. Worrying about the future is natural. Treatments are improving constantly, and if the cancer can't be controlled, symptoms can be relieved to make life more comfortable. It can be very confronting to think about your own mortality, even if the outlook for your type of cancer is reassuring. Talk to your doctor about what the diagnosis means for you and what the future may hold. Knowing more about the illness may help ease this fear.
If you've been told the cancer is advanced, you may find it harder to feel hopeful. In some cases, advanced cancer can be controlled for many years. When time is limited, people often focus on goals such as visiting special places or spending time with family and friends.
Expert content reviewers:
Dr Anna Hughes, Liaison Psychiatrist and Psycho-oncologist, Canberra Region Cancer Centre, Canberra Hospital, ACT; Mary Bairstow, Senior Social Worker, Cancer Centre, Fiona Stanley Hospital, WA; Anita Bamert, Psychologist, Cancer Council Queensland, QLD; Kate Barber, 13 11 20 Consultant, Cancer Council Victoria, VIC; Sally Carveth, Assistant Coordinator, Cancer Support Leader Program, Cancer Council NSW; Matt Featherstone, Consumer; Dr Charlotte Tottman, Clinical Psychologist, Allied Consultant Psychologists and Flinders University, SA; Shirley Witko, Senior Social Worker, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, WA.