The Fears Beyond the Unnameable: Some Worries Upon Receiving A Cancer Diagnosis

If your first two answers to a hypothetical question are: intractable pain and death–well, you might feel like there’s not a heck of a lot more to discuss.

And those two fears pervade the existence of the person suffering from cancer, and become woven into the fabric of their daily worries.

But I don’t want these two answers, with their awful finality, to shut down discourse, for it strips us of discussing what the life of a person is like once they receive their cancer diagnosis.

So let’s return to that hypothetical question: “Once you’ve heard that you have cancer, what do you worry about, leaving aside the unspeakable Voldemort of death?”

Why should we as a society worry about the cancer patient’s worries, you might ask, since we have so much work to do keeping them physically alive, comfortable, and functioning?

Well, I’m glad you asked. In a research study published in the October 1994 issue of Psycho-Oncology, Judy Harrison et al studied a group of patients within 8 weeks of receiving their cancer diagnosis. They analyzed the most common concerns among the patients (ranging from the illness itself to the future to finances to jobs to personal relationships to sexuality to feelings of alienation from other people), and discovered that patients with four or more concerns had significantly more anxiety and depression than those who had their worries allayed. Thus, not dealing with the cancer patient’s worries and fears puts them at signficantly higher risk for affective disorder–and, frankly, don’t they have enough to worry about, without adding on the worry now of treating a psychiatric illness? [That’s a hypothetical question–I’m assuming no one is going to answer ‘no.’ If you do, get back to me.]

And the worries come, pounding pebbles on the tin roof of quietude. I just list a few of many.

“It is not only fine feathers that make fine birds.” ~Aesop

Many worry about appearance. As Dr. Lawrence D. Piro of the Angeles Clinic and Research Institute in West L.A. notes, appearance isn’t what makes a person recover, but it can certainly effect mood and motivation.  “Everyone I have the chemo conversation with wants to know how it will affect their appearance,” notes Dr. Piro.

So more worries–about losing a breast, so emblematic of femininity.

About losing hair. I had one patient, not a beauty by any means, but with a long, flowing mane of reddish curls. She cried as clumps of it came out on her pillow at night.

About losing so much weight that a lovely and hard-earned hourglass figure will melt into a lollipop stick.

About being too debilitated to wear the 4-inch Manolo Blahniks bought in a pitched fit of insanity.

He had heard people speak contemptuously of money: he wondered if they had  ever tried to do without it. ~- W. Somerset Maugham

Remember back to the post on fear of cancer?Well it turns out, not unsurprisingly, that people fear the illnesses they do not just because of the pain, disfigurement, and threat of imminent death that accompanies them, but also because of a factor most of us have worried about in our lives, whether chronically or sporadically: money.

The most expensive conditions to treat in terms  of total health care spending are heart disease and trauma–but, on a per-person basis, cancer wins the money race.

A study by the  federal Centers for Disease Control and Prevention published in 2010 found that patients and their families paid around 8% of the estimated $48 billion cost of cancer treatments. (Private insurance pays only half the cost, the study found).

In fact, financial concerns are so great for the cancer patient that a piece on NPR with another one of those self-evident titles (here goes: It’s “Money Worries Keep Cancer Survivors From Getting Care”–I’m taking predictions) found that–well, many cancer survivors skip some kind of recommended treatment due to financial concerns.

Kathryn Weaver, a clinical psychologist at Wake Forest University Health Sciences led the study that found shockingly high numbers: perhaps as many as 2 million U.S. cancer survivors skipped necessary care over a three-year period due to financial reasons.

Their concerns don’t come out of nowhere. After initial treatment there can often be a number of financial changes in the cancer patient’s life. Many aren’t able to return to their old jobs at all. A number replace full-time jobs with part-time jobs due to decreased stamina, or take jobs that have fewer health benefits, since it’s all they’re up to at the time they return to the work force.

If they’re bad enough to cause the patient to skip requisite medical care, it’s clear that financial fears clearly plague the survivor, and add to his medley of worries.

About the only time losing is more fun than winning is when you’re fighting temptation. ~Tom Wilson

That clearly goes for losing your job, I’d say and thus enters another worry: many cancer patients fear being unable to keep their jobs. First is the fear that they simply won’t be able to keep up with work, due to their own debilitation. But other fears arise as well. What if the employer doesn’t believe the patient can do the job because of his illness, and would like to let him go? What if the boss wants to let him go because of the sharp increase in health insurance costs? What if the patient needs a number of days off for treatments, and the boss is not receptive?

I want to actually stop with this one and address it head-on. In this post I merely wanted to present some worries of those diagnosed with cancer–and validate their concerns. But here want to stick in my two cents, so no cancer patient is left without a job or believing he should quit because he’s not up to his old tasks, without knowing his rights.

If you have cancer, become familiar with the Americans with Disabilities Act (ADA). As long as you are qualified to do your job, your employer cannot discriminate against you just because you have cancer, even if it means the employer needs to be flexible in scheduling around your treatment needs.  Even more, if your cancer or your treatment interferes with your ability to do your former job, your employer is obligated to provide reasonable accommodations that will allow you to perform the basic duties of your job despite your temporary disability.

Reasonable accommodations include things like being reassigned to an open position, light duty, flexible hours, and possibly a period of leave time. Think to yourself if any of these adjustments could keep you working during your cancer treatments, if you would like to do so. They may make all the difference, and alleviate this particular concern.

Alternatively, the  Family and Medical Leave Act is another one worth getting to know. Under this Act, one can get up to 12 weeks unpaid weeks of medical leave in a year, either for oneself, or even to care for a seriously ill family member. There are restrictions on who gets the leave, but be certain to look into it.

We experience moments absolutely free from worry.  These brief respites are called panic.  ~Cullen Hightower

This list can’t possibly cover the worries that overcome a person when she receives a diagnosis of cancer–it’s not exhaustive. It doesn’t cover concern for family, worries about isolation, fear of abandonment. . .it just goes on and on.

But hopefully it can help give those without the illness just the smallest taste of the bombardment of fear and concern that occurs in the first few weeks after someone receives a cancer diagnosis–and allow them a taste of what life is like on the receiving end of such bad news. Then they can be more emotionally prepared to assist in what I think most people honestly want to do, despite muttering those real bloopers sometimes–shouldering their friend’s burden with her to try to prevent the fears crushing her spirit, before she even begins to fight.

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I help adults and adolescents through the particular struggles of our time: tension between couples, parenting frustration, blending new families, separation and divorce, (un)employment, cancer, and loss. When relationships come to an impasse, I use mediation techniques to try to ensure that each party will have his/her needs heard and accounted for in a dignified way. In addition to talking, listening, and reframing, I utilizes the tools of metaphor, active teaching, role-playing, visualization, and hypnotherapy.for families and businesses, as well as in cases of divorce.

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