When family physician Brian Koffman, MDCM, noticed a few lumps on the back of his neck in 2005, he didn’t think much of them. He ordered some blood tests on himself, just in case.
Within a week, Dr. Koffman learned that he had a particularly aggressive type of chronic lymphocytic leukemia (CLL), a cancer of the blood and bone marrow. He knew enough about CLL to realize his outlook wasn’t good.
“I had this disease that’s incurable, that had no good treatments, and that had a terrible prognosis,” he recalls. “It was a very difficult time for me emotionally.”
So many worries ran through his mind. Would he live to see all four of his children get married? Would he get the chance to meet his grandchildren?
“We all know that we’re going to die,” he says. “But for me, it [suddenly] became very real.”
The Emotional Whirlwind of a Cancer Diagnosis
Fear of dying tops the list of worries people experience after a cancer diagnosis, says Kathleen Ashton, PhD, a clinical psychologist and director of behavioral health for the Cleveland Clinic Breast Center in Ohio. “Although many cancers are very treatable …patients often think of [death] first,” she says. They also worry about their treatment — what side effects it might cause, and how it will affect their family and job.
And that’s not all. A whirlwind of other emotions and thoughts can follow a cancer diagnosis, Dr. Ashton says. One of the first is denial: “Is this really happening to me?” Some people feel guilty for skipping their mammogram or eating the wrong foods. Others are angry at being diagnosed with cancer when they thought they’d done everything right to be healthy.
One feeling people might not expect after a cancer diagnosis is numbness. “The emotions are so intense that your brain flips the switch and protects you from feeling almost any of it,” says Margaret Pendergrass, LCSW, a certified grief counselor in Roswell, Georgia. “It’s actually healthy. Your brain is doing what it’s supposed to do and protecting you from really overwhelming emotions.”
When Your Emotions Affect Survival
While it’s normal to feel strong emotions after your diagnosis, these feelings can sometimes intensify to the point where they affect your odds of surviving.
When Brittany Clayborne, PsyD, was diagnosed with stage 4 lymphoma in 2018, just one year after having a heart transplant to treat heart failure, she cycled through feelings of fear, frustration, anger, doom, and hopelessness. She grieved over the loss of her hair, and her former self. She worried about her 8-year-old son. “I didn’t want him to watch me go through this,” she says. “I was ready to give up.”
People with cancer are 5 times more likely to be depressed than those without it, according to studies. They’re also more likely to contemplate suicide, especially when they don’t have good social support, finds a study in JCO Oncology Practice.
Being depressed increases the risk of dying, not only from cancer, but from all causes. Researchers don’t know exactly why this is, Ashton says. “It could be that they’re less adherent to their treatments. It could be that they engage in less healthy lifestyle habits if they are depressed.”
Whatever the reason, it’s important to get mental health treatment, she says.
Where to Find Support
A good support system is important for buffering the emotional effects of a cancer diagnosis. But where can you find it?
Your oncologist will manage your cancer treatment, but they won’t necessarily address your mental health. Koffman says he was asked obligatory questions, like “How are you doing?” and “Have you ever thought about harming yourself or others?” Beyond that, he says, “I was never really offered any social or emotional support.”
You may have to take the first step. Tell your cancer team you need to talk to someone, Ashton suggests. They can connect you with the right mental health professional — a psychologist for talk therapy, a psychiatrist to prescribe antidepressant medication, or a social worker to offer counseling and connect you with resources in your community.
Family and friends can be another source of support. Koffman says he wouldn’t be alive today if it weren’t for his wife. “She essentially put her life on hold to support me and help me get through it.” Dr. Clayborne’s mother took her back and forth to chemotherapy appointments and cared for her afterward.
Yet, even those who love you most may not fully understand what you’re going through. “I needed someone to sit across from me and say, ‘I know how you feel,’” Clayborne says. “I know what it feels like to touch your head and your hair falls out. I know what it feels like to want so badly to sit up, but your body just will not do it.”
One place where you can find that level of understanding is at a cancer support group. “If you can find a support group for other people who also have your diagnosis, they might be some of the few people who actually do get it and can relate,” Pendergrass says.
Coping Strategies and How to Deal With Your Emotions
How you cope with your cancer diagnosis will determine how well you adjust to your new reality. The most important thing when you have a cancer diagnosis is to give yourself permission to feel every emotion — even unpleasant ones like sadness, anger, and fear.
Holding in your emotions is like trying to keep a beach ball underwater, Pendergrass says. “Eventually that beach ball is going to slip out and pop out of the water. That’s your emotions,” she says. “Suddenly you’re lashing out at your friends and family. You’re socially isolating yourself. You’re behaving in all these ways you don’t want to, just to keep yourself from feeling the emotions that you really need to feel.”
One of the many things that cancer takes from you is control over your own life. Being more intentional about the way you respond and how you show up each day — as a patient, as a parent, as an employee, and as a friend — gives you some of that control back, Pendergrass says.
Having cancer is hard. Be gentle with yourself. Care for your mental health using the approaches that work best for you. Ashton recommends exercise to her patients because it’s a natural antidepressant.
You might also try relaxation techniques like guided imagery, muscle relaxation, mindfulness, or prayer. These practices keep your mind grounded in the present. That’s important, because when you have cancer, your brain typically fast-forwards to worry about what happens next, or rewinds to wonder what you did in the past that caused your cancer.
“The ability to stay present, to notice what you’re feeling in your body, what’s happening in the moment, can keep you out of those two other places that really aren’t helpful,” Pendergrass says.
After taking part in multiple clinical trials of new CLL treatments, Koffman is in remission. He’s seen three of his kids get married, welcomed three granddaughters, and cofounded the nonprofit organization CLL Society. “The chance of me living five years was about 1 in 20, and now I’m 17 years out,” he says. “I’m thrilled with how I’m doing right now.”
Clayborne found her path to self-healing through helping others as a therapist, author, and speaker. “There were so many times that giving up seemed like a viable option,” she says. “I wrote letters to my son for every birthday [to come in the future], because I didn’t think I was going to make it through heart failure and cancer. And every single year that I wake up on his birthday and get to rip up one of those letters, it’s like being reborn again. It’s like being reminded that this is all a gift.”