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Cancer as Trauma: How to Best Support Patients Through the Trauma of Treatment

By Lauren Brailey, LMSW

Trauma is defined as an emotional response to any difficult life event, such as exposure to threatened or actual death, and can result in shock and denial in the short-term and emotional distress, depression, anger, distorted thought patterns, relationship conflict, and physical symptoms in the long-term.1

A cancer diagnosis and treatment can constitute a trauma for many people. Knowing about the ways in which trauma affects us can help providers and loved ones deliver better care to those undergoing cancer treatments.

Effects of Trauma

For some, receiving the news of a cancer diagnosis can be a shock and result in feeling stress, shame, and anger. It may take weeks or months for the newly diagnosed patient to fully integrate their cancer diagnosis into their sense of self, and this transition period can be a difficult time for them and their loved ones. This experience may look different for each individual. Factors such as location of the cancer, the value or importance of the cancer site to the patient, and how much the diagnosis affects their physical and cognitive functioning will impact how the person perceives and experiences this new change.

In the early stages, many people will experience relationship changes and conflicts, dependency issues, work or school disruptions, and an altered sense of self and body image. Cancer treatments that require surgery or the removal of a body part can increase body image disturbances and result in long-term consequences. Cancers that affect the reproductive organs can similarly cause disruptions in how a person identifies with his or her gender and self-perception. If fertility and intimacy are affected, additional issues related to parenthood, self-worth, and life trajectory can complicate the treatment process.2

In the long-term, the loss of autonomy, independence, or cognitive functioning can have profound and lasting effects on cancer patients and their loved ones. A cancer diagnosis and treatment can often cause physical changes, including pain, discomfort, and overall weakness and fatigue. Cognitive impairments may be caused by chemotherapy (also known as “chemo brain”), the location of the cancer, or metastasis to the brain or spinal cord.

Take, for example, Linda*, a woman in her mid-50s diagnosed with breast cancer, has a history of trauma and neglect. As a child, she was often sick and in the hospital with various types of infections and colds. Her parents were not emotionally equipped to soothe young Linda or themselves, and were often anxious, angry, and made Linda feel as though she were defective and weak. Now, her diagnosis is bringing up many of those childhood fears and vulnerabilities. Physically, her chest tightens and her shoulders slouch forward, similar to how she presented when being scolded by her parents as a child. She experiences intense anxiety around undergoing treatments and fears her mortality, even though she has a treatable cancer.

Even after treatment is completed, patients with cancer and their loved ones may have to adjust to a “new normal,” or a new way of life to accommodate the changes caused by treatment. Healthcare providers can help by providing patients and caregivers with the tools they need to restore their functioning as much as possible and facilitate adjustment to their new circumstances. 

Trauma-focused Interventions

It’s important for healthcare workers to be aware of the short- and long-term effects a cancer diagnosis can have on a person’s emotional, mental, and physical wellbeing. A strengths-based approach is one that focuses on the personal strengths of the patient to rebuild their self-esteem and confidence during this process.3 Breathing exercises, music, or art can to help calm someone if they are in distress.
Research shows that trauma produces physiological changes in the brain, including a recalibration of the brain’s alarm system and an increase in stress hormone secretion. This is why traumatized individuals often become hyper-vigilant or preoccupied with the possibility of a new threat.3 Physical touch can be a trigger for traumatized patients, and it’s important for healthcare providers to be mindful of how touch can impact these individuals. Asking questions about triggers or past or current traumas can help doctors and nurses provide the best possible care for their patients.

Providing resources that can assist patients with home care, counseling, support groups, financial and co-pay assistance, cleaning, meal delivery, medical equipment, etc. is another important intervention medical providers can utilize to help assist cancer patients and their loved ones. A cancer diagnosis affects almost every aspect of a person’s life, so making sure they are well-supported emotionally, financially, and practically will help them cope more effectively with their treatment regime and the physical and emotional changes taking place.

Lastly, educating family members and friends about how to best support the patient can help loved ones to feel more involved and provide them with some direction about how to be supportive. CancerCare can provide both emotional and financial support for both patients and their loved ones and referrals to local resources. Encouraging patients and caregivers to seek out support from professionals, friends, and family can help everyone involved to feel less alone and build a meaningful support network to help them through this difficult journey.

References
 
  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). 2013. Arlington, VA: Author.
  2. Messner C, Kornhauser C, Canosa R. The biopsychosocial implication of the site of the cancer, In Christ, G., Messner, C., & Behar, L. eds. Handbook of Oncology Social Work: Psychosocial Care of People with Cancer. 2015. New York, NY: Oxford University Press.
  3. Van Der Kolk B. The body keeps the score. New York, NY: Penguin Books.

*Names changed to protect client’s confidentiality
 
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