Is it normal to feel distress when you have cancer?

Yes. The National Cancer Institute states that almost all people living with cancer have feelings of distress. Nearly half report having a lot of it.

Distress covers a wide range. At one end it is normal sadness and fear. At the other it is depression, anxiety, panic, uncertainty about spiritual beliefs, or feeling cut off from friends and family.

One finding surprises people: in general, the type of cancer does not change how much distress a person reports. What drives it is usually something else.

What actually raises the risk

NCI lists specific risk factors for high distress, and most of them are not about the tumor.

Trouble doing usual daily activities. Physical problems and treatment side effects such as fatigue, nausea, or pain. Problems at home. Unmet social and spiritual needs. Depression, cancer-related post-traumatic stress, or other emotional problems. Advanced-stage disease. A history of childhood abuse. Being younger, female, or non-White. Having less education.

Two things follow from that list. First, treating a physical symptom often lowers distress directly. NCI gives the example of medicine for nausea helping someone adjust to chemotherapy. Second, distress rises when the demands feel high and the support feels low, so adding support changes the balance even when the demands cannot be reduced.

Distress at diagnosis predicts distress later. People who start out with high levels are more likely to keep them.

The six points where it spikes

Distress is not evenly spread across treatment. NCI names the moments when people are most likely to need checking and support:

• Soon after diagnosis.
• At the start of treatment.
• At the end of treatment.
• During remission.
• If the cancer comes back.
• If the goal shifts from cure or control to relieving symptoms.

The end of treatment surprises almost everyone. Support drops away exactly when the structure of appointments disappears. During remission, distress often rises before follow-up visits, because waiting for results is its own stressor.

When it is more than adjustment

Normal adjustment means learning to cope with the emotional strain and solve the problems cancer creates. Most people get there.

An adjustment disorder is diagnosed when the reaction is more severe than the expected amount of distress, when it damages relationships or causes problems at home or work, and when it includes symptoms of depression and anxiety or other emotional and behavioral problems. That is a treatable condition with a name, not a personal failure.

Get help the same day for thoughts of harming yourself. In the United States you can call or text 988 to reach the Suicide and Crisis Lifeline at any hour.

What helps, according to the evidence

Your doctor should screen you by asking about how you feel, your energy, relationships, work, and finances. That screening is the door to a referral.

Studies show that people struggling to adjust are helped by relaxation training, counseling or talk therapy, cancer education sessions, existential therapy, and support in a group setting. The measured benefits are lower depression, lower anxiety, fewer cancer and treatment symptoms, and more hopefulness.

Antianxiety medicine can be used alone or with talk therapy, easing fear, dread, uneasiness, and muscle tightness, and often improving sleep. Our guide to anxiety and distress during cancer covers treatment options, and the piece on mindfulness and relaxation in cancer care covers techniques you can start on your own.

Sources

• https://www.cancer.gov/about-cancer/coping/feelings/anxiety-distress-pdq