Emotional Distress and Cancer

Just as cancer affects your physical health, it can bring up a wide range of emotions you're not used to dealing with — and make familiar feelings more intense. They may change daily, hourly, or even minute to minute, whether you're in treatment, done with treatment, or caring for someone who is. The National Cancer Institute is direct about this: these feelings are all normal.

There is no one right way to cope. Some people feel they have to stay strong for their families; others turn to loved ones, other survivors, counselors, or their faith. What matters is doing what's right for you — not comparing yourself with others.

• Overwhelmed. When you first learn you have cancer, it's normal to feel like life is out of control — routines are disrupted, and medical terms fly by. Learning about your cancer and asking questions can help you feel more in control.
• Fear and worry. About pain, about looking or feeling different, about family, bills, work, and dying. Most people feel better when they learn the facts; some fears come from stories or wrong information.
• Stress and anxiety. Worry over insurance, rides, work, and daily routines is common. Anxiety can show up in the body: rapid heartbeat, headaches or muscle pain, appetite changes, upset stomach, feeling shaky or dizzy, sleeping too much or too little, or trouble concentrating. Tell your doctor about these signs — they're common with stress, but your team will want to rule out medicines or treatment as the cause.
• Anger. "Why me?" is a very normal question. Anger often stands in for feelings that are hard to show, like fear or helplessness. It's not healthy to keep it inside.
• Sadness and depression. Many people feel a sense of loss — of health, and of life before diagnosis. For some, painful feelings grow stronger and get in the way of daily life. That may be depression, which is common in people with cancer, and which can be treated.
• Loneliness and guilt. Friends may not know what to say; you may feel that no one understands, or blame yourself. NCI's reminder: having cancer is not your fault. No one knows why some people get cancer and others don't.
• Hope and gratitude, too. Once treatment becomes routine, many people feel real hope — millions of people who have had cancer are alive today — and some find new appreciation for small joys.

Depression is a medical condition, not a character flaw. Signs include sadness that doesn't go away, feeling helpless or hopeless, losing interest in things you used to enjoy, crying often, trouble concentrating, sleep changes, fatigue that doesn't lift, and thoughts of hurting yourself.

Your doctor may suggest medicine, refer you to a mental health expert, or both. NCI's advice: don't feel you should have to control these feelings on your own.

• Call 911 or go to an emergency department if you are thinking about ending your life and feel you might act on it, or you have already hurt yourself.
• Call 911 or go to an emergency department if you are so frightened, agitated, or confused that you cannot keep yourself safe.
• Call, text, or chat 988 right away if thoughts of suicide are in your head at all, even without any plan. The 988 Suicide and Crisis Lifeline answers 24 hours a day, every day of the year, and you do not need to be in danger that minute to use it. Tell your care team as well, but reach 988 first — do not sit on it waiting for a clinic to call back.
• Call your care team the same day if you have stopped eating, drinking, or taking your cancer medicines because of how you feel.
• Call your care team within a day or two if signs of depression have been with you for more than 2 weeks. Some of these symptoms come from physical problems or from medicines, which is exactly why they are worth raising.

• Counseling and support groups. Ask your doctor, nurse, or hospital social worker to suggest a counselor, an in-person or online support group, or a class that teaches ways to manage stress.
• Practical stress. Insurance, costs, rides, and help at home are real sources of distress — raising them early with your team or the hospital billing office can lighten the load.
• Physical side effects. Pain, fatigue, and other side effects can drag emotions down. Managing them often helps you feel better mentally, too.

NCI describes strategies people find helpful: expressing feelings by talking or writing them down; not blaming yourself; not forcing yourself to seem upbeat; choosing when (and whether) to talk about your cancer; relaxation practices like meditation and guided imagery; gentle activity such as walking, stretching, or yoga; hobbies and creative outlets; and focusing on what you can control — your questions, your appointments, your daily schedule, and the parts of life that bring you joy.