1. EMOTIONAL EFFECTS OF A CANCER
DIAGNOSIS IN YOUNGER WOMEN
Dee McKiernan (Cert, B.A., MSc)
Counselling Psychologist
St. Vincent’s university Hospital
September, 2012

2. OVERVIEW
• Responses to a Cancer Diagnosis
• Cancer and Younger Women
• Distress and Young Survivors
• Fertility, Body Image
• Typical Emotional Responses
• Re-evaluate
• Learning to Cope
• Top 5 things you can do
• Relaxation
• 3 sentiments

3. SCALING
Pick a number
between 0-10 that best
describes how much
distress you have been
experiencing in the past
week including today.
Adapted from the NCCN distress thermometer.

4. RESPONSES TO A CANCER DIAGNOSIS
• With the diagnosis of a chronic, potentially life-threatening
disease, such as cancer, individuals usually find themselves
in a condition of ‘crisis’, facing physical, social and
psychological challenges
• A Cancer diagnosis is one of the most emotionally
distressing events for patients throughout medical care
(Carlson, Speca, Patel, & Goodey 2004)
• Distress is very common in patients, yet often undetected.
• More depression symptoms, more negative affect in
younger women (Ganz et al., JCO, 2003)

5. RESPONSES TO A CANCER DIAGNOSIS
• While no woman wants to hear that she has breast cancer,
the physical and emotional effects can be devastating for
young women who may be less resilient, or whose lives are
focused on building job position or a family.
• A young woman diagnosed with breast cancer is also more
likely to question her own self confidence and feel anxious
about her personal relationships.

6. CANCER AND YOUNGER WOMEN
• Breast cancer challenges even the strongest woman’s self
esteem, it makes you question your body image and raises
issues in intimate relationships.
• Will I always be sick? How do I tell my boyfriend/partner
that I am losing my hair or missing a breast?
• What happens if my partner wants
children and the treatment renders me
infertile?
• These are very difficult issues for young
women, who often feel they face them
alone.

7. DISTRESS IN YOUNG SURVIVORS
• Receipt of more aggressive therapy
• Greater effects of disease or treatment on:
• Menopausal symptoms
• Fertility and family planning
• Genetic risk
• Role functioning at home and/or work
• Beauty and attractiveness
• Sexual functioning and intimacy

8. DISTRESS IN YOUNG SURVIVORS
• Distress among young women with breast cancer may be
further compounded by:
• Lack of information about the risks for many of these
issues
• Lack of provider awareness, information, and resources to
address young women’s issues with patients
• Lack of peer group support
• Lack of family support
• Lack of financial security

9. FERTILITY AFTER BREAST CANCER
• Very difficult issue for many young women when facing a
breast cancer diagnosis and treatment
• Much is known and much still
unknown
• Patient preferences critical factor

10. FERTILITY ISSUES IN YOUNG WOMEN
WITH BREAST CANCER
• 657 women average age 33 at diagnosis of breast cancer
• 57% of women recalled substantial concern at diagnosis
about fertility after treatment
• 29% reported that fertility concerns influenced treatment
decisions
(Partridge et al., J Clin Oncol, 2004)

11. YOUNG WOMEN WITH BREAST CANCER
• Young women with breast cancer
face a variety of unique treatment
and psychosocial issues at diagnosis
and follow-up
• Increasing attention to their unique
issues can improve care and
outcomes for this vulnerable
population
• Body Image – 8 – 10 months

12. • Throughout the cancer experience there are a series of
anxiety provoking stages:
• Suspicion that something is wrong
• Consulting GP
• ???
• Referral to an oncologist
• Waiting on the results
• Beginning a treatment regime
• Treatment outcome
• Fear of recurrence
• Return visit to the Oncologist
DISTRESS + STAGES

13. DISTRESS LEVELS & ILLNESS
TRAJECTORY
0
1
2
3
4
5
6
7
8
9
10
Diagnosis Treatment
Completion of treatment
End of Hospitalisation
Recovery
Fear of Recurrence
Survivorship
Further treatment
Illness
Column1
Column2

14. TYPICAL
EMOTIONAL
RESPONSES
ANYONE REMEMBER FEELING LIKE THIS....

16. TYPICAL EMOTIONAL RESPONSES
• The psychological effects of cancer are individual specific and
vary from person to person.
• These effects may occur upon diagnosis, during treatment, and
after treatment.
• Not all of the psychological effects are
negative, and some patients experience
a greater appreciation for life and
heightened spirituality.
• Some even flourish …

17. • Disbelief
• Disbelief is a common emotion that takes
over in patients following the initial
diagnosis.
• Patients sometimes refuse to believe what
they have been told as a way to soften the
blow of the diagnosis.
• Its our way of protecting ourselves from
the devastating news.
• Yet this denial can be a barrier to
appropriate and treatment if the patient is
unable to move past this and accept the
diagnosis.

18. • Fear
• Just the word “cancer” stirs up
fears in everyone.
• “What is going to happen to me?”
“Am I going to survive?”
• “How can I pay for all this
medical care?”
• Love, understanding and support
are essential to help calm you and
your loved ones fears.

19. • Anger
• Anger may stem from feelings of
“Why me?”
• The disruption of one’s life,
• One’s body,
• One’s social and professional goals.
• Discussing these feelings with
others who have been in the same
position as you can really help put
these feelings into perspective.

20. • Stress and Emotional
Upset
• Stress and anxiety are common
responses to a cancer diagnosis
• These emotional responses can also
become apparent with physical
symptoms such as difficulty sleeping,
loss of appetite, or headaches, and can
even affect the immune system.
• There are ways to reduce stress and
increase coping skills to help deal
with a diagnosis.

21. • Loss of Control
• A cancer diagnosis can make the
world seem beyond your control.
• I’m not in control of my body
anymore...
• Loss of the life you had before
diagnosis...
• You can help reduce these feelings of
powerlessness by exercising the
control you do have over your
situation.

22. • Guilt
• Some patients blame themselves
for causing worry or grief for their
family.
• Some worry that they have
become a burden both
emotionally and financially.
• Guilt and frustration about being
unable to do more to do more to
help the family.
• Resentful and impatient with the
course of the disease, the
treatment and related side effects.

23. • Aloneness
• Wanting to shut people out
• Not wanting to talk
• Tendency to Isolate
• Feeling alone
• Yet, seeking support from caring
friends can be a tremendous resource.

24. • Sadness and Depression
• Many cancer patients and their
families can experience some level of
sadness and depression.
• Persistent negative thoughts about
self / future
• Feelings of hopelessness,
• Inability to take pleasure from day to
day activities
• A sense that life has no meaning, are
part of the feelings you have when
dealing with cancer

25. BUT
It is important to note….
that high levels of distress
represent a
normal healthy adjustment reaction
to a cancer diagnosis...

26. You can’t stop the waves but you can learn how to surf....

27. • We can't change the fact that you
have had cancer.
• What you can change is how you
decide to live the rest of your life.
• Making healthy choices and feeling
as well as possible, both physically
and emotionally can make the
difference.
RE-EVALUATE YOUR LIFE...

28. GROUPWORK
SPEAK TO YOUR NEIGHBOUR, WHAT
ARE YOU ALREADY DOING TO HELP
YOURSELF….

29. • Coping is ongoing, often implicit
• You are not aiming for mastery - anxiety and stress cannot
be completely avoided
• It takes different forms and strategies, everyone varies
• There is no ‘right way’ to cope with Cancer
LEARNING TO COPE...

30. • Research tells us that psychosocial interventions for cancer
patients have shown very positive benefits.
• Top 5 components include the following:
1. Relaxation training
2. Cognitive and behavioural coping strategies.
3. Cancer education/information sessions.
4. Group social support.
5. Identify your own resources
RESEARCH AND TOP 5 INTERVENTIONS

31. RELAXATION TRAINING
• Take time out for you.... Learn to
put yourself first
• Relaxation
• Visualisation
• Learn to reward and Pamper
yourself
• Try to reduce your emotional
distress
• Play your favourite music
• Light a candle
• Mindfulness Meditation
• Medication

32. COGNITIVE COPING STRATEGIES
• Problem solving v’s worrying
• Start expressing yourself
• Writing offers a refuge ...Set a timer for 10 minutes. Write
until the time is up.
• Seriously consider therapy - patient & caregiver
• Alter your way of thinking
• Read CBT books...
• These strategies can all be very
effective in overcoming the negative
impact of a Cancer diagnosis

33. BEHAVIOURAL COPING STRATEGIES
• Distractions you enjoy - Football, Rugby, Sport, Painting,
Read a book, cinema, gardening, comedy, theatre, music,
drive, walk, golf, internet
• Tai Chi, Massage (touch therapies), Reflexology, Hatha Yoga,
Reiki
• Take a break, rest, consider a holiday
• Bring humour back into your life
• Meet friends, don't isolate
• Learn to accept help

34. CANCER EDUCATION /
INFORMATION SESSIONS
• Your at one!
• Increase your knowledge and understanding of the disease,
treatment options and side effects (REPUTABLE!!)
• ICS helpline, website, peer support service, Daffodil Centers.
• ICS Specialist Cancer Nurse
• Health care professionals - nurse, oncologist, clinical team
• Irish Cancer Society - http://www.cancer.ie/
• National Cancer Institute - http://www.cancer.gov/
• Cancer Society UK - http://www.cancersociety.com/index.php
• National Comprehensive Cancer Network -
http://www.nccn.org/index.asp
• American Cancer Society - http://www.cancer.org/

35. GROUP SOCIAL SUPPORT
• Family – educate them, offer suggestions
• Friends – be honest about how your feeling, ask for support
• GP, Health Care Professionals , Therapists, Community Groups,
Irish Cancer Society helpline, peer support, daffodil centres.
• Cancer support groups –meet other patients, online, peer
support groups
• Essential in fight against cancer
• Sharing concerns and talking to others
• Will help you cope over long periods
• They can be strong when you are not

36. • What are my physical strengths?
• high energy levels, sporty, and agility = exercise
• What are my emotional strengths?
• High self-esteem and confidence, humour and creativity
• How is my present lifestyle helping me cope?
• Housekeeper, shopping on line, babysitter, nutrition, sleep
• Highlight positives
• Start up a gratitude list – every day
• Remember its ok to feel whatever
you are feeling....
IDENTIFY YOUR OWN RESOURCES...

37. • Breathing, (1 – 4) (calm, fear)
• Relaxation
RELAXATION TRAINING

38. • Scale ???
• 3 sentiments to finish with...
Take your pick...
TO FINISH...

42. Dee McKiernan
Counselling Psychologist (Cert., B.A., MSc.)
Oscailt Integrative Health Centre
8 Pembroke Road
Dublin 4
http://www.oscailt.com
Ph: 01 660 3872 / 087 622 5011
Email: info@counsellingindublin.ie
Web: www.counsellingindublin.ie