Ask The Doctor: Finding Your “New Normal”: Adjustment after Cancer
by Diana Price
Q: We often hear the termnew normalto describe life on the other side of a cancer diagnosis. Can you explain how this term might apply to a woman’s psychological or emotional state in the wake of a diagnosis?
A: Cancer is such a jarring diagnosis to receive, and more often than not the days, weeks, and months that ensue are far from any woman’s “normal.” Finding that “new normal” begins once the crisis of diagnosis and treatment subsides. Typically, diagnosis itself is a shock, and the treatment—whether it is radiation, chemotherapy, or more-radical surgery—presents its own constellation of factors to which to adjust. It is during this crisis period that I often see women struggling with depressed mood and anxiety. It is after the shock of diagnosis and the experience of treatment that women start to familiarize themselves with their new normal. Finding and adjusting to this new normal often involves adjusting to one’s current physical appearance, accepting the body’s current capacities, acknowledging any cognitive changes, and appreciating how diagnosis and treatment have affected relationships with others.
Q: Each cancer diagnosis is obviously unique, as is each woman who is diagnosed, but are there some key, common issues that arise for women when they face a cancer diagnosis and treatment?
A: Yes. The first concern on many women’s minds is survival: What does this diagnosis mean? What is the prognosis? Given the overall increase in survivorship statistics, however, issues pertaining to family and relationships, body integrity, and career and finances often take center stage shortly after diagnosis. Relationship shifts typically occur as the woman becomes the identified patient and her partner, family member, or friend takes on more of a caregiver role. More specifically, women with children are concerned about their children’s perceptions, how to talk to them, what to share, and how to provide support and reassurance. Women also voice concern about how their illness, treatment, and incapacitation will affect their partners. In addition to coping with diagnosis, women are also faced with treatment—some relatively free of side effects and others that will leave permanent evidence of their work. Many women experience hair loss and skin changes with chemotherapy and radiation. These changes can be experienced as mild, temporary side effects or devastating losses. Women who undergo mastectomies, hysterectomies, oophorectomies, and other relatively radical procedures must cope with the loss of a very concrete and tangible aspect of their feminine identity. And, finally, the toll that illness, treatment, and recovery can exact on income and professional identity is not insignificant.
Q: Are there steps that women can take to help cope with the issues that arise during this time?
A: Absolutely! When a woman is initially diagnosed, she is likely to experience a litany of emotions—anything from shock to despair to fear to anger. First and foremost, it is important that she feel confident and comfortable with her treatment team. If she copes better with more information, she should look for a collaborative, working relationship with her providers. If she finds that more information makes her too anxious or that she becomes confused or overwhelmed, she and her caregivers should seek a doctor who can metabolize the information in a way that feels less threatening. Second, a solid support system is tremendously helpful, even for those women who pride themselves on self-sufficiency or who are perhaps loathe to “burden” others. Support is essential and can take the form of family, partner, neighbor, friend, treatment team, or social worker. Within the treatment team, many cancer treatment centers espouse a whole-patient focus, meaning that the woman’s medical, nutritional, psychological, physical, and occasionally various financial needs can be addressed and supported in one place.
If a woman feels particularly overwhelmed, anxious, or hopeless, I would certainly encourage her to share her feelings with her physician or nurse and to request a referral for a therapist. It can be so comforting to simply share with another person, someone who can help you talk through your experience, to process the upcoming changes, and to problem-solve as to how to find that new normal. It most certainly is a process, and therapy can be an invaluable tool in a woman’s toolbox.
Q: How can caregivers or partners help women through this time?
A: Support is incredibly important at all stages of diagnosis, treatment, and recovery. Support can take all different forms. For some it may be arranging transportation, attending appointments, or assisting with tasks of daily living; for others it may simply be the touch of a hand or a silent but supportive presence. A cancer diagnosis and treatment challenge us to ask for what we need. If we can identify and articulate our needs without getting too mired down in feelings of guilt, this can be incredibly beneficial to us as well as our caregivers. Our partners, family, and friends who are there to support us want to be helpful, useful, and effective, and to that end we can give them the opportunity by communicating our needs.
Another essential tool for caregivers is to seek support themselves. All too often caregivers care for others at their own expense, without considering that by ignoring their own needs for sleep, pleasurable activities, and support, they are in fact compromising caring for both themselves as well as their loved one. It is essential that caregivers take care of themselves and seek additional support as needed. Similarly, these resources can be found in many cancer treatment centers.
Lindsay Sortor, PsyD, is the senior psychologist at the Penn Center for Women’s Behavioral Wellness and a clinical assistant professor of psychology at the University of Pennsylvania. Her areas of expertise include psycho-oncology and reproductive psychology. Her practice focuses on women at all stages of cancer diagnosis, treatment, and remission as well as caregivers. Additionally, she sees women in various phases of infertility, pregnancy, and motherhood, many of whom have faced the potential for infertility in the context of a cancer diagnosis and treatment.