Cancer diagnosis awakens many fears and emotions. Cancer is always a mental struggle, too. We discussed cancer with psychiatrist Irja Idman, who works at the HUS cancer clinic in Helsinki. A couple of hundred cancer patients visit Dr. Idman each year for professional support. According to her, it is vital that the patient does not become withdrawn and does not face the illness alone.

Prostate cancer
What are cancer patients afraid of?

“Cancer patients fear the suffering and pain as well as the loss of vitality and strength related to the illness and its treatments.”

“They also fear the resulting changes in the roles that are important to their sense of self-worth, the feelings of weakness and shame related to the illness and being left alone. The patient may also worry about losing love and appreciation. Underlying all the others is the greatest fear of all – the fear of death.”

“Each patient goes through these basic fears in an individual way, filtering them through their own perceptions and views. Earlier experiences in life play an important role in how patients experience fear.”
 
How can patients
cope with the illness?

“They should try to find as much information about the illness and its treatment as they possibly can. It is very important to receive case-specific information from doctors and other healthcare personnel.”

“With this information, patients can assess their preconceptions critically and correct any misconceptions to ease their fears. This also gives the patient some feeling of control over life to which the illness has introduced a great deal of uncertainty.”

“In a way, patients hold an internal, mental dialogue with their preconceptions and fears. The process could also be described as internal speech, in which structure is introduced to the more or less chaotic emotional landscape by conscious thoughts and information.”

As regards erotic life, what is most important is how well the patient can process these changes mentally.”

“It helps if the patient can share these thoughts with someone by vocalising them. The listener should remain neutral and avoid evaluating the mental landscape of the patient to any great extent. A suitable listener may be a close friend or a professional.”

How to prevent
depression?

“Patients should try to understand their own situation and maintain the feeling of control. It is very important to maintain the main social contacts, too.”

“They should avoid trying to stubbornly keep everything just like it was before the diagnosis, because illness does change things. However, it gives a good chance for re-evaluating personal values. Decide what is valuable and work to maintain what is important in your life.”

“Try to maintain the landscape of physical satisfaction, too, although treatments such as chemotherapy will make this more difficult. Exercise in general in all means that the patient’s current physical state allows is very important and helps prevent depression.”

“And last but not least ─ make sure you are not facing the illness alone!”

What is the role of healthcare personnel
and the doctor who diagnoses the illness?

“The healthcare personnel must be encouraging and supportive. But the doctor must also be realistic and avoid giving the patient a misleadingly optimistic prognosis or progress estimate.”

“Finding a suitable way to give this information to each patient is one of the most demanding tasks that the doctor faces when treating cancer patients. How to be encouraging and maintain hope when the illness is progressing to a point where it becomes untreatable?”

“Mutual trust, respect and openness are a big help. It is essential that the doctor can make the patient feel safe even under the most difficult situations and ensure that the patient has access to suitable care.”

When should a patient seek
outside specialist support?

“Patients should seek to get outside help if they feel stuck or unable to think about their situation.”

“Sometimes it can seem that they are facing a dead end or an unsurpassable wall. If the feeling lasts for weeks instead of just days, the patient should reach out and get outside specialist support.”

“The patient should also turn to cherished ones or seek professional help if they feel no joy in life and suffer from general lack of interest. They may find it hard to sleep, do not feel like getting out of bed at all or feel annoyed day in and day out.”

How important
are peer groups?

“Peer groups are very important for patients who are comfortable sharing their experiences. I consider peer groups an important means of erasing illness-related feelings of shame and maintaining the patient's sense of worth.”

What are the most common
family problems?

“The family and spouse in particular find it very difficult if the man of the house becomes withdrawn to an extent which makes it hard to know what he is thinking.”

“When this happens, the man often becomes irritated and even angry. It is very hard for the spouse if the man clams up and mulls over his bad feelings alone. It can also scare the children.”

“The man may be ashamed of his strong emotional reactions, but these are easier for the family to cope with. They give the family an opportunity to face the situation together and discuss it.”

What about
sexual challenges?

“Prostate cancer and cancer treatments may weaken the male libido. Many patients voice this concern by referring to themselves as former men. This expression carries many meanings.”

“Physical functional shortcomings can usually be overcome with modern means. As regards erotic life, what is often most important is how well the patient can process these changes mentally.”

“First, he needs to face the facts. After that, he should look for innovative new ways of doing things. The partner has an important role and can help the man feel masculine by being responsive and enticing. It is important to maintain the overall dynamic tension between the partners. Love carries us along!”

Text Matti Välimäki | Photo Istockphoto