Maggie's in the News - Cancer and the three stages of grief: where to find hope and how to lower your anxiety as you fight the disease
Keith Yip was 34 years old when he was diagnosed with stage 3 liver cancer in March 2017.
His first reaction was one of complete disbelief. He told himself that the diagnosis wasn’t real and tried to get a second opinion from other specialists.
He also feared how his wife of one year would take the news.
“She was distraught, to say the least,” says Yip, now 39, who works for a cleaning services company in Hong Kong. “I felt depressed thinking about how we’d pay our bills if I lost my ability to work, plus we were newly married and wanted to start a family.”
Over the following months, during which time he says he “faced reality”, Yip had surgery to remove the tumour in his liver. He thought that would put him in the clear, so he was shocked to learn in late 2017 that the cancer had returned.
He immediately underwent a series of chemotherapy treatments, which caused him a lot of pain and discomfort. The experience shattered his expectation of a recovery and left him feeling helpless and hopeless.
Every year, thousands of people in Hong Kong are diagnosed with cancer. According to the Hong Kong Cancer Registry, 35,082 new cancer cases were diagnosed in 2019, up from 25,977 in 2009.
It’s hard to feel hopeful after receiving a cancer diagnosis. And that’s even if we can accept that we have the condition in the first place.
“Many people think of cancer as something that happens to others, which is why a diagnosis can come as a shock, especially if the individual has very few symptoms and isn’t in any of the high-risk groups,” says Tam Korodi, a Hong Kong-based counsellor who specialises in health-related issues.
Because a cancer diagnosis is threatening and brings out anxiety about death, our brain will try to protect us by going into denial. We may believe there was a mix-up with our lab results and expect our doctor to tell us that he made a mistake. Once the shock and denial pass, we will start to grieve.
Speaking ahead of World Cancer Day on February 4, Korodi says the grieving occurs in three “time zones”: past, present and future.
“Grieving one’s present is focused on what’s happening now: pain, changes in lifestyle, treatments, operations, and so on. Grieving for one’s past involves grieving the loss of part of an old carefree self and a life free of worries. And finally, one grieves for a future that may never happen.”
During this emotional process, someone newly diagnosed may also experience a lot of anger. In the case of a terminal diagnosis, they may feel guilty for leaving their loved ones behind; regret not taking care of themselves better or earlier; feel fearful and anxious about the future; and experience sadness and hopelessness.
“Grieving is not a linear process, so I would expect people to vacillate between different stages and emotions before they come to what is often the final stage – acceptance,” Korodi says.
She adds that there’s no right way to process a cancer diagnosis, because we all have different coping styles. What usually helps is having time to grieve and to experience all the emotions – anger, guilt, fear, anxiety, regret, sadness, loneliness, hopelessness and so on – before arriving at the acceptance stage.
Writing your feelings in a journal or opening up to loved ones or a therapist may also help you process the news and arrive at the acceptance stage sooner.
When it comes to finding hope after a cancer diagnosis, it helps to remember that the disease isn’t always terminal.
“Advances in medicine mean that the death rates from cancer have declined by about 30 per cent over the past three decades,” Korodi points out.
“Obtaining more information about the diagnosis and prognosis, researching treatment options and consulting different professionals can all help a patient feel in control of their situation and reduce their anxiety. Ultimately, this may help with acceptance.”
Cancer support groups can be useful when you’re a cancer patient. Unlike family and friends, whose empathy and support you most certainly need, support groups are made up of people dealing with the same experiences. They can help you feel less lonely and provide practical support in the form of doctor recommendations and advice on life adjustments.
It might also help to receive counselling from a therapist who specialises in or has experience working with chronic and terminal illness.
“Sometimes you may have upsetting or angry thoughts and feelings that you can’t share with your loved ones because you don’t want to upset them or be misunderstood or judged. That’s why it’s important to be able to offload this emotional burden in a safe environment,” Korodi says.
Yip received plenty of support and encouragement from his wife, other family members and friends, as well as the staff at Maggie’s Cancer Caring Centre in Tuen Mun.
Cherie Lo Wen-chee, the head of Maggie’s, worked closely with Yip after he approached the centre for help. She gave him emotional support whenever he felt depressed or worried, comforted him when he suspected that the cancer had spread to his bones, and gave him information about medical treatments.
She stresses the crucial need for cancer patients to have hope as they deal with their illness.
“If you have advanced or terminal cancer, in particular, your future may seem uncertain. Hope is vital to stay alive and help you through your treatments. Hope is always supported by a positive mind. To feel positive, I recommend that patients set achievable goals and do things that bring them joy and satisfaction.”
If you’re struggling to feel positive after a cancer diagnosis, Korodi suggests focusing on what you can still do rather than on what you can’t, and thinking about what you still have rather than on what you feel you’ve lost.
It’s also essential to take a break from cancer, so talk about non-health-related topics, meet friends if you can and continue to do what you love. Find your “new normal” by making a list of everything in your life that’s still the same and everything that’s changed, Korodi says.
It’s key to accept that certain things may never be the same again, and to find new ways to live – for example, to come up with new ways to dress, try a new hairstyle or find new activities to enjoy.
Talking to Lo and attending Maggie’s workshops and programmes helped Yip feel more empowered and gave him the hope he needed to soldier on. He also started going to church, which strengthened his resolve to stay strong and keep up his cancer fight.
“My most recent scan was clear so I don’t need treatment for now but the fight isn’t over because I’m still experiencing the side effects of previous treatments, like back pain, liver pain and sensitive skin,” he says.
“I’ve realised that all I can do is live in the moment and face life with a positive spirit. I can’t worry about the future because it’s out of my control.
“Now, I just try to live well with my family and friends by my side, exercise and play music when I can, because I enjoy those activities a lot, and continue to have hope that this cancer will soon be gone.
“I try to be calm and cheerful and give thanks every day for what I’ve been blessed with.”