For many people, a sense of relief accompanies starting treatment: “At last, I’m doing something to fight the cancer cells in my body.” Your initial uncertainty and anticipation are over, and you have renewed hope and the feeling of getting back in control of your life.

I feel sometimes as if I’m caught in a gigantic bunch of moving gears. I panic for a minute . . . then take a deep breath and realize things aren’t so bad. I’m actually coping well with a lot of stuff and the panicky feelings get back under control.

– Judy, a forty-year-old chef with leukemia, reflecting on her early treatment

It is only in quite recent years that oncologists . . . have begun to confront squarely the emotional impact of

[cancer and its treatment] and the fact that emotional states play a large role in the tolerability of treatment and, perhaps, in the outcome as well. . . . To many patients, stunned by the [cancer] diagnosis . . . it is like being trapped in the workings of a huge piece of complicated machinery.

– Lewis Thomas, M.D., physician-philosopher

Now begins the time of coping with the actual treatment. Waiting for your first treatment, you may feel a return of that fear of the unknown, which goes along with facing any new, unfamiliar, and potentially frightening experience. The “horror stories” we’ve all heard, of how difficult cancer treatments were in the earlier days can add to the fears. Surgery used to be more radical, meaning a bigger incision, more scarring, more pain, and a longer, more difficult recovery. Radiation doses were less controlled, causing more tissue damage, and chemotherapy was given without the medications that are used today to control the side effects of nausea and vomiting. One woman expressed it as, “Oh, yes, I had the chemo-terror!” This fear of what’s coming, which is often based on misinformation and misperceptions, can be greatly reduced by asking your doctor to walk you verbally through exactly what is going to happen, step by step, in advance, like a rehearsal for the main event. This exercise reduces stage fright, or “treatment fright.” When you are well informed about what you will go through, you can mentally prepare yourself for each event, becoming less fearful and more self-confident about dealing with each other.

What makes coping easier?

Several factors tend to make coping with cancer and its treatment easier-or harder. Factors that can help you cope:

Being a person who is . . .

Generally positive towards life

Able to make one day at a time, to deal with the immediate

Optimistic and unlikely by nature to feel helpless during a crisis

Able to meet a challenge (like treatment) head-on

Not prone to become highly stressed in the face of challenges (treatment)

Able to commit to a goal and “hang in” (fighting spirit)

Able to see the humorous side of negative things (“black” humor)

Having enough information about the treatment, its goals, and possible side effects.

Having a caring medical team that is supportive and reassuring.

Having a caring nurse who can interpret the doctor’s communications.

Having support from others (family, friends).

Having belief system or philosophy of life that gives meaning to stressful situations.

Seeking counseling to change behaviors or ways of coping that are counter-productive.

Factors that can hinder how you cope:

Being a person who is . . .

Generally negative toward life and its problems

Unable to think one day at a time and worries about the future

Pessimistic by nature and can easily feel helpless in the face of stress

Apt to try to avoid a challenge when possible

Prone to become nervous and distressed in the face of challenge

Reluctant to persist in the face of stress and can easily become overwhelmed and feel hopeless

Unable to see the funny side of a situation or to take oneself less seriously

Feeling inadequately informed about the nature of the treatment: the need for it and its goals and side effects

Having a medical team that communicates poorly and doesn’t convey a sense of caring

Feeling isolated, without a person with whom to share the stress

Having no personal philosophy of life or belief system that gives you perspective on adverse events

Personality and coping

Personality is first and foremost. It is clear that certain personality and coping styles augur well for coping effectively with treatment. They are largely enduring qualities that one simply has or doesn’t have. Each of us copes with crisis and adversity in a slightly different way, but if you tend to be optimistic in your outlook and to “see the glass as half-full” (or, even better, three-quarters full) rather than “half empty,” you’re apt to be less distressed and less likely to anticipate the worst. People cope better when they face a problem or crisis head-on, rather than try to avoid the inevitable or count on its going away (the old ostrich, head-in the-sand syndrome). Successful copers tend to feel challenged rather than thrown or defeated by a problem, and they believe they can master it. They also demonstrate a “fighting spirit,” committing themselves to a goal, hanging in, and following through.

Don’t despair if you weren’t born with these traits. Your cancer doesn’t know it. Your personality traits affect how you behave, not how the cancer behaves. Some people seem to be born pessimistic, just as others seem like born alarmists or complainers; that’s how they see the world and it’s how they let off steam. People with these so-called negative characteristics can also get through cancer and survive it well. If you fall into this category or find it hard to hang in through tough times, you need to compensate by getting extra support from friends, family, your oncology team, or a counselor. Talking with a cancer survivor who has gone through the same treatment can be helpful; someone who is living proof that you can make it becomes a beacon of hope. (The OCF message board for example.) Practical advice from survivors has a credibility that other people’s advice lacks, because you know they have been there. Many hospitals and cancer centers have peer counseling programs, in which survivors of the same cancer you have are available to talk with you about what to expect as you go through treatment. If no such program is available, ask if you can talk with someone who has had the same cancer you have.

If you have traits that might lead to poor coping, it is important to be alert early in your treatment to how you are doing. Ask for help, since some of these negative coping styles can be turned around, making it easier for you to go through your treatment. Psychological help is available through individual sessions or in groups with other cancer