Coping With Cancer
Coping with Cancer Surgery:
The "Psychology" of Chemotherapy
Chemo gets a bad rap. There are now over 90 different chemotherapy drugs, some of which have many side effects and some of which do not. Most chemo regimens are given in cycles: every day for a week or two, then off for a week or two, or some combination thereof. Hence, you may experience fatigue immediately after a treatment but then experience an upsurge of energy during your week off from chemo. These cycles of treatment can last up to 6 months or longer.
Cancer chemotherapy (also referred to as "anti-neoplastic" or "cytotoxic" drug therapy) is used for five things:
- To cure cancer
- To keep it from spreading
- To slow its growth
- To kill cells that may have spread to other parts of the body
- And to relieve pain.
One of the most promising developments in chemotherapy has to do with the recent FDA approval (May of 2001) of a new Leukemia drug called, "Gleevec." In one study, it was shown to have helped "more than 90 percent of patients" with a rare form of leukemia. Gleevec works by blocking chemical signals sent by one cancer cell to another. Health and Human Services Secretary Tommy Thompson said the drug is based on the principle of "molecular targeting," killing leukemia cells while leaving normal white cells alone. "We believe such targeting is the wave of the future."
Chemotherapy: What Is It and How Does It Work?
We now know what has to take place for cancer to develop. First, an abnormal cell has to get past your immune system and appear in your body. A malignant tumor is an abnormal cell that can survive ANYWHERE in your body, hence making it more dangerous. The malignant tumor continues to divide and subdivide in rapid succession after it should have stopped. It can't "turn off." It is the malignant tumor, that chemotherapy drugs have been designed to kill.
If you have been diagnosed with cancer, and your oncologist is thinking about putting you on chemotherapy, I recommend that you ask your doctor the following National Cancer Institute questionsquestions from the soulbefore deciding whether or not to go on chemo:
- Why do I need chemotherapy?
- What are the benefits of chemotherapy?
- What are the risks of chemotherapy?
- Are there any other treatments for my type of cancer?
- What is the standard care for my type of cancer?
- Are there any clinical trials for my type of cancer?
- How many treatments will I be given?
- What drug or drugs will I be taking?
- How will the drugs be given?
- Where will I get my treatment?
- How long will each treatment last?
- What are the possible side effects of the chemotherapy?
- When are side effects likely to occur?
- What side effects are more likely to be related to my type of cancer?
- What can I do to relieve the side effects?
- Are there any side effects that I should report to you right away?
- Are there foods or drinks that I should avoid while taking this medication?
- Are there printed instructions and drug information available for me to take home?
- And, how do I contact you after hours?
Chemotherapy drugs "aim" to destroy rapidly dividing cells. Unfortunately, this not only includes rapidly dividing cancer cells, but other fast replicating cells as wellespecially your hair cells, blood cells and cells in your digestive tract. These too are "hit" by the chemo. Because of this, all of the cancer chemotherapy drugs have the potential (not a guarantee, and each person reacts differently, but a potential) to cause one or more side effects. In knowing this ahead of time, you can learn to soulfully side step, in your dance with chemo, the more problematic manifestations of these adverse drug effects by being prepared and being "in the know."
For example, such side effects could include a decrease in white blood cells called neutropenia (normal white blood cell count [WBC] is between 4,000-10,000) which could cause infections; a decrease in red blood cells called anemia (normal red blood cell count [RBC] is between 4.0 and 6.0) which can lead to a lack of energy; a decrease in blood platelets leading to bruising (normal platelet counts are usually between 150,000 and 450,000); as well as nausea, vomiting, tingling, numbness, mouth sores, loss of hair, skin rash, dizziness, drowsiness, taste changes (such as a metallic taste in your mouth), and blurred vision.
Strategies to Cope With Chemo Anxiety and Side Effects
Research has shown that if you have a history of motion sickness or aversion to certain food odors, you will tend to be more nauseas and experience more vomiting before or after getting chemotherapy. Those of us who are highly anxious will also tend to have more problems with chemotherapy.
For example, one research study showed that highly anxious chemotherapy patients suffered twice as much (18.1%) "anticipatory nausea"nausea from being worried about getting chemothan did mildly anxious patients (9.8%).
Psychologists believe that those of us who undergo chemotherapy and appraise the process as "threatening," or who are unprepared to cope with its demands, will be more likely to experience a "negative outcome," than those of us who view chemo as a challenge or an ally, as Randy Stein did.
Between 25%-65% of us who undergo chemo will develop a phobic-like fear of it. The term phobia comes from the Greek term, phobos, which means "flight," or "terror." The most potent trigger for "anticipatory" anxiety is when the nurse cleans our skin with rubbing alcohol just prior to giving us the chemo. Just like Pavlov's dogs who learned to salivate to a tone that preceded food, we cancer patients, after four or five chemo treatments, begin to feel nauseas or dizzy in response to the alcohol or the nurse's perfume. These reactions can be either "clinic specific," limited to the actual chemo room, or "pervasive," occurring throughout the entire day prior to receiving our chemo treatment.
Therapy for Chemo Phobia
Behavior therapy, cognitive-behavioral therapy, hypnosis, progressive muscle relaxation and biofeedback are the most common ways that therapists like myself treat anticipatory nausea or chemo-phobia. In behavior therapy, I would attempt to eliminate your fear by modifying your behavior. With cognitive-behavioral therapy, I Larry would attempt to challenge and modify your fear producing thoughts. My initial goal would be to get you to remain relaxed when simply imagining that you are going to the chemo office. Then I'd gradually expose you to the actual chemotherapy session that you fear, while helping you remain relaxed by having you do some deep breathing from your lower stomach and muscle relaxation exercises.
Also, as in the preceding chapter on surgery, this is a perfect time to use your SANITYMatrix and the Transformational Grid with the 14 Pods of Healing. This will go a long way in helping you bring down your anticipatory anxiety regarding chemo while again, helping you focus on getting through the assault on your being that some chemotherapy drugs can cause. I am including another blank SANITYMatrix for you to use at the end of this chapter.
Many times, you will find yourself thinking in distorted ways that help maintain your fear of chemotherapy. There are four common ways to distort your thinking. They are:
- All-or-nothing/black-and-white thinking: You see things in extreme. ("Too feel good, I will avoid all treatment. If I go and get chemo, I will be constantly throwing up and in pain.")
- Overgeneralization: You take one event and apply that experience to all other like experiences ("My cousin's neighbor passed out, threw up, and experienced repeated infections when she underwent chemo. All chemo drugs are painful and dangerous to all people with any kind of cancer.")
- Disqualifying the positive: You reject positive experiences by insisting that they "don't count:" ("That one nice lady at the hospital who said she never threw up or had pain with her chemo must have been a fluke! Chemo is not like that.")
- And, Magnification and minimization: You exaggerate the importance of negative characteristics while minimizing the positive. ("Although Susan had energy to go places and could eat small meals, look how much she naps. See, that's the sneaky way chemo gets to you.")
My Recommendations For Getting Through Chemo
For the counselor or therapist who is treating a cancer patient with chemo phobia, I'd recommend that you help your client reframe their situation from seeing chemo as poison to viewing chemo as a "friend." Help your client be a part of the decision making process regarding their treatment. And help your client with "skill acquisition," (e.g., distraction, relaxation, counter conditioning, calming and reassuring imagery and so on), to help alleviate some of the undesirable effects of the various treatments.
For you--the person with cancer-- I'd recommend that you give yourself permission to "lean on" others, as a sort of return on your investment from having given all these years when your were healthy and fit. While on chemo, you should avoid big meals, drink liquids an hour before or after meals, eat and drink slowly, stay away from sweet, fried or fatty foods, eat foods at cold or room temperature to avoid strong odors inducing nausea, and chew your food well for easier digestion.
If nausea is a problem in the morning, try eating dry foods like cereal, toast or crackers, or drink cool, clear, unsweetened fruit juices and suck on ice cubes, mints or tart candies. Breathe deeply and slowly when you feel nauseated. Distract yourself by chatting with friends, listening to music, or TV. When possible, take a walk before meals; this may make you feel hungrier. Try changing your mealtime routine. For example, eat by candlelight or in a different location. Eat with friends or family members. If you live alone, you might want to arrange for "Meals on Wheels" or a similar program to bring food to you. Ask your doctor, nurse, local American Cancer Society office, or the Cancer Information Service about these programs. And, avoid eating for at least a few hours before getting your chemo treatment.
It is my hope that in reading and using these coping strategies, you too can make chemo your "ally," and reduce the severity of whatever treatment related side effects you experience while increasing the odds of curing your cancer once and for all.