Post-traumatic stress syndrome (PTSD) may occur when an individual has been exposed to a traumatic event and responds with fear, helplessness, or horror. It is now recognized that a small percentage of patients being treated for cancer experience PTSD. The trauma-related symptoms in patients with cancer have been under increasing study. Individuals with a history of PTSD are at a substantial risk for continued emotional difficulties so it is encouraged that these patients receive timely and effective treatment for this syndrome.

It is difficult to recommend a “best therapy” approach for PTSD. Most clinicians recommend a multimodality approach, using components of therapy that meet the specific needs of each patient, taking into account any concurrent psychiatric disorders such as depression or substance abuse.

A crisis intervention approach is often recommended in order to facilitate the adjustment of patients experiencing cancer. In this approach, the therapist takes an active stance focusing on problem resolution, teaching specific coping skills, and providing a safe and supportive environment. Cognitive-behavioral approaches have proven very effective. This approach includes the former in addition to the use of relaxation techniques, restructuring cognitions or negative thoughts, and providing exposure to opportunities that provide systematic desensitization of the symptoms being experienced. Support groups have also been shown to benefit people who experience PTSD. In the group setting, patients can receive emotional support from others who have experienced similar symptoms, thereby validating their own feelings and learning coping strategies from others.

For patients with severe symptoms, psychopharmacology may prove effective. Antidepressants may be used when the symptoms of depression occur with PTSD. Antidepressants are also useful in decreasing the hyperarousal and intrusive symptoms that often accompany PTSD. Antipsychotic medications may reduce flashbacks and antianxiety medications may help reduce arousal and anxiety. Therefore, the best therapeutic approach to PTSD may be a combination of therapies tailored to the individual’s experiences and symptoms. Most importantly, therapeutic intervention is highly recommended for any person experiencing any of the symptoms associated with PTSD. Post-traumatic stress syndrome (PTSD) may occur when an individual has been exposed to a traumatic event and responds with fear, helplessness, or horror. It is now recognized that a small percentage of patients being treated for cancer experience PTSD. The trauma-related symptoms in patients with cancer have been under increasing study. Individuals with a history of PTSD are at a substantial risk for continued emotional difficulties so it is encouraged that these patients receive timely and effective treatment for this syndrome.

It is difficult to recommend a “best therapy” approach for PTSD. Most clinicians recommend a multimodality approach, using components of therapy that meet the specific needs of each patient, taking into account any concurrent psychiatric disorders such as depression or substance abuse.

A crisis intervention approach is often recommended in order to facilitate the adjustment of patients experiencing cancer. In this approach, the therapist takes an active stance focusing on problem resolution, teaching specific coping skills, and providing a safe and supportive environment. Cognitive-behavioral approaches have proven very effective. This approach includes the former in addition to the use of relaxation techniques, restructuring cognitions or negative thoughts, and providing exposure to opportunities that provide systematic desensitization of the symptoms being experienced. Support groups have also been shown to benefit people who experience PTSD. In the group setting, patients can receive emotional support from others who have experienced similar symptoms, thereby validating their own feelings and learning coping strategies from others.

For patients with severe symptoms, psychopharmacology may prove effective. Antidepressants may be used when the symptoms of depression occur with PTSD. Antidepressants are also useful in decreasing the hyperarousal and intrusive symptoms that often accompany PTSD. Antipsychotic medications may reduce flashbacks and antianxiety medications may help reduce arousal and anxiety. Therefore, the best therapeutic approach to PTSD may be a combination of therapies tailored to the individual’s experiences and symptoms. Most importantly, therapeutic intervention is highly recommended for any person experiencing any of the symptoms associated with PTSD.

Routine, follow-up physical examinations are vital for the cancer survivor. Communication with the physician of any side-effects experienced is the best way to monitor and keep track of long-term side-effects. The healthcare provider will be able to follow, monitor, and chart in the medical record any and all of the side-effects experienced. This helps the physician look for any patterns or changes in symptoms over time. Many cancers also give off tumor markers that can be followed by specific blood tests, warning the physician that there is a possibility that cancer changes are occurring; for example, the CEA test for colorectal cancer or the CA 125 test for ovarian cancer.

Hopefully, the healthcare team educates the patient about which long-term side-effects may be expected from which specific cancer and treatment experienced, for example, radiation therapy to the chest may cause long-term fibrosis of the lung fields causing a dry, non-productive cough or shortness of breath on exertion with exercise. The patient will then know what may be a permanent long-term side-effect and be able to differentiate this from an abnormal symptom that arises; for example, a wet productive cough.

Every survivor should be familiar with side-effects that are not normal from expected long-term side-effects. The American Cancer Society uses the algorithm C-A-U-T-I-O-N to outline the seven warning signs of cancer: C=changes in bowel or bladder habits, A= a sore that does not heal, U= unusual bleeding or discharge from any place, T= thickening or lump in the breast or elsewhere, I= indigestion or difficulty swallowing, O= obvious change in a wart or mole, and N= nagging cough or hoarseness. These warning signs can be indicative of a new cancer or a recurrent cancer and any change in symptoms should warn the patient to bring these to the attention of the physician. Other symptoms that should be monitored include any unusual fever, chills, or night sweats which can be indicative of malignancy or recurrence along with any unusual nausea, vomiting, or anorexia. A very important symptom to monitor is unusual, unintended weight loss.
Routine, follow-up physical examinations are vital for the cancer survivor. Communication with the physician of any side-effects experienced is the best way to monitor and keep track of long-term side-effects. The healthcare provider will be able to follow, monitor, and chart in the medical record any and all of the side-effects experienced. This helps the physician look for any patterns or changes in symptoms over time. Many cancers also give off tumor markers that can be followed by specific blood tests, warning the physician that there is a possibility that cancer changes are occurring; for example, the CEA test for colorectal cancer or the CA 125 test for ovarian cancer.

Hopefully, the healthcare team educates the patient about which long-term side-effects may be expected from which specific cancer and treatment experienced, for example, radiation therapy to the chest may cause long-term fibrosis of the lung fields causing a dry, non-productive cough or shortness of breath on exertion with exercise. The patient will then know what may be a permanent long-term side-effect and be able to differentiate this from an abnormal symptom that arises; for example, a wet productive cough.

Every survivor should be familiar with side-effects that are not normal from expected long-term side-effects. The American Cancer Society uses the algorithm C-A-U-T-I-O-N to outline the seven warning signs of cancer: C=changes in bowel or bladder habits, A= a sore that does not heal, U= unusual bleeding or discharge from any place, T= thickening or lump in the breast or elsewhere, I= indigestion or difficulty swallowing, O= obvious change in a wart or mole, and N= nagging cough or hoarseness. These warning signs can be indicative of a new cancer or a recurrent cancer and any change in symptoms should warn the patient to bring these to the attention of the physician. Other symptoms that should be monitored include any unusual fever, chills, or night sweats which can be indicative of malignancy or recurrence along with any unusual nausea, vomiting, or anorexia. A very important symptom to monitor is unusual, unintended weight loss.

First, I hope that you have undergone adequate lymphedema treatment. There are treatments available and most are now covered by insurance. Treatments include compression sleeves, manual lymph drainage (MLD) by specialty trained lymphedema therapists, special bandaging, sequential gradient pump, or some medications (although diuretics have proven to have little effect). Of course if your lymphedema is ever caused or made worse by an infection, then antibiotics should be prescribed.

You mention feeling isolated and embarrassed by the lymphedema. This may be due to the fact that you feel the lymphedema is a sign that you had cancer and the diagnosis in itself is one that you struggle with. It may be difficult for you to tell people why you have lymphedema if asked, or you may be afraid that you will be asked and the cancer is an experience you don’t want to talk about. Did you have body-image concerns prior to the cancer that have been exacerbated by the lymphedema? If you answered yes to these questions, you may have underlying emotional issues that are unresolved and that are triggering your embarrassment and isolation. I would strongly recommend seeking out a therapist who can help you overcome these painful issues. You can also reach out to lymphedema societies that provide ongoing support for patients who suffer from lymphedema: the National Lymphedema Network at 1-800-541-3259 or http://www.lymphnet.org; the Lymphedema International Network at http://www.lymphedema.com. First, I hope that you have undergone adequate lymphedema treatment. There are treatments available and most are now covered by insurance. Treatments include compression sleeves, manual lymph drainage (MLD) by specialty trained lymphedema therapists, special bandaging, sequential gradient pump, or some medications (although diuretics have proven to have little effect). Of course if your lymphedema is ever caused or made worse by an infection, then antibiotics should be prescribed.

You mention feeling isolated and embarrassed by the lymphedema. This may be due to the fact that you feel the lymphedema is a sign that you had cancer and the diagnosis in itself is one that you struggle with. It may be difficult for you to tell people why you have lymphedema if asked, or you may be afraid that you will be asked and the cancer is an experience you don’t want to talk about. Did you have body-image concerns prior to the cancer that have been exacerbated by the lymphedema? If you answered yes to these questions, you may have underlying emotional issues that are unresolved and that are triggering your embarrassment and isolation. I would strongly recommend seeking out a therapist who can help you overcome these painful issues. You can also reach out to lymphedema societies that provide ongoing support for patients who suffer from lymphedema: the National Lymphedema Network at 1-800-541-3259 or http://www.lymphnet.org; the Lymphedema International Network at http://www.lymphedema.com.

Fatigue is one of the most distressing side-effects of cancer treatment and a side-effect that negatively impacts quality of life. Unfortunately, fatigue does not disappear when treatment ends. Many patients have reported that fatigue post-treatment is ongoing and long-lasting. As a cancer survivor who underwent six surgeries, chemotherapy, and radiation therapy, I felt that it took over two years for me to feel like I had returned to a sense of normalcy in regard to energy and exercise. Fatigue can be physical, mental, or both. The treatment of course depends on the cause but there are general preventive strategies and then ways of taking care of oneself in order to heal and re-nourish.

If you are working long hours or doing more physical work, allow yourself more time to sleep and rest. Take work breaks to sit and rest. Delegate tasks if possible during times of stress. Ask your nurse or physician about taking vitamin or mineral supplements and consider eating smaller meals 4-6 times per day to help you maintain a higher energy level. Avoid foods that contain a lot of sugar and avoid caffeine, alcohol, and other drugs.

Taking care of yourself is always a challenge! Getting enough rest and sleep is vital. Sleep hygiene includes basic measures such as staying in bed only to sleep, establishing a routine wake time and bedtime (creating a bedtime routine), avoiding caffeine and alcohol and heavy meals before bed, no napping after 3 p.m., etc. It is important to talk to your healthcare provider about insomnia. The use of relaxation techniques such a progressive muscle relaxation, guided imagery, and yoga are measures that help aid restorative rest and sleep.

A major strategy to offset fatigue is to walk or exercise according to your healthcare provider’s recommendations. Exercise can increase your energy and boost your mood! If fatigue is caused by undue emotional stress then counseling is advised. Lastly, allow yourself time to relax and carry out activities that you enjoy! Developing new interests and being stimulated by new friends, new work, etc., can help with emotional fatigue which is often a side-effect of physical fatigue.
Plan your day. Be active at the time of day when you feel most alert and energetic.Choose how to spend your energy. Try to let go of things that don't matter so much.

Although radiation therapy aims to spare normal tissues in the body, there are expected side-effects that are related to the specific, local area being treated. For example, brain irradiation will cause hair loss in the area of the scalp but irradiation to the chest will only cause hair loss in the chest area. Dry mouth, thick secretions, and dental carries may be a side-effect from radiation to the head and neck. Radiation to the chest may cause cough or pneumonitis where as radiation to the abdomen may cause nausea and vomiting or diarrhea. Side-effects will occur in the area being treated only. All side-effects should be reported to the radiation therapist or the nurse so that symptoms can be managed by medications and/or taking time off from the treatment until the normal tissue heals. The skin within the radiation field may also undergo changes such as redness or desquamation. It is recommended to avoid trauma, protect the skin, and use lotions and creams as only prescribed by your physician. Other side-effects that should be reported to your radiation therapist or nurse include any fevers, chills, or night sweats that could indicate an infectious process developing. Fatigue is an expected side-effect but symptoms such as insomnia and difficulty resting should be reported so that the physician or nurse can help you prioritize and provide sleep aids if needed. Although radiation therapy aims to spare normal tissues in the body, there are expected side-effects that are related to the specific, local area being treated. For example, brain irradiation will cause hair loss in the area of the scalp but irradiation to the chest will only cause hair loss in the chest area. Dry mouth, thick secretions, and dental carries may be a side-effect from radiation to the head and neck. Radiation to the chest may cause cough or pneumonitis where as radiation to the abdomen may cause nausea and vomiting or diarrhea. Side-effects will occur in the area being treated only. All side-effects should be reported to the radiation therapist or the nurse so that symptoms can be managed by medications and/or taking time off from the treatment until the normal tissue heals. The skin within the radiation field may also undergo changes such as redness or desquamation. It is recommended to avoid trauma, protect the skin, and use lotions and creams as only prescribed by your physician. Other side-effects that should be reported to your radiation therapist or nurse include any fevers, chills, or night sweats that could indicate an infectious process developing. Fatigue is an expected side-effect but symptoms such as insomnia and difficulty resting should be reported so that the physician or nurse can help you prioritize and provide sleep aids if needed.

Radiation therapy can be a frightening experience for patients who don’t fully understand the purpose and goals of treatment. Therefore, the oncology nurse must educate the patient and family about the purpose of radiation treatment –it is a local treatment using high-dose particles or x-rays which create ionizing radiation and energy. The chemical reactions that occur from radiotherapy act to kill abnormal cells and the therapy is focused or aimed at the site of the tumor bed trying to spare normal tissue and cells. There are different types of radiation therapy; external beam that is administered using linear accelerators, e.g., breast cancer after lumpectomy, and brachytherapy, which is when a radioactive source is placed directly into the tumor or the tumor bed, e.g., cervical cancer implants. There is also radioisotope therapy where unsealed sources of radiation are used such as radioactive iodine for thyroid cancer.

External radiation is the most common so I will address that here. It is important to instruct the patient that the first appointment for radiation therapy is long because this is when the radiation therapist “maps out” the area to be irradiated and sets led blocks to protect the normal tissues surrounding the tumor bed. They call this simulation. The oncology nurse can prepare the patient for simulation and encourage them to take medication as needed for comfort during this appointment; it can take greater than an hour. But after this simulation, all other appointments take only several minutes. It is also important for the nurse to tell the patient that they are NOT radioactive and that radiation is only being emitted during the time the machine is on. Radiation therapy is fractionated in doses, e.g., doses are spread over weeks usually 5 days per week (to spare normal tissue damage). This also allows normal cells to recover on the weekends.

The majority of treatments are aimed to spare normal tissue yet in some cases there may be expected side effects within the specific, local area being treated. This could be the case when using radiation therapy to treat the upper lung field and the patient develops a cough, or when used for colorectal cancer and the patient develops diarrhea. The normal side-effects will only occur in places where the radiation is aimed, therefore, if the head is not being radiated then the patient will not lose their hair (alopecia). Radiation is a local treatment so side-effects are mainly localized. Although most times the machines are skin-sparing, often patients may develop changes to the surface of their skin (redness, moist desquamation) during treatment. All side-effects are monitored closely by the radiation therapist and symptoms are managed with creams and medications. Overall, the major side effect of external radiation is fatigue, often expressed by patients to be overwhelming. It is theorized that this side-effect may be due to the breakdown of cells within the body. Patients should be encouraged to take appropriate rest periods during the day and to try to delegate tasks during their treatment time.
Radiation therapy can be a frightening experience for patients who don’t fully understand the purpose and goals of treatment. Therefore, the oncology nurse must educate the patient and family about the purpose of radiation treatment –it is a local treatment using high-dose particles or x-rays which create ionizing radiation and energy. The chemical reactions that occur from radiotherapy act to kill abnormal cells and the therapy is focused or aimed at the site of the tumor bed trying to spare normal tissue and cells. There are different types of radiation therapy; external beam that is administered using linear accelerators, e.g., breast cancer after lumpectomy, and brachytherapy, which is when a radioactive source is placed directly into the tumor or the tumor bed, e.g., cervical cancer implants. There is also radioisotope therapy where unsealed sources of radiation are used such as radioactive iodine for thyroid cancer.

External radiation is the most common so I will address that here. It is important to instruct the patient that the first appointment for radiation therapy is long because this is when the radiation therapist “maps out” the area to be irradiated and sets led blocks to protect the normal tissues surrounding the tumor bed. They call this simulation. The oncology nurse can prepare the patient for simulation and encourage them to take medication as needed for comfort during this appointment; it can take greater than an hour. But after this simulation, all other appointments take only several minutes. It is also important for the nurse to tell the patient that they are NOT radioactive and that radiation is only being emitted during the time the machine is on. Radiation therapy is fractionated in doses, e.g., doses are spread over weeks usually 5 days per week (to spare normal tissue damage). This also allows normal cells to recover on the weekends.

The majority of treatments are aimed to spare normal tissue yet in some cases there may be expected side effects within the specific, local area being treated. This could be the case when using radiation therapy to treat the upper lung field and the patient develops a cough, or when used for colorectal cancer and the patient develops diarrhea. The normal side-effects will only occur in places where the radiation is aimed, therefore, if the head is not being radiated then the patient will not lose their hair (alopecia). Radiation is a local treatment so side-effects are mainly localized. Although most times the machines are skin-sparing, often patients may develop changes to the surface of their skin (redness, moist desquamation) during treatment. All side-effects are monitored closely by the radiation therapist and symptoms are managed with creams and medications. Overall, the major side effect of external radiation is fatigue, often expressed by patients to be overwhelming. It is theorized that this side-effect may be due to the breakdown of cells within the body. Patients should be encouraged to take appropriate rest periods during the day and to try to delegate tasks during their treatment time.

Cancer survivors must learn to handle their fears of recurrence. It is a coping response that all survivors will experience. Depending upon the phase of the cancer trajectory, different fears and anxieties will surface. After initial treatment ends survivors may fear recurrence because no active treatment is being carried out. The first year following treatment cessation is when fears are most intense. Survivors may have felt that active treatment was keeping the cancer at bay and treatment provided them with a feeling of control over the cancer. Once treatment stops, recurrence anxiety can peak. It is normal for survivors to enter the remission phase with some ambivalence. Feelings of uncertainty about the future may arise at this time. Fears of recurrence may especially threaten persons who were treated for more advanced disease.

As a cancer survivor myself, I understand the reality of these fears. The anxiety often recurs with doctor appointments, follow-up scans, or coming in contact with other cancer survivors who have experienced recurrent disease. Recurrence anxiety may also surface when symptoms such as chronic fatigue occur. I try to give the same advice to survivors as I give to myself. Returning to an active, normal lifestyle of work and play, being surrounded by family and friends, is the healthiest way to cope with these anxieties. Talking about the fears with significant others that you feel emotionally safe with is always important. Also, recognizing that these fears are normal and expected can make you feel less isolated and will help you discuss these fears with your healthcare providers. Again, over time, recurrence anxiety usually diminishes, with normal fears resurfacing during follow-up appointments and exams, or in the presence of unusual somatic complaints. I encourage all survivors to speak openly with their healthcare providers so that reassurance can be provided and if, by chance, symptoms warrant investigation, the earlier a recurrence is caught the more likely it is treatable. Cancer survivors must learn to handle their fears of recurrence. It is a coping response that all survivors will experience. Depending upon the phase of the cancer trajectory, different fears and anxieties will surface. After initial treatment ends survivors may fear recurrence because no active treatment is being carried out. The first year following treatment cessation is when fears are most intense. Survivors may have felt that active treatment was keeping the cancer at bay and treatment provided them with a feeling of control over the cancer. Once treatment stops, recurrence anxiety can peak. It is normal for survivors to enter the remission phase with some ambivalence. Feelings of uncertainty about the future may arise at this time. Fears of recurrence may especially threaten persons who were treated for more advanced disease.

As a cancer survivor myself, I understand the reality of these fears. The anxiety often recurs with doctor appointments, follow-up scans, or coming in contact with other cancer survivors who have experienced recurrent disease. Recurrence anxiety may also surface when symptoms such as chronic fatigue occur. I try to give the same advice to survivors as I give to myself. Returning to an active, normal lifestyle of work and play, being surrounded by family and friends, is the healthiest way to cope with these anxieties. Talking about the fears with significant others that you feel emotionally safe with is always important. Also, recognizing that these fears are normal and expected can make you feel less isolated and will help you discuss these fears with your healthcare providers. Again, over time, recurrence anxiety usually diminishes, with normal fears resurfacing during follow-up appointments and exams, or in the presence of unusual somatic complaints. I encourage all survivors to speak openly with their healthcare providers so that reassurance can be provided and if, by chance, symptoms warrant investigation, the earlier a recurrence is caught the more likely it is treatable.

One of the most common psychological responses to the experience of cancer is anxiety!

A clear distinction does not always exist between the normal fears that cancer initiates and other anxiety reactions that are intense. What is known is that cancer is a stressful journey and normal anxiety reactions present at different points along the cancer continuum: at diagnosis, during treatment, at recurrence, and other times when the patient does not know what to expect and feels powerless to what is happening to them.

The most effective anxiety and stress relief technique I have found is in the form of education! I believe that if the patient has insight and knowledge about what exactly is happening to them and what they are facing, it gives them a sense of control and empowerment. Thus, decreasing the amount of stress and anxiety! For example, if I were to do a bone marrow biopsy on a patient I would first explain the purpose of the test. I would then take the person through the procedure one step at a time so that they would know what to expect at each moment in time.

Apprehension and fear drive stress and anxiety. Feelings of helplessness also contribute to stress and anxiety. To me, knowledge translates into control. It is important for us as healthcare practitioners to make the patient an informed "partner" in the his or her health care plan.

After education I believe in relaxation techniques such as progressive relaxation, deep breathing, guided imagery, yoga, biofeedback, and meditation. Progressive relaxation and deep breathing techniques can be learned easily by the patient and can give them a sense of control over what may be a frightening treatment or procedure. Listening to relaxation or guided imagery tapes during chemotherapy treatments is very effective in reducing anxiety.

There is also a role for the short term use of anxiolytics (drugs that reduce anxiety) such as the benzodiazepenes (ativan, xanax, etc) but these should be reserved for special circumstances, e.g., the fear and physical discomfort associated with a bone marrow biopsy.

Educating the patient is weaved through all the interventions mentioned and is my number one choice! One of the most common psychological responses to the experience of cancer is anxiety!

A clear distinction does not always exist between the normal fears that cancer initiates and other anxiety reactions that are intense. What is known is that cancer is a stressful journey and normal anxiety reactions present at different points along the cancer continuum: at diagnosis, during treatment, at recurrence, and other times when the patient does not know what to expect and feels powerless to what is happening to them.

The most effective anxiety and stress relief technique I have found is in the form of education! I believe that if the patient has insight and knowledge about what exactly is happening to them and what they are facing, it gives them a sense of control and empowerment. Thus, decreasing the amount of stress and anxiety! For example, if I were to do a bone marrow biopsy on a patient I would first explain the purpose of the test. I would then take the person through the procedure one step at a time so that they would know what to expect at each moment in time.

Apprehension and fear drive stress and anxiety. Feelings of helplessness also contribute to stress and anxiety. To me, knowledge translates into control. It is important for us as healthcare practitioners to make the patient an informed "partner" in the his or her health care plan.

After education I believe in relaxation techniques such as progressive relaxation, deep breathing, guided imagery, yoga, biofeedback, and meditation. Progressive relaxation and deep breathing techniques can be learned easily by the patient and can give them a sense of control over what may be a frightening treatment or procedure. Listening to relaxation or guided imagery tapes during chemotherapy treatments is very effective in reducing anxiety.

There is also a role for the short term use of anxiolytics (drugs that reduce anxiety) such as the benzodiazepenes (ativan, xanax, etc) but these should be reserved for special circumstances, e.g., the fear and physical discomfort associated with a bone marrow biopsy.

Educating the patient is weaved through all the interventions mentioned and is my number one choice!

A woman confronting mastectomy can do several things to prepare for the emotional loss of her breast. Losing one's breast will have an impact on body-image, self-esteem, and sexuality.

To help with body-image the woman can educate herself regarding options post-mastectomy such as reconstructive surgery or the prostheses and bras that are available. If the woman is prepared for one of these options prior to mastectomy she will feel more empowered and less vulnerable than the woman who waits until she has already lost her breast. Investigating reconstructive options can take place prior to surgery and reconstruction can even take place at the time of surgery, dependent upon the type of surgery and the reconstruction chosen. For a woman who does not choose reconstruction it would also be helpful to learn about available prostheses and bras prior to surgery. Although it isn't advised to wear a prosthesis until the chest wound has healed, educating oneself about the options available can help prepare the woman for body image changes.

Reaching out to other women who have had mastectomy can be very valuable emotionally. Many hospitals or private practice settings have arranged for cancer survivors to be available to talk to others who are in a similar position; much like the American Cancer Society's Reach to Recovery program. Talking to someone else who has survived mastectomy can provide hope for emotional healing.

Losing one's breast can be an assault on a woman's sense of femininity and wholeness both of which play an important part in self-esteem. Expressing one's feelings about the impending loss of one's breast is very important. This should begin at the time the decision of mastectomy is made. Sharing with a partner, a friend or confidant can begin the process of grief. Grieving the loss of the breast is normal and should be encouraged so that healthy psychological recovery can take place. Losing a body part is devastating and the emotions associated with the loss require a healthy outlet. If a woman cannot confide in a partner or friend then therapeutic intervention in the form of counseling is advised.

Mastectomy affects the total being, including the sexual aspect's of one's self. The breast plays an important role in our sexuality. Sexuality not only refers to intercourse but also to intimate body language, hugging, kissing, and touching. Mastectomy can alter a person's sexuality but it cannot take away a woman's sense of her sexual self. If a woman can express the role that her breasts play in her sexual being, this is a first step in identifying how the loss will be translated emotionally.

Empowerment occurs when the necessary insight takes place for the individual to successfully meet the challenges faced with mastectomy. Preparing emotionally for losing a breast depends upon grieving the loss and gaining insight into the meaning of that loss for the woman. A woman confronting mastectomy can do several things to prepare for the emotional loss of her breast. Losing one's breast will have an impact on body-image, self-esteem, and sexuality.

To help with body-image the woman can educate herself regarding options post-mastectomy such as reconstructive surgery or the prostheses and bras that are available. If the woman is prepared for one of these options prior to mastectomy she will feel more empowered and less vulnerable than the woman who waits until she has already lost her breast. Investigating reconstructive options can take place prior to surgery and reconstruction can even take place at the time of surgery, dependent upon the type of surgery and the reconstruction chosen. For a woman who does not choose reconstruction it would also be helpful to learn about available prostheses and bras prior to surgery. Although it isn't advised to wear a prosthesis until the chest wound has healed, educating oneself about the options available can help prepare the woman for body image changes.

Reaching out to other women who have had mastectomy can be very valuable emotionally. Many hospitals or private practice settings have arranged for cancer survivors to be available to talk to others who are in a similar position; much like the American Cancer Society's Reach to Recovery program. Talking to someone else who has survived mastectomy can provide hope for emotional healing.

Losing one's breast can be an assault on a woman's sense of femininity and wholeness both of which play an important part in self-esteem. Expressing one's feelings about the impending loss of one's breast is very important. This should begin at the time the decision of mastectomy is made. Sharing with a partner, a friend or confidant can begin the process of grief. Grieving the loss of the breast is normal and should be encouraged so that healthy psychological recovery can take place. Losing a body part is devastating and the emotions associated with the loss require a healthy outlet. If a woman cannot confide in a partner or friend then therapeutic intervention in the form of counseling is advised.

Mastectomy affects the total being, including the sexual aspect's of one's self. The breast plays an important role in our sexuality. Sexuality not only refers to intercourse but also to intimate body language, hugging, kissing, and touching. Mastectomy can alter a person's sexuality but it cannot take away a woman's sense of her sexual self. If a woman can express the role that her breasts play in her sexual being, this is a first step in identifying how the loss will be translated emotionally.

Empowerment occurs when the necessary insight takes place for the individual to successfully meet the challenges faced with mastectomy. Preparing emotionally for losing a breast depends upon grieving the loss and gaining insight into the meaning of that loss for the woman.

There are many psychosocial issues that women need to be aware of when resuming their "normal" life after treatment. The diagnosis and treatment of cancer is a life-changing event like no other. Many times it changes a person's perspective of the world, changes their spirituality, changes their identity, and changes relationships. The personal meaning of cancer involves our intellect, emotions, body, and spirit. I believe that there is no part of one's life that is left untouched by the cancer experience. The journey even takes us into existential realms, transcending the present. Therefore, I don't think that a women can expect to return to the same "normal" life after their journey. Instead, I envision women integrating a "new-normal."

Many of the common psychosocial issues that women face are related to long-term side-effects of treatment. This can include side-effects such as fatigue and chemotherapy-induced menopause, body-image changes,alterations in sexuality, and cognitive dysfunction. Most of these side-effects are intertwined, fatigue affects the whole person, body and spirit, and menopause and body-image changes (mastectomy) affect sexuality.

The fatigue from treatment is a subjective sense of tiredness that often interferes with functioning and it typically is not relieved by sleep or rest. Fatigue has a detrimental effect on the woman's quality of life. In research studies, fatigue has been reported as the most distressing side-effect of cancer and its treatment. Closely associated with fatigue is a general lack of energy, difficulty concentrating, and depressed mood. A major psychosocial roadblock for a woman may be that she assumes she will quickly return to "normal" levels of energy soon after treatment has ended. It may take months to years for a woman to recapture pre-treatment energy depending upon the extent of treatment. Important for the woman is to recognize that fatigue is a normal, expected side-effect of treatment that can be treated in the following ways: delegate tasks, take time to rest (too much rest can decrease energy), stay as active as possible (exercise has been shown to increase energy and boost mood), eat a balanced and nutritious diet, drink plenty of fluids, and watch for signs of stress. Fatigue can also contribute to psychiatric disorders such as depression and anxiety and women should be astute to these symptoms and seek appropriate treatment from trained professionals.

Body-image changes range from weight loss to alopecia to loss of a body part. Our body-image makes up part of our identity; our sense of self and our sense of self-esteem. If a woman has incurred a mastectomy there will be significant changes in her body-image. Even a woman with a strong sense of self will grieve over a lost breast. Responses to body-image changes can include feelings that one's body has deceived them, feelings that one's body has been violated, feelings that one's body has betrayed them, or feelings of fear and vulnerability. The healthy self-image can be permanently damaged with treatment. Hopefully through interactions with the self, partner, and society, a woman can generate a new, positive body-image.

Changes in body-image can also include chemotherapy-induced menopause. Menopause can affect energy, mood, cognition, and impact sexuality. Drugs such as tamoxifen and the aromatase inhibitors (aromasin, arimidex) can also negatively affect healthy self-image due to their side-effect profile. Many women on aromatase inhibitors complain of arthritic type symptoms that interfere with their activities of daily living. Being on these agents also extends treatment for 5 years or more which some women find distressing. Side-effects of menopause and hormonal therapy may include decrease libido, and vaginal dryness, both interfering with sexual expression.

Sexuality is more than just sexual function. It includes feelings of intimacy, emotions, and fertility. It includes our image of our self, or body-image. Changes in sexuality occur with cancer treatment and many women do not seek medical attention for these changes. Permission should be given to women to discuss these concerns. Many women feel a loss of femininity following hormonal and body changes.

Menopause can contribute to cognitive dysfunction as well as chemotherapy. Chemotherapy-induced cognitive dysfunction is referred to as "chemo-brain" or "chemo fog." The symptoms are distressing and include memory loss, trouble concentrating, trouble finding the right words, trouble doing math, and trouble learning something new. Chemo-brain and menopause can also cause mood swings. Research continues to investigate the exact causes of chemo-brain and how long it lasts. It is important for women to know that certain things can exacerbate the symptoms including depression, anxiety, fatigue, insomnia, and certain medications. Although there is no definitive treatment it is also important for women to decrease stress levels, allow a quiet environment when needing to focus, and to try to not multi-task.

Lastly, it is not uncommon for women to suffer from anxiety or depressed mood after treatment ends. This is due to multiple factors including fatigue, changes in hormonal status, changes in body-image and sexuality, and changes in relationships. Women may also be at risk for post-traumatic stress syndrome (PTSD) that can be delayed for 6 or more months after treatment has ended. Any woman who finds herself experiencing symptoms of mood swings, overwhelming sadness, feelings of worthlessness, anxious mood, irritability, or feelings that she is reexperiencing the treatment through recollections or nightmares, should seek professional help.

One of the valuable lessons from the cancer journey is that it teaches one the value of being alive. Illness can restore a sense of living that is lost when we take life for granted. There are many psychosocial issues confronting the woman who has endured cancer and treatment. The hope is that the experience leads the woman on a path towards self-transcendence and a positive meaning for being alive. There are many psychosocial issues that women need to be aware of when resuming their "normal" life after treatment. The diagnosis and treatment of cancer is a life-changing event like no other. Many times it changes a person's perspective of the world, changes their spirituality, changes their identity, and changes relationships. The personal meaning of cancer involves our intellect, emotions, body, and spirit. I believe that there is no part of one's life that is left untouched by the cancer experience. The journey even takes us into existential realms, transcending the present. Therefore, I don't think that a women can expect to return to the same "normal" life after their journey. Instead, I envision women integrating a "new-normal."

Many of the common psychosocial issues that women face are related to long-term side-effects of treatment. This can include side-effects such as fatigue and chemotherapy-induced menopause, body-image changes,alterations in sexuality, and cognitive dysfunction. Most of these side-effects are intertwined, fatigue affects the whole person, body and spirit, and menopause and body-image changes (mastectomy) affect sexuality.

The fatigue from treatment is a subjective sense of tiredness that often interferes with functioning and it typically is not relieved by sleep or rest. Fatigue has a detrimental effect on the woman's quality of life. In research studies, fatigue has been reported as the most distressing side-effect of cancer and its treatment. Closely associated with fatigue is a general lack of energy, difficulty concentrating, and depressed mood. A major psychosocial roadblock for a woman may be that she assumes she will quickly return to "normal" levels of energy soon after treatment has ended. It may take months to years for a woman to recapture pre-treatment energy depending upon the extent of treatment. Important for the woman is to recognize that fatigue is a normal, expected side-effect of treatment that can be treated in the following ways: delegate tasks, take time to rest (too much rest can decrease energy), stay as active as possible (exercise has been shown to increase energy and boost mood), eat a balanced and nutritious diet, drink plenty of fluids, and watch for signs of stress. Fatigue can also contribute to psychiatric disorders such as depression and anxiety and women should be astute to these symptoms and seek appropriate treatment from trained professionals.

Body-image changes range from weight loss to alopecia to loss of a body part. Our body-image makes up part of our identity; our sense of self and our sense of self-esteem. If a woman has incurred a mastectomy there will be significant changes in her body-image. Even a woman with a strong sense of self will grieve over a lost breast. Responses to body-image changes can include feelings that one's body has deceived them, feelings that one's body has been violated, feelings that one's body has betrayed them, or feelings of fear and vulnerability. The healthy self-image can be permanently damaged with treatment. Hopefully through interactions with the self, partner, and society, a woman can generate a new, positive body-image.

Changes in body-image can also include chemotherapy-induced menopause. Menopause can affect energy, mood, cognition, and impact sexuality. Drugs such as tamoxifen and the aromatase inhibitors (aromasin, arimidex) can also negatively affect healthy self-image due to their side-effect profile. Many women on aromatase inhibitors complain of arthritic type symptoms that interfere with their activities of daily living. Being on these agents also extends treatment for 5 years or more which some women find distressing. Side-effects of menopause and hormonal therapy may include decrease libido, and vaginal dryness, both interfering with sexual expression.

Sexuality is more than just sexual function. It includes feelings of intimacy, emotions, and fertility. It includes our image of our self, or body-image. Changes in sexuality occur with cancer treatment and many women do not seek medical attention for these changes. Permission should be given to women to discuss these concerns. Many women feel a loss of femininity following hormonal and body changes.

Menopause can contribute to cognitive dysfunction as well as chemotherapy. Chemotherapy-induced cognitive dysfunction is referred to as "chemo-brain" or "chemo fog." The symptoms are distressing and include memory loss, trouble concentrating, trouble finding the right words, trouble doing math, and trouble learning something new. Chemo-brain and menopause can also cause mood swings. Research continues to investigate the exact causes of chemo-brain and how long it lasts. It is important for women to know that certain things can exacerbate the symptoms including depression, anxiety, fatigue, insomnia, and certain medications. Although there is no definitive treatment it is also important for women to decrease stress levels, allow a quiet environment when needing to focus, and to try to not multi-task.

Lastly, it is not uncommon for women to suffer from anxiety or depressed mood after treatment ends. This is due to multiple factors including fatigue, changes in hormonal status, changes in body-image and sexuality, and changes in relationships. Women may also be at risk for post-traumatic stress syndrome (PTSD) that can be delayed for 6 or more months after treatment has ended. Any woman who finds herself experiencing symptoms of mood swings, overwhelming sadness, feelings of worthlessness, anxious mood, irritability, or feelings that she is reexperiencing the treatment through recollections or nightmares, should seek professional help.

One of the valuable lessons from the cancer journey is that it teaches one the value of being alive. Illness can restore a sense of living that is lost when we take life for granted. There are many psychosocial issues confronting the woman who has endured cancer and treatment. The hope is that the experience leads the woman on a path towards self-transcendence and a positive meaning for being alive.

The "general" tips that I give to patients are the same tips that I followed myself when I underwent chemotherapy for breast and ovarian cancer.
My tips begin by addressing what I think are the three major side-effects that patients find most distressing: alopecia, nausea and vomiting, and fatigue.

First it is helpful to understand why side-effects occur. Chemotherapeutic agents are drugs that attack rapidly reproducing cells such as cancer cells. Therefore, the rapidly reproducing cells of our body are also affected by the drugs. These include our hair follicles (alopecia), our skin (rashes), our digestive tract (nausea and vomiting),our bone marrow(decreased red cells causing anemia causing fatigue or decreased white cells causing infection).

Hair loss is predictable if given the drug(s) that cause alopecia. First and foremost, it is vital for the patient to know if they are receiving a drug that will cause hair loss. Some drugs cause thinning of the hair but do not actually cause complete hair loss. I inform the patient of which drug they are given which predicts hair loss. General tips I give them is to buy some scarves, hats, and wigs PRIOR to receiving their first dose of chemotherapy. It is always good to choose wigs when you have your hair so that you can match your color and style as closely as possible. Although some patients like myself choose to get different styles and play around a little! I suggest that if the patient has long hair that they may want to cut it short prior to the first dose of chemotherapy but it isn't a necessity because hair loss is predictable. Once the first dose of chemotherapy is administered hair loss will occur 14-17 days after the first dose. I therefore didn't cut or shave my head prior to chemotherapy. When I could pull out the first "chunk" of hair on day 14 is when I choose to shave my head. I was ready with scarves, hats, and wigs. Being prepared helped to decrease my overall anxiety about alopecia. I also tell patients that there hair WILL grow back after chemotherapy. It may be a different color and texture but it will DEFINITELY grow back. I also tell them that it only takes 3-4 weeks after the last dose to feel sprouts of hair!

Nausea and vomiting are most distressing but PREVENTABLE side-effects of certain drugs administered. Fortunately, now there are many antiemetic (anti-nausea) medications that are used to control both nausea and vomiting. It is very rare for vomiting to occur but those at high-risk are patients who got morning sickness with pregnancies or those patients who get car-sick or sick riding roller-coasters. Otherwise, the very important thing is to take the antiemetics as ordered, which most likely means to take them starting at the time of chemotherapy and continually thereafter for 2-3 days AFTER CHEMOTHERAPY AND AROUND THE CLOCK. The antiemetics are not as effective if they aren't taken until nausea and vomiting occurs. Prevention is the key. Take the medicines routinely as prescribed and usually even nausea can be prevented. Each chemotherapy regimen has specific antiemetic protocols to match the drugs being given. The doctor and nurse will know which drugs and which antiemetics and when to take them before, at the time of, and after treatment. Diet is another important facet to avoid nausea and vomiting. It is wise to not overeat the day of chemotherapy and for a few days afterwards. Small, frequent meals are advised to ease digestion. Avoiding spicey foods and irritants (smoking) will also decrease nausea and vomiting. Most important tip; take the medicines as prescribed because they work!

Fatigue is a major complaint for those patients undergoing chemotherapy. The fatigue can come from anemia caused by bone marrow suppression and decreased red cells. But there are now medicines such as Procrit to treat anemia and the nurse and doctor will be monitoring your blood counts on a weekly basis through treatment. Even so, chemotherapy is given in cycles (to allow those normal rapidly producing cells to recover) and general fatigue incurs possibly as a side-effect of all the cells being broken down in the body. I encourage patients to monitor their energy levels, especially patients that continue working or who are raising small children. Taking breaks from activity or taking short naps during the day can be rejuvenating. Believe it or not, research has shown that exercise transforms into energy! I encourage patients to walk during treatment. It doesn't need to be any exercise that is stressful or demanding. Even short walks around the block have been found to be beneficial. Lastly, and very important, is identifying the need for help with daily chores and daily responsibilities. While undergoing chemotherapy, many people will offer their help. It is important to take them up on it and save your own energy! Let friends and neighbors do some cooking for you,carpooling, or grocery shopping. I had one friend who every chemotherapy cycle left me a warm meal for my family on my front porch. I counted her as a blessing during a very difficult time. Fatigue can cause a change in normal activities but energy usually returns a few weeks after chemotherapy is stopped. I do warn patients that other symptoms of fatigue include the risk of depression and difficulty concentrating and staying on task. I tell patients to tell their healthcare team if they have these symptoms (although we always should be asking!).

There are other side-effects that will be closely monitored by your healthcare team. I tell my patients that there is a risk of infection during chemotherapy due to depression of bone marrow cells. There is a medication, Neupogen, that will be administered if white cell counts fall below normal. But even so, I tell my patients to avoid people with flu or colds during chemotherapy as their resistance and immunity is lower. I also encourage good hygiene.

Sloughing of normal cells of the digestive tract can cause anything from mouth sores to constipation to diarrhea. Some drugs specifically cause mouth sores and the nurse and doctor should tell the patient if they are getting that drug. If so, we encourage the patient to carry out good dental hygiene and keep the mouth moist with just a warm water rinse. Mouthwashes contain alcohol and they are drying to the mucosa.
Certain drugs, especially the new agents that are called targeting agents, can cause skin rashes. The rashes are unfortunate but often a sign that the chemotherapy is working. Rashes can be cared for with topical or oral antibiotics and good skin care.

There are always drugs that have specific side-effects such as nail changes or turning the urine red, etc. I try to educate the patient on each drug administered and the normal, expected side-effects so that the patient doesn't needlessly worry and so that the patient is astute in catching an abnormal side-effect, e.g., fever, to call the nurse or doctor immediately. The "general" tips that I give to patients are the same tips that I followed myself when I underwent chemotherapy for breast and ovarian cancer.
My tips begin by addressing what I think are the three major side-effects that patients find most distressing: alopecia, nausea and vomiting, and fatigue.

First it is helpful to understand why side-effects occur. Chemotherapeutic agents are drugs that attack rapidly reproducing cells such as cancer cells. Therefore, the rapidly reproducing cells of our body are also affected by the drugs. These include our hair follicles (alopecia), our skin (rashes), our digestive tract (nausea and vomiting),our bone marrow(decreased red cells causing anemia causing fatigue or decreased white cells causing infection).

Hair loss is predictable if given the drug(s) that cause alopecia. First and foremost, it is vital for the patient to know if they are receiving a drug that will cause hair loss. Some drugs cause thinning of the hair but do not actually cause complete hair loss. I inform the patient of which drug they are given which predicts hair loss. General tips I give them is to buy some scarves, hats, and wigs PRIOR to receiving their first dose of chemotherapy. It is always good to choose wigs when you have your hair so that you can match your color and style as closely as possible. Although some patients like myself choose to get different styles and play around a little! I suggest that if the patient has long hair that they may want to cut it short prior to the first dose of chemotherapy but it isn't a necessity because hair loss is predictable. Once the first dose of chemotherapy is administered hair loss will occur 14-17 days after the first dose. I therefore didn't cut or shave my head prior to chemotherapy. When I could pull out the first "chunk" of hair on day 14 is when I choose to shave my head. I was ready with scarves, hats, and wigs. Being prepared helped to decrease my overall anxiety about alopecia. I also tell patients that there hair WILL grow back after chemotherapy. It may be a different color and texture but it will DEFINITELY grow back. I also tell them that it only takes 3-4 weeks after the last dose to feel sprouts of hair!

Nausea and vomiting are most distressing but PREVENTABLE side-effects of certain drugs administered. Fortunately, now there are many antiemetic (anti-nausea) medications that are used to control both nausea and vomiting. It is very rare for vomiting to occur but those at high-risk are patients who got morning sickness with pregnancies or those patients who get car-sick or sick riding roller-coasters. Otherwise, the very important thing is to take the antiemetics as ordered, which most likely means to take them starting at the time of chemotherapy and continually thereafter for 2-3 days AFTER CHEMOTHERAPY AND AROUND THE CLOCK. The antiemetics are not as effective if they aren't taken until nausea and vomiting occurs. Prevention is the key. Take the medicines routinely as prescribed and usually even nausea can be prevented. Each chemotherapy regimen has specific antiemetic protocols to match the drugs being given. The doctor and nurse will know which drugs and which antiemetics and when to take them before, at the time of, and after treatment. Diet is another important facet to avoid nausea and vomiting. It is wise to not overeat the day of chemotherapy and for a few days afterwards. Small, frequent meals are advised to ease digestion. Avoiding spicey foods and irritants (smoking) will also decrease nausea and vomiting. Most important tip; take the medicines as prescribed because they work!

Fatigue is a major complaint for those patients undergoing chemotherapy. The fatigue can come from anemia caused by bone marrow suppression and decreased red cells. But there are now medicines such as Procrit to treat anemia and the nurse and doctor will be monitoring your blood counts on a weekly basis through treatment. Even so, chemotherapy is given in cycles (to allow those normal rapidly producing cells to recover) and general fatigue incurs possibly as a side-effect of all the cells being broken down in the body. I encourage patients to monitor their energy levels, especially patients that continue working or who are raising small children. Taking breaks from activity or taking short naps during the day can be rejuvenating. Believe it or not, research has shown that exercise transforms into energy! I encourage patients to walk during treatment. It doesn't need to be any exercise that is stressful or demanding. Even short walks around the block have been found to be beneficial. Lastly, and very important, is identifying the need for help with daily chores and daily responsibilities. While undergoing chemotherapy, many people will offer their help. It is important to take them up on it and save your own energy! Let friends and neighbors do some cooking for you,carpooling, or grocery shopping. I had one friend who every chemotherapy cycle left me a warm meal for my family on my front porch. I counted her as a blessing during a very difficult time. Fatigue can cause a change in normal activities but energy usually returns a few weeks after chemotherapy is stopped. I do warn patients that other symptoms of fatigue include the risk of depression and difficulty concentrating and staying on task. I tell patients to tell their healthcare team if they have these symptoms (although we always should be asking!).

There are other side-effects that will be closely monitored by your healthcare team. I tell my patients that there is a risk of infection during chemotherapy due to depression of bone marrow cells. There is a medication, Neupogen, that will be administered if white cell counts fall below normal. But even so, I tell my patients to avoid people with flu or colds during chemotherapy as their resistance and immunity is lower. I also encourage good hygiene.

Sloughing of normal cells of the digestive tract can cause anything from mouth sores to constipation to diarrhea. Some drugs specifically cause mouth sores and the nurse and doctor should tell the patient if they are getting that drug. If so, we encourage the patient to carry out good dental hygiene and keep the mouth moist with just a warm water rinse. Mouthwashes contain alcohol and they are drying to the mucosa.
Certain drugs, especially the new agents that are called targeting agents, can cause skin rashes. The rashes are unfortunate but often a sign that the chemotherapy is working. Rashes can be cared for with topical or oral antibiotics and good skin care.

There are always drugs that have specific side-effects such as nail changes or turning the urine red, etc. I try to educate the patient on each drug administered and the normal, expected side-effects so that the patient doesn't needlessly worry and so that the patient is astute in catching an abnormal side-effect, e.g., fever, to call the nurse or doctor immediately.

You are so right. The impact of a cancer diagnosis on the patient and family is reciprocal in nature. Essentially, the family is the "unit of care." What affects one individual in the family system will reverberate within the entire family. Therefore, if you suspect that you may be suffering from post-traumatic stress syndrome (PTSD) then the family as a unit may be suffering from the same symptoms.

PTSD is a response to events that involve actual or threatened death or serious injury or other threat to one's physical integrity, to which the person's response involves intense fear, helplessness, or horror. PTSD is a psychiatric diagnosis that is linked closely to an acute stress disorder resulting from experiencing a traumatic event. The actual Diagnostic and Statistical Manual of the American Psychiatric Society (DSM IV-TR, 2000) defines a life-threatening diagnosis such as cancer as a traumatic event. The National Cancer Institute (2010) estimates that approximately 35% of patients experiencing cancer may suffer symptoms of PTSD.

The signs of PTSD may be similar to signs of other states such as depression and anxiety. In fact, a majority of patients who suffer from PTSD also suffer from another co-morbid condition such as depression, anxiety, panic disorder, or obsessive compulsive disorder. Therefore, it is important that a thorough evaluation be carried out so that the individual is appropriately treated.

One of the main signs that distinguishes PTSD from other disorders is the reexperiencing of symptoms related to the traumatic event. This reexperiencing is often in the form of recurrent dreams, recollections, or intrusive thoughts that are related to the traumatic event. In the case of a cancer diagnosis this could be recurring dreams about receiving chemotherapy or radiation therapy. Often these dreams or recollections can even consist of sensations from the event, including taste, smell, touch, and sound. It is not uncommon for a chemotherapy patient suffering from PTSD to say that they can "taste" the metallic taste of chemotherapy at different times with recurrent thoughts of the event.
Traumatic memories can be triggered by certain stimuli related to the trauma. For example, a patient who had chemotherapy in the doctor's office may feel slightly nauseated when going to see the doctor for follow-up treatment. The doctor's office and the doctor him/herself may be the trigger for this feeling. If chemotherapy was traumatic for the individual then this event may be reexperienced with objects that remind the patient of receiving chemotherapy.

Other signs of PTSD consist of avoidance and feelings of emotional "numbness." Reexperiencing the event in the present may cause the individual to avoid certain situations or stimuli that remind them of the trauma. For example, a patient with alopecia from chemotherapy may avoid going to their local grocery because everyone he/she meets may ask them, "How are you feeling?" bringing forth unwanted memories of the trauma they are experiencing. With avoidance comes feelings of detachment or isolation from other people or certain events. It is not uncommon for the patient with cancer to feel isolated in their feelings or to avoid certain social situations.

The anxiety component of PTSD is through the state of hyperarousal. The individual's nervous system always feels that it is on alert for danger! The "fight" and "flight" reaction is always on even though there is no present danger at hand. The individual has a heightened startle response and sleep patterns become disrupted. Individuals will many times complain of feeling "jumpy," "on-edge," or "irritable." They will also find it difficult to concentrate, to stay on task, or find that short-term memory is affected.

Overlapping symptoms of depression may also occur with PTSD. Individuals may have overwhelming feelings of grief and loss associated with feelings of helplessness, worthlessness, and sadness. Other signs of PTSD include somatic complaints such as chronic pain and the individual also runs the risk of substance abuse (which is a behavior to help mask the psychic pain). Lastly, an important sign of PTSD is that quality of life becomes diminished because the individual has difficulty in relationships, poor work performance, social impairments, and mood disorders.

You can see how many symptoms of PTSD may overlap with symptoms of depression and anxiety and also overlap with symptoms of the cancer diagnosis and treatment, e.g., short-term memory loss related to chemotherapy. That is why it is so important to have a professional person diagnose PTSD and initiate appropriate treatment. In addition, the individual with PTSD does feel isolated and lonely, making it imperative to have the correct treatment.

Treatment for PTSD can take on many forms. Psychopharmacology is very effective in treating PTSD. Medicines from antidepressants to anxiolytics help to decrease the co-morbid symptoms of depression and anxiety. Psychotherapy focused on the trauma is very important for individuals suffering from PTSD. A psychiatrist or psychologist should diagnose the disorder but there is an important role for therapy from counselors, psychiatric advanced practice nurses, social workers, etc., who are trained to treat individuals with PTSD. Cognitive-behavioral therapy is effective in helping the individual "re-frame" the traumatic experience and there is a definitive role for integrative medicine such as acupuncture, yoga, guided imagery and relaxation. You are so right. The impact of a cancer diagnosis on the patient and family is reciprocal in nature. Essentially, the family is the "unit of care." What affects one individual in the family system will reverberate within the entire family. Therefore, if you suspect that you may be suffering from post-traumatic stress syndrome (PTSD) then the family as a unit may be suffering from the same symptoms.

PTSD is a response to events that involve actual or threatened death or serious injury or other threat to one's physical integrity, to which the person's response involves intense fear, helplessness, or horror. PTSD is a psychiatric diagnosis that is linked closely to an acute stress disorder resulting from experiencing a traumatic event. The actual Diagnostic and Statistical Manual of the American Psychiatric Society (DSM IV-TR, 2000) defines a life-threatening diagnosis such as cancer as a traumatic event. The National Cancer Institute (2010) estimates that approximately 35% of patients experiencing cancer may suffer symptoms of PTSD.

The signs of PTSD may be similar to signs of other states such as depression and anxiety. In fact, a majority of patients who suffer from PTSD also suffer from another co-morbid condition such as depression, anxiety, panic disorder, or obsessive compulsive disorder. Therefore, it is important that a thorough evaluation be carried out so that the individual is appropriately treated.

One of the main signs that distinguishes PTSD from other disorders is the reexperiencing of symptoms related to the traumatic event. This reexperiencing is often in the form of recurrent dreams, recollections, or intrusive thoughts that are related to the traumatic event. In the case of a cancer diagnosis this could be recurring dreams about receiving chemotherapy or radiation therapy. Often these dreams or recollections can even consist of sensations from the event, including taste, smell, touch, and sound. It is not uncommon for a chemotherapy patient suffering from PTSD to say that they can "taste" the metallic taste of chemotherapy at different times with recurrent thoughts of the event.
Traumatic memories can be triggered by certain stimuli related to the trauma. For example, a patient who had chemotherapy in the doctor's office may feel slightly nauseated when going to see the doctor for follow-up treatment. The doctor's office and the doctor him/herself may be the trigger for this feeling. If chemotherapy was traumatic for the individual then this event may be reexperienced with objects that remind the patient of receiving chemotherapy.

Other signs of PTSD consist of avoidance and feelings of emotional "numbness." Reexperiencing the event in the present may cause the individual to avoid certain situations or stimuli that remind them of the trauma. For example, a patient with alopecia from chemotherapy may avoid going to their local grocery because everyone he/she meets may ask them, "How are you feeling?" bringing forth unwanted memories of the trauma they are experiencing. With avoidance comes feelings of detachment or isolation from other people or certain events. It is not uncommon for the patient with cancer to feel isolated in their feelings or to avoid certain social situations.

The anxiety component of PTSD is through the state of hyperarousal. The individual's nervous system always feels that it is on alert for danger! The "fight" and "flight" reaction is always on even though there is no present danger at hand. The individual has a heightened startle response and sleep patterns become disrupted. Individuals will many times complain of feeling "jumpy," "on-edge," or "irritable." They will also find it difficult to concentrate, to stay on task, or find that short-term memory is affected.

Overlapping symptoms of depression may also occur with PTSD. Individuals may have overwhelming feelings of grief and loss associated with feelings of helplessness, worthlessness, and sadness. Other signs of PTSD include somatic complaints such as chronic pain and the individual also runs the risk of substance abuse (which is a behavior to help mask the psychic pain). Lastly, an important sign of PTSD is that quality of life becomes diminished because the individual has difficulty in relationships, poor work performance, social impairments, and mood disorders.

You can see how many symptoms of PTSD may overlap with symptoms of depression and anxiety and also overlap with symptoms of the cancer diagnosis and treatment, e.g., short-term memory loss related to chemotherapy. That is why it is so important to have a professional person diagnose PTSD and initiate appropriate treatment. In addition, the individual with PTSD does feel isolated and lonely, making it imperative to have the correct treatment.

Treatment for PTSD can take on many forms. Psychopharmacology is very effective in treating PTSD. Medicines from antidepressants to anxiolytics help to decrease the co-morbid symptoms of depression and anxiety. Psychotherapy focused on the trauma is very important for individuals suffering from PTSD. A psychiatrist or psychologist should diagnose the disorder but there is an important role for therapy from counselors, psychiatric advanced practice nurses, social workers, etc., who are trained to treat individuals with PTSD. Cognitive-behavioral therapy is effective in helping the individual "re-frame" the traumatic experience and there is a definitive role for integrative medicine such as acupuncture, yoga, guided imagery and relaxation.

Cancer is a disease of both the individual and their families. Spouses, parents, children, and significant others are profoundly affected by the diagnosis. The first step in helping our spouses/significant others to grasp the emotional changes we've been through is to understand that although it may be difficult for them to express their own feelings, in the majority of cases, they care very deeply about what has and is happening to us.

Unfortunately, just as our diagnosis was a shock to us, most often spouses and family members are tossed into the caregiving role without warning and without the necessary communication skills that are so important for providing compassionate care. Our loved ones may also be so affected about what is happening to themselves in relation to what is happening to us that their focus is inward or expressed inappropriately. For example, a spouse or loved one may be very angry about the cancer diagnosis and treatment and inadvertently project the anger towards you. Fear also underlies blocked communication and your loved ones may be afraid that they cannot meet emotional needs or provide adequate comfort. These factors often put the responsibility of effective communication on the shoulders of the individual who is experiencing the cancer. We must be able to identify our own emotional needs and then take responsibility for communicating these needs to our loved ones.

In a practical sense identifying our needs begins with "I" statements to our loved ones, such as "I want" or "I feel" or "I think." Being clear and clarifying our needs is important with statements such as "I sometimes feel frustrated when my hands ache from neuropathy and I'm unable to do the chores around the house, therefore I need you to help me." Asking your loved ones if they understand your needs is also important. An example might be, "I keep asking myself if I should share my diagnosis with my parents. What do you think?"

Finally of course, we must be receptive to the feedback that our loved ones communicate and also be receptive to their help and support without being defensive. It is a challenge for our loved ones to grasp the emotional changes we've been through when they are going through their own changes at the same time. Once a cancer is diagnosed the repercussions reverberate throughout every relationship--spouse to spouse or individual to individual. Therefore, the first step is clear understanding of these changes through effective communication. Besides taking the responsibility on ourselves alone there are support networks and support groups that can also help your loved ones understand the journey you are taking by listening and being informed by others. Cancer is a disease of both the individual and their families. Spouses, parents, children, and significant others are profoundly affected by the diagnosis. The first step in helping our spouses/significant others to grasp the emotional changes we've been through is to understand that although it may be difficult for them to express their own feelings, in the majority of cases, they care very deeply about what has and is happening to us.

Unfortunately, just as our diagnosis was a shock to us, most often spouses and family members are tossed into the caregiving role without warning and without the necessary communication skills that are so important for providing compassionate care. Our loved ones may also be so affected about what is happening to themselves in relation to what is happening to us that their focus is inward or expressed inappropriately. For example, a spouse or loved one may be very angry about the cancer diagnosis and treatment and inadvertently project the anger towards you. Fear also underlies blocked communication and your loved ones may be afraid that they cannot meet emotional needs or provide adequate comfort. These factors often put the responsibility of effective communication on the shoulders of the individual who is experiencing the cancer. We must be able to identify our own emotional needs and then take responsibility for communicating these needs to our loved ones.

In a practical sense identifying our needs begins with "I" statements to our loved ones, such as "I want" or "I feel" or "I think." Being clear and clarifying our needs is important with statements such as "I sometimes feel frustrated when my hands ache from neuropathy and I'm unable to do the chores around the house, therefore I need you to help me." Asking your loved ones if they understand your needs is also important. An example might be, "I keep asking myself if I should share my diagnosis with my parents. What do you think?"

Finally of course, we must be receptive to the feedback that our loved ones communicate and also be receptive to their help and support without being defensive. It is a challenge for our loved ones to grasp the emotional changes we've been through when they are going through their own changes at the same time. Once a cancer is diagnosed the repercussions reverberate throughout every relationship--spouse to spouse or individual to individual. Therefore, the first step is clear understanding of these changes through effective communication. Besides taking the responsibility on ourselves alone there are support networks and support groups that can also help your loved ones understand the journey you are taking by listening and being informed by others.