The First Year
Hearing a cancer diagnosis is a moment we all remember forever. In 1993, after a biopsy of my first breast cancer, I left the OR to be told that: "The doctor will talk to you in there." As I entered the small room, I saw my husband's back; he was wearing a black and white striped shirt, and it is that image that stays powerfully with me. Even twenty years later, my stomach knots as I type these words. Without hearing any words, his presence was the message.
When learning we have cancer, our first thought inevitably is a version of: "Am I going to die?" For those of us who are parents, especially parents of young children, the next thought is: "What will happen to my children?" It is no wonder that we are in instant panic and crisis mode.
Over the years, I have learned that it is impossible and unfair to assess someone's baseline mood and coping at the time of diagnosis. To a greater or lesser degree, we are all crazed. Many times, I receive an urgent referral about someone who is reportedly "losing it, really upset" shortly after being diagnosed. When I first meet her, she may or may not have settled down a bit, but, six months or a year later, she is absolutely a different person than she was in those first days. We know from crisis theory that no one can stay in high alert for more than about six weeks; we just start to adapt and manage. When I speak with someone who is newly diagnosed with metastatic disease, I tell them that it will feel a bit easier in six weeks, but that it likely will take a full year to settle into this new life. Inevitably, that is true, and, a year later, assuming the person has been a little lucky and is feeling pretty well, s/he has figured out how to live with Stage IV cancer.
These thoughts are stimulated by this article from Supportive Cancer Care; their findings absolutely reinforce my own experience. Here is the abstract and a link if you want to read the whole thing:
Emotional adjustment over 1 year post-diagnosis in patients
with cancer: understanding and predicting adjustment
W. Linden & R. MacKenzie & K. Rnic & C. Marshall &
Purpose The aim of this study was to determine the prevalence
of basic trajectories in emotional adjustment in cancer
survivors and identify predictors of long-term change.
Methods We assessed 421 patients with cancer after diagnosis
and 6 and 12 months later. Measures comprised anxiety,
depression, perceived support, desired support, and illness
Results Anxiety decreased over time, whereas depression increased
as did need for support. About one third of initial
diagnostic classifications (into low distress, symptoms, or
clinical level of distress) changed from one assessment to
the next. Lower age and higher illness intrusiveness predicted
which patient showed worse adjustment over time.
Conclusion To avoid both over- and undertreatment of distressed
individuals, repeated measurements are needed to
identify actual adjustment trajectories. Initial assessment of
emotional reaction to a diagnosis is not a reliable predictor of
long-term adjustment. Patients should be made aware that
completion of initial medical treatment even when accompanied
by a positive prognosis does not in and of itself forecast
how well patients adjust during survivorship.