Coping With Stress

People with cancer, their loved ones, and their caregivers are under a lot of pressure. It is common, even expected, for your loved one to experience mood changes. In your new role as caregiver, you also may find that you have feelings of guilt. Some caregivers may experience doubts or questions about their spirituality, faith, or religion. All of these new feelings and experiences can be stressful, but there are strategies that can help you cope.

Changes in Your Loved One’s Mood or Behavior

Coping with treatments, side effects, and anxieties that accompany a cancer diagnosis can be overwhelming. The cancer experience can feel like a roller coaster with ups and downs that affect your loved one’s mood and emotions.

Mood changes are common and may occur at any time during your loved one’s cancer experience. Some people feel anxious or depressed right after diagnosis. Others have mood changes during treatment. Survivors even report having mood swings within moments of each other. They might feel joy that treatment is over, and at the same time feel fear of recurrence. It is common to experience profound happiness and sadness within a very short time.

While it may be frustrating or even frightening, it is important for caregivers to expect mental changes. They are just as important as physical changes to monitor. Both can be hard for the whole family. Your loved one may have short periods of feeling down. If it turns into an inability to function or lasts for several days, talk to their healthcare team. This may be a sign of depression, which needs to be addressed.

Here are symptoms to watch out for:

• Feeling down or depressed every day
• Limited desire to do any activities of daily life or spend time with others
• Loss of energy and motivation (beyond expected fatigue post-surgery or treatment)
• Feelings of hopelessness or that life is not worth living
• Panic attacks

Tips to Manage Mood Changes

If your loved one experiences milder mood changes, it may be helpful for them to attend a support group for people with cancer. Seeing that they are not alone may help your loved one cope with a cancer diagnosis.

As a caregiver, it can be hard to know what emotions are a normal part of the cancer experience or may be more serious and need attention. Consider keeping a log or journal and discuss it with your healthcare team or oncology social worker. You can help your loved one track how and when their mood changes. Is it after taking a certain medication? During treatment? Right before a scheduled check-up? Understanding if there is a pattern may help you, your loved one, and their healthcare team address the issue.

Know When to Seek Help

People with more serious mood changes may benefit from mental health support and possibly medication. Consult with your healthcare team or oncology social worker. They can say what professional referrals might help, such as counseling or medication.

Your job isn’t to diagnose your loved one. But you can help identify areas of concern and advocate for them. 

If you or your loved one has thoughts of suicide, please call 9-1-1 or go to a nearby emergency room. You can also contact your regional or national hotline to be connected to help:

National Suicide Prevention Hotline (U.S.): (800) 273-8255 
Suicide Prevention Service (Canada): (833) 456-4566 or text 45645
Canada Kids Help Phone: (800) 668-6868 or text CONNECT to 686868 
Distress Centers of Greater Toronto (Canada): (416) 408-4357 
Quebec Suicide Prevention Hotline (Canada): (866) 277-3553

Feeling Guilty

It is common, even expected, for caregivers to feel guilty. You may feel guilty for:

• Not spending enough time with your loved one
• Not taking care of yourself or other loved ones
• Resenting your caregiver role

The burden on caregivers is often a silent one. Support is frequently given to the person with cancer, while the caregiver feels a variety of emotions in the background. Guilt can be motivating or debilitating. Your control comes in how you respond to it.

Caregivers are affected in significant ways. There are many demands and emotional roller coasters. It is OK to admit that you are feeling guilty or even angry at times. This does not make you a bad person or caregiver. Both you and your loved one are adjusting to a “new normal,” which can be hard. This is understandable and very common.

No one asks for cancer to enter their lives and to step into a caregiver role so abruptly. Caregivers may even feel guilty for wanting to take time off (for example, spending time alone or visiting a friend). Remember that you need to take care of yourself so that you can continue to support your loved one.

Recognize Your Feelings

It is important to pay attention to guilt and other underlying feelings. You may feel resentment, anger, or loneliness. It is OK to dislike the role of caregiving at times. It doesn’t mean you don’t still love the person you are caring for.

If you notice that guilt or other negative emotions are getting in the way of what you need to do or continue for many days, reach out to your healthcare team. They can help you find support options.

Tips to Manage Feelings of Guilt

• Give yourself a break. You will have good and bad days. Give yourself permission to feel these feelings and to schedule time for yourself. Self-care is vital to caring for your loved one physically and emotionally.
• Ask for help. Ask friends and family to help with activities, come visit, or simply listen on the phone. Create your own online network of support to help avoid isolation.
• Seek out community resources. Your healthcare team or oncology social worker can help you locate resources to assist you in caregiving. Support groups can also help you feel less alone and gain helpful resources and information. Receiving counseling with a mental health provider — even just a few sessions — can also be helpful.
• Embrace the “new normal.” Life may not go back to being the exact same as it was for you and your loved one before their cancer diagnosis. Rather than feeling guilty, resentful, or missing what was, it can be helpful to find meaning in what life is right now. Try to find new opportunities, new goals, or new ways of appreciating life. You and your loved one can embrace this challenge together and increase control over your emotions and daily life.

Eating & Nutrition

It is common for caregivers to feel guilty for eating normally while their loved one is not. It's important to find a balance in supporting your loved one and meeting your nutritional needs. This may mean eating at different times, eating different foods than your loved one, and eating when your loved one isn’t.

Take notice of any emotional or physical factors that might affect your appetite, such as fear, depression, or loneliness. This can cause problems with overall health and well-being. It is important to understand how nutrition affects your health and ability to care for your loved one.

Here are some tips to help you and your loved one better manage eating and nutrition:

Voice your opinion about food. While eating habits and meals may change when supporting your loved one, it is important for you to eat healthy foods and foods that you enjoy. Try to find a balance with your loved one that allows you to also eat the foods that you need.

Be flexible about where eating occurs. If there are specific places that might make it easier or more pleasant for your loved one with cancer to eat, eat in those areas during mealtimes as much as possible. Their appetite might vary, which might make their mealtimes different from yours. Ask family to sit with them or adjust family mealtime so that they don’t always have to eat alone.

Be supportive in social settings. Food and eating are a large part of social activities. Understand that your loved one may eat more during social activities. Or they may want to avoid these settings if eating is difficult. This social time may be important to you and provide you some respite, so work together to find middle ground.

Anticipate varied likes/dislikes. It is not uncommon for people with cancer’s taste buds to change, at least temporarily. Be supportive of different requests by your loved one. Suggest different options than what they ate before cancer.

Regardless of how you define it, caring for a loved one with cancer may cause you to think more about your beliefs. Caregivers often find that cancer prompts them to search for meaning in their lives or question their purpose in life.

For some people, turning to religion or spirituality brings comfort, meaning, or hope. Some find that cancer leads to a new or renewed sense of faith in a higher power. Other people may not feel a need to turn to religion, or they may find this aspect of their lives upsetting as they struggle to make sense of their loved one’s illness.

A cancer diagnosis can prompt some people to doubt their beliefs or feel angry at God. Some question the existence of a higher power or an afterlife. Many people ask themselves, “Why me?” or “Why my loved one, and not me?” Some people wonder whether God or a higher power is punishing them. If you have had similar thoughts and feelings, you are not alone.

Tips to Cope With Questions or Doubts

Explore what brings you comfort and meaning. Some people find that going to a special place where they find beauty or a sense of calm is helpful. Others find comfort in spending time with loved ones or reading uplifting stories about the human spirit. It’s different for everyone. Take time to learn what activities, places, or people help you find comfort and meaning.

Meditate or pray. Sitting quietly may help you to create the mental space and perspective to answer your questions. You may have many questions about:

• The meaning of life
• The impact of your loved one’s cancer on you as a person
• How you may be changing because of the experience

Seek support. Support groups, prayer circles, and religious or secular communities can help you connect with others. They may share ways they have found meaning or coped with spiritual distress when facing cancer. These groups also may provide practical support, such as help with meals or rides to medical appointments.

Talk with a hospital chaplain. If you are struggling to make sense of your experience, a trusted clergy member or professional counselor may be able to help. They can help you think through your questions about the meaning of life and the cancer experience. It may be particularly helpful to talk with a chaplain about these topics. Chaplains are specially trained to support people coping with a serious illness like cancer. They help people of all different faiths, as well as those who don’t consider themselves religious or spiritual.

A chaplain can help you explore your thoughts. Whether you have a broad question about the meaning of life or a specific concern about your religious beliefs, they are there for you. They are also there if you would like someone to pray with you. Many healthcare facilities employ hospital chaplains. Ask your loved one’s healthcare team about how to get connected with one at your hospital or medical center.