If you're starting chemotherapy, you may already know about the effects on your body, like nausea and fatigue. But are you prepared for the emotional changes that may come along with treatment?
"They can be hard to predict," says Susan Englander, a clinical social worker at the Dana-Farber Cancer Institute in Boston. Over the course of a week -- or even one day -- you may find yourself energized, upbeat, angry, frustrated, and down in the dumps.
Learn what triggers these twists and turns in your outlook. It's the first step in bringing the mental upheaval under control.
Why Does Chemo Cause Emotional Changes?
It's a combination of psychological and medical factors, says Joanne Buzaglo, PhD, a clinical psychologist and two-time cancer survivor who lives outside Philadelphia. She had chemotherapy in the late 1980s for Hodgkin's lymphoma and then again for breast cancer in 2013.
On one hand, you face stress during treatment. You may have worries about how to care for your family, keep up at work, or whether your treatment will be successful. On the other hand, you have to deal with the emotional impact of physical symptoms, like nausea and fatigue.
"It's a treatment that's supposed to make you feel better," Englander says, "but the process can make you feel worse." And that can take an emotional toll.
Take Action if You're Feeling Down
If you're in the middle of chemo and your mood takes a hit, there are plenty of ways to push back.
Focus on what's upsetting you. Don't bury your feelings or let them take over. "You sometimes have to play detective to figure out what's really bothering you," Englander says. Instead of feeling overwhelmed, you may realize that there's a specific issue you can fix.
Tell your doctor. "People sometimes don't speak up to their doctors because they want to be the 'good patient' who doesn't complain," Buzaglo says. "And other people just assume that they're supposed to feel terrible during chemotherapy, so they don't say anything either."
Don't suffer in silence. Your doctor can help treat difficult side effects and find a counselor or therapist you can talk to.
Lean on your support network. Reach out to friends and family for help, Englander says. Some days, you'll want to talk about what you're going through, but there may be times you may just be looking for distraction from your thoughts.
Sometimes, asking for practical help will lift your mood, like having a friend come stock your freezer with a week's worth of dinners. Ask for what you need.
Adopt Healthy Habits
Since a full course of chemotherapy can sometimes last months, you need to plan ahead for the emotional impact. Try these tips:
Get in a routine -- but stay flexible. Sticking to a plan can help you feel in control, but be ready to tweak it if chemo throws you a curve, Buzaglo says.
After months of treatment, you could suddenly develop new side effects that surprise you. If that happens, check with your doctor to see what's behind them. New side effects may call for new routines. You might need to make adjustments.
Track mood changes with a journal. You'll feel better if you write about your experience. Englander says that keeping a diary will also help you see patterns in mood changes, so you can predict them -- and plan for them.
Make treatments into a relaxing (or fun) ritual. When you head to chemo, be prepared with whatever comforts you. Englander says that some people choose to be alone and rest, read, or watch movies.
Others are more social. "I've seen people who bring picnics to eat with their families," she says. Another patient brought a friend so they could give each other facials, she says.
Get support. Check out your in-person or online options for support groups. They offer a way to learn more about how other people deal with the effects of chemotherapy.
Get moving. You may not be up to your regular fitness routine, but physical activity is still a good idea during chemotherapy. Talk to your treatment team about trying relaxed, gentle forms of exercise, like yoga or tai chi.
Try relaxation techniques. Check with your health care team about ways to help calm your mind, like meditation, guided imagery, massage, or acupuncture. See if your treatment center offers any on site.
There's no foolproof way to manage the emotional ups and downs of life during chemotherapy, Englander says. The right approach varies from person to person. And it will always need a lot of tweaks along the way.
"You just have to accept that you may feel fine one minute and the next you don't," Buzaglo says. "When it happens, have compassion for yourself. I'm not saying it's easy, but that's how you'll get through it."
