The emotional impact

First reactions

When you first find out you or someone you love has advanced cancer, you will probably feel a range of emotions, such as shock, anxiety or disbelief. Sometimes people also feel relief: you may have suspected that something was wrong and now you know what it is.

Common reactions

Most people have mixed emotions. These reactions are normal. Talking about your feelings may help you deal with them; not talking is likely to be more distressing. Common reactions include:

• Fear - You may be scared of losing control of your life, becoming dependent on others or dying.
• Anger - You may be angry because you've dealt with cancer already or because you weren't diagnosed earlier.
• Guilt - You may blame yourself for the cancer or  may be worried about the impact of cancer on your family
• Sadness or depression -   It is okay to feel that you're not coping very well at this time. Often, the sadness lessens over time, but if the depression is ongoing or severe, tell your doctor about it as counselling or medication can help.
• Denial - It can be hard to accept that you have advanced cancer. Denial can give people time to adjust to their diagnosis, but if it stops them from getting treatment or assistance, it can become a problem.
• Loneliness - You may feel lonely even if you have many people around you. It's natural to feel that nobody understands what you're going through. You may feel too sick to enjoy your usual social activities or your family may limit visits from friends. Tell friends and relatives when you need some quiet time or if you want company.
• Lack of control - Facing an uncertain future is difficult to come to terms with.
• Search for meaning - A diagnosis of cancer often leads people to question the meaning of life.

Ongoing effects

Having advanced cancer means living with uncertainty. Learning to live with uncertainty can be challenging, and every day is likely to be different. Cancer is a personal experience. There is no right way to deal with cancer, but there are different ways to face it, depending on your outlook.

Feeling down

It is common to feel depressed. You may not be able to think clearly, you may lose interest in things, stop enjoying things you used to find satisfaction in, or you may not want to get up in the morning.

Depression can be treated. Tackling it early on means you can deal with other problems more easily and quickly.

• Counselling - Speak to your treatment team or call the Cancer Council Helpline on 13 11 20.
• Medication - This is helpful for some people. Even if you feel you have good reason to be depressed, medication can stop depression becoming an additional problem on top of everything else.

For information on depression and tips to overcome it, call:

• beyondblue - 1300 224 636, www.beyondblue.org.au.
• Black Dog Institute - (02) 9382 4523, www.blackdoginstitute.org.au.

Being positive

Often people believe that the attitude of the person with cancer will influence the outcome of the disease.  There is no conclusive evidence that thinking either positively or negatively will influence one's prognosis. Trying to think positively won't always be possible. Acknowledging how you feel - whether that is positive or negative - doesn't mean you can't maintain hope.

Looking for meaning

It's quite common for people diagnosed with advanced cancer to re-examine the meaning of their life. For some people, cancer may change what they think is important in their lives.

You may want to look for meaning in your life with someone close to you, your spiritual or religious adviser or a professional. If you'd prefer not to talk to someone else, you could write in a journal, meditate or pray.

Celebrating your life

Having advanced cancer often gives people a chance to look back on their life and all they've done. Some people like to prepare something to hand down to family and friends as a memory of themselves, like a legacy.

Some things you could consider are:

• writing letters
• making a video or DVD of special memories
• arranging photo albums
• writing your family's history
• making a CD of favourite songs
• gathering favourite recipes into a cookbook.

The effect on people close to you

Family and friends need time to adjust to the diagnosis of advanced cancer. They may experience similar fears and anxieties, and need as much information and advice as you do.

Sometimes people stay away or stop contacting you. Their behaviour can be hurtful, but it is quite a common experience for people with advanced cancer. Some people will not know how to respond. Your friends or family may need to be guided by you as to how much you want to talk about the illness and the different issues you need to think about.

Getting help

People might be eager to offer help when they first hear your news. This  can be a problem if friends want to protect you rather than help you stay independent. It can also  be hard to ask for help when you do need their assistance.

It may be useful to delegate one friend or relative to coordinate offers of help from other people and to update friends about your progress if you're not able to contact everyone individually yourself. Some people will prefer doing practical things, such as cooking a meal; others may be good at keeping you company. Sometimes you might need friends and family to help by staying away for a while.