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Billura Rasulova
Lecturer,
Master of Psychology, Pediatrician
Department of Pedagogy and Psychology,
Baku Slavic University,
Baku, Azerbaijan
Email: dr.billura@hotmail.com
ORCID: 0009-0008-9125-0625
https://doi.org/10.5281/zenodo.15562494
Keywords: psychological support in oncology, mental health in cancer patients, psychotherapy for cancer patients, EMDR therapy in oncology, trauma-focused therapy
Abstract. A cancer diagnosis is one of the most difficult to accept and one of the most widespread diagnoses of our time. Cancer can lead to various psychological consequences, especially during chemotherapy treatment. This illness has not only physical but also significant psychological effects. Therefore, the diagnosis and treatment of cancer present a complex challenge and often have a substantial impact on the patient’s mental health. Doctors and other healthcare professionals working in oncology face a large number of patients and situations where cancer treatment becomes extremely complicated due to the form of the disease, the presence of metastases, the patient’s lack of psychological preparedness for treatment, as well as the wide range of side effects caused by chemotherapy, and so on. One of the most common reactions to a cancer diagnosis is anxiety. Patients may worry not only about the outcome of treatment and their physical condition but also about how the illness will affect their loved ones. This anxiety can lead to physical symptoms such as rapid heartbeat, excessive sweating, sleep disturbances, and panic attacks.
Introduction
The diagnosis of cancer is widely recognized as one of the most difficult and emotionally distressing diagnoses of our time. It not only poses a significant physical health threat but also brings about profound psychological consequences for patients. Cancer can trigger a wide range of emotional responses, especially during intensive treatments such as chemotherapy, which are often accompanied by severe side effects and extended recovery periods. These psychological effects are not secondary—they are integral to the overall experience of the illness, influencing patients’ quality of life, treatment adherence, and long-term outcomes. The process of diagnosing and treating cancer is inherently complex. It requires a multidisciplinary approach, addressing both medical and psychosocial dimensions. Physicians, oncologists, nurses, and other healthcare professionals working in oncology are frequently confronted with challenging clinical scenarios. These challenges include the nature and stage of the cancer, the presence of metastases, the patient’s psychological preparedness for treatment, and the overwhelming burden of chemotherapy’s side effects such as fatigue, nausea, immunosuppression, and neuropathy. Each of these factors adds to the complexity of care and increases the emotional strain on both patients and caregivers. One of the most common psychological reactions to a cancer diagnosis is anxiety. Patients often experience heightened concern not only about the outcome of the treatment but also about their physical well-being and the potential emotional and practical impact on their families and loved ones. This anxiety can manifest in various physical symptoms, including increased heart rate, excessive sweating, sleep disturbances, restlessness, and even panic attacks. In some cases, it may escalate into generalized anxiety disorder, depression, or post-traumatic stress symptoms, especially in patients undergoing aggressive or long-term treatment. Given the profound mental health burden associated with cancer, it is essential to incorporate psychological care as a core component of oncology services. Psycho-oncological interventions, including individual and group psychotherapy, EMDR therapy, mindfulness practices, and stress management techniques, have proven effective in reducing distress and improving emotional resilience among cancer patients. By addressing the psychological aspects of cancer, healthcare providers can foster a more holistic, patient-centered approach to treatment, ultimately contributing to better clinical outcomes and enhanced quality of life.
Main part. Cancer diagnosis is almost always considered a crisis that demands adaptation to catastrophic information. Negative psychological states such as stress, anxiety, and depression are often associated with the diagnosis and treatment of cancer [1]. In the initial stage of the illness — diagnosis, followed by the beginning of treatment—patients experience a certain amount of emotional distress, which is regarded as a normal response to a stressor [Durosini & Pravettoni, 2021], as cancer is classified under post-traumatic stress disorder. The experience of cancer is a negative life event requiring considerable effort from both patients and their families to adapt to the numerous challenges related to the disease. Understanding the psychosocial aspects of cancer and its treatment has become an essential and necessary part of care. Although the psychosocial components of cancer have been studied in the literature since 1958, only in the past 25 years has this area evolved into a distinct discipline known as psycho-oncology [Durosini and others, 2021]. Emotional stress, anxiety, and depression in cancer patients can affect various life domains (e.g., work, family, and relationships) and may reduce treatment adherence, thereby negatively impacting treatment outcomes.
Furthermore, individuals diagnosed with cancer may experience shifts in motivation for daily activities and changes in personality traits. Some patients report difficulty returning to life after a diagnosis, perceiving it as traumatic. These consequences can arise regardless of cancer stage and even at the moment of diagnosis. Confronting a life-threatening diagnosis requires physical and psychological adaptation to a new situation. In this context, it becomes increasingly important to understand not only the medical facts of the diagnosis but also the personal and subjective perception patients have of their illness. However, such subjective representations of the disease may lead patients to view themselves as «high-risk» or «low-risk» individuals, which can have negative implications for their treatment.
People may have various mental images of their cancer, using different colors, shapes, sizes, consistencies, and textures to represent how they think their cancer looks and/or feels. For example, when drawing their tumor, patients often use sulfurous, black, and red colors. Moreover, chronic illness cannot be separated from the emotional burden that significantly influences cognitive perceptions. The presence of a tumor deeply alters one’s relationship with their body, where previously unnoticed physical sensations are suddenly perceived as potentially threatening and experienced with strong negative arousal. All existing data suggest that patients may have individual perceptions of their cancer, which shape their understanding of health importance, caregiving behavior, and health-related anxiety. According to Williams (1997), individuals’ beliefs about their illness, themselves, and others may result in dysfunctional behavior during illness. Illness representation includes, for example, beliefs about the consequences and causes of cancer, as well as perceived manageability of the diagnosis (Williams, 1997).
Patients’ personal perceptions of their condition are influenced by social context and others’ opinions. Due to its negative reputation in public discourse and representations in media (e.g., films, scientific literature, or broadcasts), which often emphasize the destructive side effects, chemotherapy is frequently perceived as the “main” and frightening method of cancer treatment, typically associated with severe cases. Patients or survivors who have not undergone chemotherapy may feel intimidated or insecure when interacting with those who have [Durosini and others, 2022].
They may feel that «their cancer» is «definitely» less serious, and thus, their current need for care, self-expression, and active listening (in a social context) is less important than others’. These beliefs can hinder patients from acknowledging the significance of their physical and emotional burdens, leading them to passively accept their diagnosis [5]. This can significantly affect their overall well-being. In this regard, psychologists play a crucial role in addressing patients’ fears and beliefs about their diagnosis, as well as the influence of social representations of the disease and treatment on psychological perceptions. The internal image of the disease is equally important. Studying and managing all these aspects is vital in addressing negative emotions and distorted views of clinical conditions that may lead to harmful consequences and dysfunctional behavior in illness.
A central aspect of medical care is the communication between healthcare providers and patients. Discussing the diagnosis and treatment can be a stressful experience for patients and a source of emotional discomfort if not handled appropriately. Instances of insensitivity from doctors and medical staff can exacerbate these conditions—for example, bluntly delivering the diagnosis or when a patient overhears a conversation about their grave condition. The lack of effective and supportive communication where patients can understand clinical information may result in reduced comprehension of their illness and unrealistic expectations regarding associated risks. Generally, cancer diagnoses are linked to anticipation of potentially adverse events such as pain, death, and loss of function [7].
It is essential in such cases to help patients recognize their health status and reframe their illness narrative within their life story. Understanding their beliefs and needs regarding their cancer journey allows them to gain personal control over the illness, applying their skills across life domains. In this context, psychologists play an active role in supporting patients emotionally, assisting physicians during communication, and ensuring targeted education and information for patients and caregivers. Additionally, patients may benefit from peer support.
Research reports related to each of these areas are analyzed, suggesting that these variables serve as a basis for forming testable hypotheses [9]. Clinical research programs could measure medical status changes following interventions that:
- modify stress levels and coping mechanisms,
- assist in processing unresolved grief,
- stimulate the will to live,
- promote realistic positive expectations,
- enhance mental capacities for psychophysiological self-regulation,
- enable constructive confrontation with denial,
- facilitate appropriate emotional expression,
- strengthen specific personal qualities.
Subsequent research in countries like the USA, Europe, and Russia shows that cancer patients who attended support groups or received psychotherapy and counseling post-hospitalization not only improved quality of life during illness but were also less susceptible to recurrence. For instance, in 1990, F. Fawzy et al. [11]
demonstrated that after group psychotherapy for breast cancer and malignant melanoma patients, remission duration and quality of life significantly improved, positively affecting emotional well-being. A key point is that psychological support and psychotherapy were not positioned in opposition to core cancer treatment but instead enhanced its effectiveness. Today, the positive clinical impact of psychotherapeutic interventions for oncology patients is widely accepted.
Professional support for cancer patients is one of the psychologist’s tasks. The specific nature of this support stems from the complexity of the patient’s condition and treatment. Extreme emotional reactions may also be caused by immediate or delayed side effects of radiotherapy, surgery, or chemotherapy—even when patients are informed of these possibilities.
Managing anxiety, depression, and other mental health issues related to cancer can be overwhelming. After assessing a patient’s condition, the psychologist can determine the goals of psychological support during radiation therapy or follow-up, helping decide which method or form to use for an individual or group. Thus, it’s important to consider steps to improve mental health during cancer treatment.
Today, in all developed countries, «Psycho-Oncologist Associations» issue psychological care guidelines for cancer patients, tailored to the cultural, national, and religious contexts of their populations. This involves forming a comprehensive rehabilitation team including oncologists, psychologists, psychotherapists, social workers, etc. Developed countries devote much more attention to the psychosocial problems of cancer patients than low-income countries and recognize the importance of psychological support. Psychological interventions should be provided:
- Before and after chemotherapy,
- Before and after surgery,
- After hospital discharge.
Rehabilitation work is also essential with the patient’s close relatives, who will provide care during the postoperative and treatment periods. As noted, the main goal is to help patients cope more easily with treatment, adapt peacefully to their altered appearance, and reasonably evaluate their current situation and future potential.
Hence, the diversity of stages and tasks must be accompanied by varied forms of psychological intervention:
- Psychological counseling;
- Crisis interventions;
- Rehabilitation;
- Prevention and health promotion;
- Psychotherapy.
The most common post-diagnosis symptoms include generalized anxiety disorder, depression, PTSD symptoms, low self-esteem, obsessive symptoms, and guilt.
Conclusion
It is important to note that in Azerbaijan, rehabilitation of cancer patients has on-ly recently begun. Our work with 140 patients in Azerbaijan has shown that those who receive psychological support endure chemotherapy more easily and are more willing to undergo it. After psychotherapy courses, their perception of illness changes, and they express a desire to return to work and social life. Among all types of therapy, I personally prefer CBT (Cognitive Behavioral Therapy), EMDR (Eye Movement Desen-sitization and Reprocessing), and Emotion-Focused Therapy. I believe it is crucial to continue work in this area. Cancer patient rehabilitation can only be considered comprehensive if psycholog-ical rehabilitation is mandatorily included—before, during, and after surgical and chemotherapeutic interventions.
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