The Case of the Emotional Emergency
Sharon, age 40, was diagnosed with invasive ductal carcinoma. Pathologically, her tumor was grade I, estrogen- and progesterone-receptor positive, and HER2 negative. The mass measured 0.5 cm on ultrasound.
Sharon has no family history of cancer and is devastated by the diagnosis. One of her close friends recently died from metastatic breast cancer, and she is certain will have the same fate. She tells Jennifer, an RN in the breast center, that she is going home to “get her affairs in order.”
What Would You Do?
A person’s response to hearing a cancer diagnosis is highly individualized. Emotions can range from fighting determination to immobilizing fear. Oncology nurses can teach patients the difference between emotional and physiological emergencies by first clearly understanding the patient’s diagnosis and then recognizing and addressing common emotional reactions experienced by people in the immediate stages of learning they have cancer (see sidebar).
Psycho-oncologists have identified three stages of response to a health crisis:
- Initial reaction
Sharon’s initial reaction began with disbelief and shock, then quickly morphed into a feeling of impending doom. You might expect, given her friend’s recent passing, that Sharon’s response is normal. However, patients are at increased risk for developing stress disorders when extreme emotions are not addressed. Helping Sharon differentiate between her emotional reaction and her physiologic state can reduce her risk of getting stuck in a state of chronic distress (https://www.cancer.gov/about-cancer/coping/feelings/anxiety-distress-hp-pdq).
Jennifer first addresses Sharon’s obvious distress by asking her to describe what she means by “getting her affairs in order.” Phrases like these can easily be misinterpreted. For example, affairs could be mean immediate life events or carpool assignments. Sharon explains she needs to take care of legal matters, including determining who will acquire custody of her three children.
Although a cancer diagnosis may provoke a sense of emergency, patients can find comfort by understanding the physiologic basis and potential implications of their diagnosis. Sharon listens as Jennifer explains the implications of estrogen-sensitive breast cancer and why additional information is needed to fully stage the cancer and determine prognosis. She helps Sharon understand grading and staging and what to expect in the days and weeks to come.
By reviewing common emotions related to a cancer diagnosis, Jennifer validates Sharon’s expressed fear and anxiety. Sharon leaves the breast center stating that the feeling of doom and gloom she originally experienced improved by having a better understanding of the physiologic aspects of her diagnosis.