Types of Psychosocial Challenges: What am I Experiencing?
Below are some areas where AYAs may struggle during their cancer experience. Not all of these will apply to you, but they might help you recognize and understand your own feelings, concerns, and stressors.
Emotional Distress
Experiencing some level of emotional distress is understandable and expected. However, symptoms of emotional distress can range from mild, moderate, or severe. You might feel these symptoms every once in a while, once a week, or every day. If you feel like your symptoms are hard to manage on your own, getting worse, or interfering with your day-to-day life or ability to make decisions, it may be helpful to seek professional help. Ask your medical team for a referral to speak to a therapist.
Anxiety and Depression:
Anxiety and depression are among the most common types of emotional distress that are experienced by AYAs with cancer. These symptoms may be experienced at various (or all) stages of your illness, including after treatment is completed.
Common signs of anxiety can include:
- Feeling nervous or worrying a lot
- Difficulty controlling the worry
- Finding it hard to sit still or feeling "on edge"
- Difficulty concentrating
- Tension in your muscles
- Sleep problems
- Feeling more irritable than usual
Common signs of depression can include:
- Feeling sad or empty
- Losing interest or motivation in things you used to enjoy or are important to you
- Feeling tired a lot of the time
- Trouble sleeping or eating
- Hard to focus or make decisions
- Feeling down about yourself or guilty
- Thoughts about dying and self-harm
Uncertainty:
Not knowing what the future holds or being scared about the cancer coming back, along with the physical and mental toll of treatment can cause more emotional distress.
Anger and Frustration:
Being young and healthy are "supposed" to go hand in hand. It is understandable to feel some anger and frustration about your diagnosis and treatment, and when the illness or treatment limits what you'd like to be able to do.
Post-Traumatic Stress:
Post-traumatic stress disorder (PTSD) is a mental health condition caused by an extremely stressful or terrifying event — either being part of it or witnessing it. Symptoms may include flashbacks, nightmares, severe anxiety and uncontrollable thoughts about the event. Some people with cancer may experience this from treatment. They will need formal support if the symptoms get worse over time. PTSD needs to be diagnosed by a psychologist or psychiatrist.
Grief:
Grief is the state of having lost something important to you; it doesn’t only refer to the loss of a person. For example, grief can come from the loss of social community, physical ability/physical appearance, or fertility. It can also come from loss of cognitive clarity, loss of jobs and income, or disruptions to life plans (e.g., school or work).
Fear of Recurrence and 'Scanxiety':
Patients who have been treated for cancer may experience fear of recurrence, which refers to the worry that the cancer may come back. Or they may experience scanxiety, which refers to the anxiety or stress people feel before, during or after important tests (e.g., MRI, CT scans, blood work, biopsies). Both of these experiences can add to the emotional distress AYAs feel.
What Mental Health Symptoms Do I Have?
There are short tools online that can help you understand your symptoms. These tools aren't meant to give you a diagnosis - that should be done by a qualified mental health professional or your family doctor. You can fill them out and share them with a member of your medical team (like your family doctor or oncologist) to help with figuring out the next steps.
Social Disconnect
Peer Relationships:
At times, cancer and side effects from treatment can make it harder for younger people to maintain friendships and meet new people. For some, it can feel like their friends don’t fully understand what they're going through. Depending on the situation, it can be hard to figure out whom to tell and how much to share.
Family and/or Close Relationships:
The diagnosis can bring changes in family roles and/or other close relationships. For example, some people may need more support from their close relationships and also desire to keep their independence. This can sometimes be a hard balance to figure out.
Changes in Relationships:
Many patients share that relationships can change. Some become stronger or new bonds form that were unexpected. Other times, you became less connected. Despite the disruptions that cancer may be causing to certain relationships, it can help your mental health to focus on the relationships that have nourished you or remind yourself where there are positives/where you can feel gratitude for the people who are supporting you.
Sexual Health and Identity
Physical Changes:
Treatments like chemotherapy, radiation, and surgery can lead to physical changes that affect body image and self-esteem. Hair loss, weight changes, and scars can be especially challenging.
Sexual Health and Intimacy:
AYAs may experience concerns related to sexual health and intimacy, including concerns about fertility, sexual function, and forming intimate relationships.
Identity Development:
Young people are often figuring out who they are and setting goals for their future, like what they want to study or what career they want. When cancer comes into the picture, it can disrupt these plans and make things more difficult. Some young people share that they feel disconnected from who they were before cancer, and this changing identity or loss of prior identity can cause grief that is important to name.
Fertility Concerns
Worry about fertility can be a major source of stress for AYAs with cancer. Some people might feel upset or anxious about losing their ability to have a child because of their cancer diagnosis or treatment. Sometimes, even the loss of the ability to make that choice in the future can be upsetting. Having to make quick decisions about fertility preservation procedures can add pressure and stress. These worries can make navigating the cancer experience harder.
Practical Concerns
Juggling cancer with school, work and typical life activities/obligations can create practical concerns for AYAs. They may struggle with managing independence, navigating insurance, and maintaining social relationships during a time in life typically focused on building independence and pursuing future goals.
