Cancer is so common in Singapore, yet many of us struggle to cope with it when it hits home.

How do you cope when you’ve just been diagnosed and are awaiting treatment? ​How can you best support a loved one through cancer emotionally? ​Or how do you take care of yourself emotionally when you’re taking care of someone with cancer?

Dr Gilbert Fan, Master Social Worker at National Cancer Centre Singapore explains how to better cope with the emotional stress of cancer.

Question by healthblur

How do I enquire with a friend how she is doing?

She had breast cancer 5 years ago and now seems fine.

I want to ask how she is, to show I care, but don't want to make her unnecessarily worried or start thinking about relapse etc

What should I say?

Help!!

Answered by Dr Gilbert Fan, Master Medical Social Worker at the National Cancer Centre Singapore​:

If we try to focus on the person who has the cancer and not on the cancer itself, we should be able to strike a sensible, meaningful and appropriate conversation with them. Understanding the person whom you are talking with is important. What fits you may not befit another. Perhaps, what helps is to strike a good balance between showing concern and obtaining information. Showing concern in a way that would bring across the message that you care, and obtaining enough information to know how to be of help. It boils down to being appropriate and helpful.

You may not even need to refer back to her cancer diagnosis. When we meet up with friends whom we have not kept in touch for a long time, we simply ask "How have you been?". Let her direct the conversation to a comfortable level with you. Let her take the lead.

If you keep thinking about her having cancer, the 'C' word will appear in your conversation with her. This becomes your preoccupation, not hers. Trust her that she knows how to handle a conversation with you. Should you find her not comfortable talking at any point in time, check in with her whether she is fine to carry on with the conversation. Relapse is something which many cancer patients fear and would think about. You need not over-worry that you are distressing her. She should be able to tell you if she feels troubled. Be earnest in your communication.

Question by john

I had NPC six years ago and now in remission.

But, sometimes I just wake up in the middle of the night feeling scared that it will come back...! It's just an uncontrollable feeling!

I don't dare tell my wife as I dont want toscare her too.

Please help me. How can I get rid of this fear and feeling???​

Thanks

Answered by Dr Gilbert Fan, Master Medical Social Worker at the National Cancer Centre Singapore​:

Thanks John for writing to us about your fear. It is common for patients to be fearful of having a relapse. Most of the time, their fear is not disabling and they can still function normally. However, I noted that you have disrupted sleep as a result of your fear. I suggest that you see a counsellor or social worker to ascertain your current fear. You may see a counsellor or social worker at the hospital where you are treated through your physician. Alternatively, you may come and see me for a session to understand your current predicament. You may write to me at my Department's email address: mss@nccs.com.sg

Question by aror009

Hi Dr Gilbert, my granny was recently diagnosed with liver cancer. She’s refusing treatment and said she accepts God’s will. The thing is my mum and aunts don’t know how to accept/make sense of this. They want her to do more tests, get a second opinion but nobody dares to push the matter further with her. When we visited her, my mum warned me beforehand “do not use the c word in front of grandma. Act like normal” How can we discuss my grandma’s decision as a family without adding stress to her (since she’s very clear that she doesn’t want treatment)? Your advise is appreciated.

Answered by Dr Gilbert Fan, Master Medical Social Worker at the National Cancer Centre Singapore​:

Your grandmother might have good reasons for not wanting treatment. The important point to note is that she understands her medical condition fully and treatment availability and side-effects. It would be good if a healthcare professional assess her understanding of the treatment options. I often inform my patients that treatment options are time-limited options in that some treatments will not be offered with the original intent when a patient's medical condition changes, especially surgical options.

It will be a dilemma for you and your family to be concerned about your grandmother's decision not to treat versus the family's value to treat. I suggest that the family has a good discussion and sharing over the value to treat with a healthcare worker like a medical social worker who can facilitate the discussion. If the family chooses to discuss the issue on their own, do consider your grandma's final goals in life versus the family's goals for her. In some occasions, the family has to appreciate that no treatment may not be tantamount to choosing death. It could simply mean that your grandma may want a short burst of good quality of life rather than prolonging an agonizing life ahead. Your grandma can still receive the love and concern from her family with or without treatment. Knowing when to 'let-go' requires a balance between rational thinking and fluctuating emotions. 'Letting-go' is not giving- up hope but rather it is about giving-in to one's yearnings.

You can contact a medical social worker at the hospital where your grandma is being treated.

Question by stormynight95

Hi Dr,

I am a second year student in uni and my father has stage 3 cancer. My father has quit his job and my mum is a home maker. I work part time to support the family and I haven’t been doing well academically. I really want to pull my grades up before I reach my final year. My question is, how can I stay focused in school and better cope with my father’s situation?

Answered by Dr Gilbert Fan, Master Medical Social Worker at the National Cancer Centre Singapore​:

I am deeply concerned about your family's current finances. I am not sure if your father is already receiving financial assistance for his medical treatments. It seems that he might be eligible for some form of financial assistance at restructured hospitals. If he is yet to receive any financial aid, please kindly see a medical social worker at the hospital where he is being treated. On top of the medical aid, the Singapore Cancer Society (SCS) and Comcare @ SSO (Social Service Office) provide temporary cash aid to families in need. For SCS, you need a doctor's referral. You can go to any SSO nearest your locality.

No amount of advice can help you to cope better having to juggle between school and caregiving. You may have anticipatory fears of losing control over family finances, probably increasing complexities of your dad's medical condition and not doing as well in your studies. It would be good if your family can divide your roles and responsibilities as much as you can. Entrust your mother with the caregiving role to your dad. Involve help from extended family if offered. Reduce your part-time work if cash aid is adequate. Divide your time carefully by recognizing the important school dates. Work out short burst of quality time with your dad on a daily or weekly basis. Seek counselling if you feel that you need a listening ear and for someone to support you during this difficult time. Most hospitals have medical social workers or counsellors who can provide the support. Just ask for the service.

Question by sl190994

Dear Dr Fan,
My best friend was diagnosed with breast cancer and had surgery last year.
Cancer has taken a toll on a mental health. She gets moody and angry very easily.
Any advice on how I can cheer her up even when she just wants to be left alone?
Thank you Dr Gilbert!

Answered by Dr Gilbert Fan, Master Medical Social Worker at the National Cancer Centre Singapore​:

Thanks for writing to us. Though it is not uncommon to witness mood changes and emotional upheavals amongst newly diagnosed cancer patients, it is still important to monitor them closely. While many will make some improvements and adjustments without much assistance, some may get stuck with their current predicament. Observe her for about one to two weeks to ascertain if her mood gradually improves.

If you are very close to your best friend, have a conversation with her about your observations. Be gentle in your conversations and be respectful towards her unwillingness to talk. Talk about how she is coping with the cancer but not about the cancer itself in terms of treatment and implications. Show interest in her and not the cancer as the focus. You may also ask her how you can be of help and be in contact with you.

Many patients may be stuck with making meaning of their cancer condition. They need time to digest and understand what the cancer means in their lives. They may have lost dreams and hopes. They may even lose confidence in themselves. 

Advise her to see a social worker or counsellor to guide her through the cancer journey. She can ask for a referral through her attending physician.

Question by gemini29

Dear Dr Fan,

My aunty has breast cancer. She has body-image concerns due to rapid hair loss from chemotherapy. She also hates going for chemotherapy despite the opportunity to receive this lifesaving treatment. What can my family do to make her feel better and coax her into going for more chemotherapy sessions?

Thank you in advance!

Regards,
Gemini29

Answered by Dr Gilbert Fan, Master Medical Social Worker at the National Cancer Centre Singapore​:

Thanks for writing to us. Prior to the commencement of chemotherapy, she would have been counselled by a trained nurse on the possible side-effects and a temporary change in body-image like hair-loss. Encourage her to talk with a nurse at the chemotherapy treatment unit. It is very important for her to have a heart-to-heart talk with the nurse to share her fears and concerns. Assure her that every question she has in mind is important for us to know in order to assist her appropriately. Most treatment-related issues can be resolved.

I often tell my patients that treatment opportunities are time-limited. If you miss one opportunity, it does not necessarily mean that you still have another chance to undergo a similar treatment of a similar intent. Some patients need specific guidance to overcome their fears and concerns in order to complete their chemotherapy regime. This requires the help of a professional counsellor / social worker. As a family, listening attentively, showing respect and pacing the patient would be helpful. You may persuade but do not coerce patient into undergoing the treatment.

Many hospitals have breast cancer support groups and patient ambassadors who can share and guide her in her cancer journey. Asked for a referral to one of these support groups. You can also find breast cancer support groups at Breast Cancer Foundation and Singapore Cancer Society. It is her choice.

Question by bluecorrine

Doctor Gilbert: My mum was diagnosed with stage 1 lung cancer not too long ago even though she doesn't smoke and is very health conscious. It took almost 7 weeks from the time of diagnosis before we got an operating table and in between my mum couldn't sleep and got very depressed. It wasn't until she was hospitalized for severe anxiety and depression that my dad and I realised how it was affecting her and we feel guilty for not noticing that she was depressed. We though the melatonin and aromatherapy etc helped her sleep). Even after she was hospitalized for anxiety, her doctors said she's very lucky because her cancer is treatable and other people are not so lucky. But she thought even this comment was insensitive. So what should we or the doctors have said to her to show that we're there for her or to alleviate her anxiety? Her surgery was successful and she's recovering now but she's still on medication for anxiety as she still has anxiety attacks and is reluctant to meet some family members who have "bad energy". Neither my mum nor any of us know what triggers the attacks so we feel like we have to be very careful not to say anything that may agitate her. Should we just give her space?​

Answered by Dr Gilbert Fan, Master Medical Social Worker at the National Cancer Centre Singapore​:

I am glad you wrote to us. Your mother’s anxiety needs further assessment. Medications will help but counselling is as important at this phase of her illness. If she is not already receiving any counselling, please ask for a referral to see a psychologist. Some patients may have a specific anxiety whilst others may have what we termed as ‘generalized anxiety’. This requires further assessment.

As a family member, be patient with her. Conversations need not be centred on the illness and treatment matters. Have your usual conversations with her. Do not over-persuade as persons with anxiety tend to be self-limiting.

Any change for her must be gradual and timed. If she is repetitive, listen to the underlying meaning and focus of her conversation. If she is silent, gives her the space and time to be herself but remember to engage her in the family’s daily routines.

Question by ca0122

Hi Doc,

3 months back, my grandma was diagnosed with pancreatic cancer.

Since realising she has cancer, she hasn't been able to sleep well at night and also complains about going for chemotherapy. Going for chemotherapy makes her depressed and has worsened her anxiety. How can we support her so that she will feel better about her situation?

Thank you very much for your help.​

Answered by Dr Gilbert Fan, Master Medical Social Worker at the National Cancer Centre Singapore​:

Thanks for writing to us. Some treatments affect sleep thus it is best to check with your grandma’s attending physician about the matter. As in my earlier replies on anxiety, an assessment is necessary to understand the severity and root of the problem. Many older persons cannot face ‘suffering’ and your grandma could be interpreting her current predicament as suffering. Do get a referral for your grandma to see a psychologist for further assessment.

See previous page for more information on Dr Gilbert Fan.

Ref: O17