A cancer diagnosis often elicits a series of reactions in each person. While 5 stages are usually described, not all patients necessarily go through each one of them. Additionally, the duration of each stage is variable in each patient. As doctors and relatives, they must be kept in mind to know how to accompany and understand the affected person. This way, we will be able to help them transit this path in a closer and more effective manner.
STAGE ONE: DENIAL
It is commonly seen in patients when the diagnosis of their disease is disclosed directly to them from the beginning, as well as when it is not explicitly revealed and they come, on their own, to the conclusion that they have cancer a little later. They often say “no, not me, that cannot be true”. Patients can convince themselves that “the radiograph or the diagnosis is misled”. When non of this is validated, they ask to get out of the hospital right away and search for another doctor in the vain hope of getting a better explanation for their problem. Some doctors can calm them down, and some others confirm the previous suspicion, but the patient deep down knows that the first diagnosis was right.
Denial is generally a provisional defense mechanism and it will soon be substituted with partial acceptance.
STAGE TWO: ANGER
When the first denial stage cannot be sustained any longer, it is substituted by feelings of anger, rage, envy, and resentment. Patients often claim “Oh, yes! It is me, there has not been a mistake”, “Why me?”, or also “Well, why could it not have been him or her?”.
In contrast with the denial stage, this anger stage is very difficult to face for the family because anger goes in all directions and projects towards everything that surrounds them, sometimes almost randomly.
The problem relies on the fact that only a few people stand in the patient’s shoes and ask themselves where their anger comes from. This is why it is important to know that it is a normal and transient reaction.
Anywhere the patient looks at that moment he will find a reason to complain. They do every possible thing to get attention. They raise their voice, ask for things, complain, and ask for attention, and perhaps as their last resource they claim: “I am alive, and do not forget about that. You can hear my voice. I am not dead yet!”.
STAGE THREE: BARGAINING
This is the least known stage but is equally useful for the patient, even though it only lasts shortly.
Most of the bargaining is done with God or other people, depending on the religious beliefs of each person. They are generally kept secret or they tell a close person.
Psychologically, the promises can relate to a hidden sense of guilt, and thus it would be useful that the doctor and the hospital personnel did not ignore this type of commentary from patients.
STAGE FOUR: DEPRESSION
This stage is usually seen in two types of patients with cancer. On the one hand, in those recently diagnosed and regardless of the risk of dying from the disease; namely, it can revolve around very small malignant tumors with scarce odds of dying. Patients can often get overwhelmed because of the whole disease situation, the inconvenience they represent for their relatives (generally unjustified), or fear of death.
On the other hand, the depression stage can be seen in terminally ill patients who cannot keep denying their disease. When they cannot avoid going through more surgeries or hospitalizations when they start experiencing more symptoms or they get weaker and lose weight; that is when they can enter this stage.
On top of the treatment and hospitalizations, there is the economic burden. This is also aggravated by the loss of employment. If the disease affects the parents, the most affected ones are generally the children.
Therefore, professionals must know that this stage (depression) is necessary and beneficial for the patient to die in an acceptance stage and peace.
STAGE FIVE: ACCEPTANCE
If a patient has had enough time (not a sudden death) and has been helped through the stages described, they will reach the acceptance stage. They will have cried the loss of so many people and so many important places to them and will contemplate their upcoming end with relative peace of mind. They will be tired and, in most cases, very weak. Additionally, they will feel the need to sleep often, and in short, intervals, which is different from sleeping in depression stages, This is not an evasive sleep or a period of rest to alleviate pain, discomfort, or unease. It is a growing need of increasing sleeping hours similar to that of a newborn, but inversely.
This stage is almost feelings-free. It is as if the pain had gone away, the fight had ended, and the moment of final rest had come before the long journey. In these moments, the family is generally the one needing more help, understanding, and support than the patient. The latter might want to be left alone, or at least not be agitated with news and problems from the outside world.
The patient can make a simple hand gesture to invite us to sear for a while, or only seat there in silence. These moments can be the most significant messages for people who do not feel uncomfortable in the presence of a dying person. That presence is only to confirm that they will be available until the end.
It is only a few patients who struggle, who fight until the end and preserve hope that makes it impossible for them to reach this acceptance stage.
The best way of helping a family in this stage s the presence of a calming doctor who ensures every effort shall be made.