What Emotional Effects Can I Expect?

Chemotherapy can bring major changes to your life. It can affect your overall health, threaten your sense of well-being, disrupt your daily routines, and put a strain on your relationships. It is normal and understandable for you and your family to feel tearful, anxious, angry, or depressed. There are ways to cope with these emotional "side effects," just as there are ways to cope with the physical side effects of chemotherapy. You can draw support from many sources.

Here are some of the most important:

• Doctors and nurses--If you have questions or worries about your cancer treatment, talk with members of your cancer care team.
• Counseling professionals--Counselors can help you express, understand, and cope with the emotions cancer treatment can cause. Depending on your preferences and needs, you might want to talk with a psychiatrist, psychologist, social worker, sex therapist, or member of the clergy.
• Friends and family--Talking with friends or family members can help you feel a lot better. Often, they can comfort and reassure you in ways that no one else can. You may find, though, that you may have to make the first move.

Many people do not understand cancer and may withdraw from you because they're afraid of your illness. Others may worry that they will upset you by saying the wrong thing. You can help relieve their fears by talking openly with others about your illness, your treatment, your needs, and your feelings, and you can correct mistaken ideas. You can also let people know that there's no single "right" thing to say. Once people know they can talk with you honestly, they may be more willing and able to open up.

Support Groups

Support groups are made up of people who are going through the same kinds of experiences as you. Many people with cancer find they can share thoughts and feelings with group members more easily than with anyone else. Support groups can also serve as an important source of practical information about living with cancer. You can also find support in one-to-one programs that match you with a person similar to you in age, gender, type of cancer, and so forth. You might talk with this person on the phone or arrange visits.

Where to find information about support programs:

• Your hospital's social work department
• Your local ACS office or by calling us at 1-(800)-ACS-2345

Coping Techniques for Daily Life

Here Are Some Tips to Help You During Chemotherapy:

• Try to keep your treatment goals in mind. This will help you keep a positive attitude on days when the going gets rough.
• Eating well is very important. Your body needs food to rebuild tissues and regain strength.
• Learn as much as you want to know about your disease and its treatment. This can lessen your fear of the unknown and increase your feeling of control.
• Keep a journal or diary while you're being treated. A record of your activities and thoughts can help you understand the feelings you have as you go through treatment and highlight questions you need to ask your doctor or nurse. You can also use your journal to record side effects. This will help you discuss them with your doctor and nurse. You can also write down the steps you take to cope with side effects and how well those steps work. That way, you'll know which methods worked best for you in case you have the same side effects again.
• Take it easy. You may not have as much energy as usual, so try to get as much rest as you can. Let the "small stuff" slide, and only do the things that are most important to you.
• Try new hobbies and learn new skills.
• Exercise if you can and if your doctor approves. Using your body can make you feel better about yourself, help you get rid of tension or anger, and build your appetite.

How to Relieve Stress and Relax

Simple techniques can help you cope with stress and help you relax - anytime and for any reason. Try some of these methods to find the ones that work best for you. You may want to check with your doctor before using these techniques, especially if you have lung problems.

Muscle Tension and Release

• Lie down in a quiet room.
• Take a slow, deep breath.
• As you breathe in, tense a particular muscle or group of muscles. For example, clench your teeth or stiffen your arms or legs.
• Keep your muscles tense for a second or 2 while holding your breath.
• Then breathe out, release the tension, and let your body relax completely.
• Repeat the process with another muscle or muscle group.

A variation of this technique is called "progressive relaxation." You work your way up your body starting with the toes of one foot. Progressively tense and relax all the muscles of one leg. Next, do the same with the other leg. Work your way up your body, tensing and relaxing each of the muscle groups in your body, including those in your neck and face. Remember to hold your breath while briefly tensing your muscles and to breathe out when releasing the tension.

Rhythmic Breathing

• Get into a comfortable position and relax all your muscles.
• Close your eyes or focus on a distant object if you prefer to keep them open.
• Breathe in and out slowly and comfortably through your nose. If you like it, keep the rhythm steady by saying to yourself, "In, 1, 2; Out, 1, 2."
• Feel yourself relax and go limp each time you breathe out.
• You can continue this technique for just a few seconds or for up to 10 minutes.

Biofeedback With training in biofeedback you can control body functions such as heart rate, blood pressure, and muscle tension. A machine will sense and alert you when your body shows signs of tension. The machine will also give you feedback when you relax your body. Eventually, you will be able to control your relaxation responses without having to depend on feedback from the machine. Your doctor or nurse can refer you to someone trained in teaching biofeedback.

Mental Imagery

• Close your eyes, breathe slowly, and feel yourself relax.
• Imagine a ball of healing energy, perhaps a white light forming somewhere in your body.
• When you see the ball of energy, slowly breathe in and blow the ball to any part of the body where you feel pain, tension or discomfort, such as nausea.
• When you breathe out, picture the air moving the ball away from your body, taking with it any painful or uncomfortable feelings. (Be sure to breathe naturally; don't blow.)
• Continue to picture the ball moving toward you and away from you each time you breathe in and out. You may see the ball getting bigger and bigger as it takes away more and more tension and discomfort.

Visualization Visualization is similar to imagery.

With visualization you create an inner picture that represents your fight against cancer. You might visualize rockets blasting away the cancer cells in your body or knights in armor battling the cells.

Hypnosis

Hypnosis puts you in a trance-like state that can help reduce discomfort and anxiety. You can be hypnotized by a qualified person, or you can learn how to hypnotize yourself. If you are interested in learning more, ask your doctor or nurse to refer you to someone trained in the technique.

Distraction

Distract yourself from your worries or discomforts by watching TV, listening to the radio, reading, going to the movies, or working with your hands by doing needlework or puzzles, building models, or painting. You may be surprised how comfortably the time passes.

How Do I Pay for My Chemotherapy?

The cost of chemotherapy varies with the kinds of drugs used, how long and how often they are given, and whether you get them at home, in a clinic, office, or in the hospital. Most health insurance policies, including Medicare Part B, cover at least part of the cost of many kinds of chemotherapy. To reduce their costs, private insurance companies are deciding more often not to pay for the use of some chemotherapy drugs, even if those drugs are effective cancer therapies. Before you begin treatment, find out whether your insurance company or Medicare will pay for your care.

What You Need to Know About Insurance Coverage Insurance companies Deny Payment for Chemotherapy for These Reasons:

• They may not be aware of new treatments.
• They may limit the selection of drugs that physicians can use for chemotherapy.
• They may restrict payment to the uses initially approved by the Food and Drug Administration.
• If you are going to participate in a clinical trial, find out if your insurance will cover the cost of patient care. In some situations, insurers may deny payment. Coverage may vary by state.
• If your insurer denies payment for your treatment, don't give up. Most people do get payment eventually.

What to Do If Your Claim Is Not Paid:

• Tell your health care team if you have been denied payment so that they can consult with your insurer and help answer any questions.
• Ask your doctor's office staff to provide insurance companies with the results of scientific studies showing that a particular drug is effective for your type of cancer.
• Ask hospitals and cancer centers to provide similar information. These actions are often sufficient for your claim to be paid.
• Contact reimbursement specialist hotlines at pharmaceutical companies.

In some states, Medicaid (which makes health care services available for people with financial need) may help pay for certain treatments. Contact the office that handles social services in your city or county to find out if you are eligible for Medicaid and whether your chemotherapy is a covered expense. Medicaid approval can take a long time, so begin the process as early as possible. You can also contact your hospital's social service office, which may be able to direct you to other sources of help. A last alternative may be to sue the insurance company to get payment for your chemotherapy. In many cases, courts have sided with patients and ordered insurance companies to pay for treatment.