A cancer diagnosis can cause a range of emotions in the patient herself as well as in those who care about her. While each individual's experience is unique and depends upon multiple factors, several themes emerge in the stages people go through in reaching acceptance of a cancer diagnosis. How each person deals with grief is influenced by their prior experiences with terminal illness, their upbringing, the support they have from other people and the course of the disease.
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Barriers to Acceptance
Often the first stages after diagnosis keep patients and loved ones busy mentally and physically, and quiet reflection and coming to terms with the implications of the illness are not always possible at this point. The first phase happens when a diagnosis is given and rapid education must occur in order for informed decisions to be made. During treatment, the patient and family must deal with the side effects as well as dramatic changes in the daily routine. If the disease is terminal, pain relief and spiritual peace often become the focus. Anticipatory grief is the sadness that the patient and her loved ones feel when death is expected to occur. This type of grief may be very similar to the mourning experienced after a death has occurred.
Kubler-Ross Stages
The best-known stages leading to acceptance were described by Elizabeth Kubler-Ross, who authored the book "On Death and Dying." Kubler-Ross lists five stages through which patients progress when they know their disease is terminal. The first stage is denial, and at this point the patient and her family may believe that a mistake has been made and question the diagnosis. When the diagnosis is certain, the second stage involves anger and questioning the fairness of the illness. According to Kubler-Ross, patients then move into a bargaining phase, where they attempt to make promises and deals with God to secure healing. Before coming to acceptance of the condition and prognosis, depression and lethargy often occur.
Temes Stages
The National Cancer Institute uses the less well-known three steps to acceptance outlined by Dr. Roberta Temes in her book, "Living With An Empty Chair---A Guide Through Grief." She first describes a stage of shock and numbness characterized by rote, mechanical functioning and a desire to be more socially isolated. Temes then describes the next step, which she labels "disorganization," in which friends and family suffer intensely painful feelings which may lead to depression. They may have difficulty planning for the future and have trouble with concentration. Hallmarks of this stage include yearning for the loved one who has passed away and an inability to accept the death. Survivors wish to have the person back and feel frustrated and discouraged because this is not possible. The final stage is labeled "reorganization," and it involves a new alignment of your sense of self to become adjusted to all that has been lost. This final stage is ongoing and characterized by a re-entry into social circles, perhaps even forming new social circles, and coming to a place of acceptance of this new stage of life without the loved one.
