Virginia Commonwealth University

VCU Massey Cancer Center

Experiencing grief

What is grief?
What are the different stages of grief?
What are the symptoms of grief?
Discussing death

What is grief?

Grieving is a normal response to loss. A family experience with cancer — loss of control, health, independence, body image, normal lifestyle and routines — as well as the impact of the diagnosis on other family members, and the financial impact of the diagnosis can all contribute to the experience of grief.

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What are the different stages of grief?

The person with cancer, spouses, parents, siblings and other family members will all experience grief. In general, grief has been described to occur in five stages. However, it is important to remember that people experiencing grief may move in and out of these stages in their own time and in their own way.

Denial
Denial is a stage where people try to believe that the cancer diagnosis is not happening to them or their family. One may feel numb or in a state of shock. Denial is a protective emotion when a life event is too overwhelming to deal with all at once.

Anger
Anger is a stage in which you understand the cancer diagnosis but are very upset and angry that it has happened to you, a friend or family member. One of the best ways of dealing with bursts of anger is to exercise or participate in another type of physical activity. Talking with family and friends, other people who have cancer and the hospital staff also may be helpful. The person with cancer may be able to express his or her anger either verbally explaining how he or she feels or by writing in a journal.

Bargaining
Questioning God, asking “Why me?” and “What did I do to deserve this?” are common questions in this stage. It is normal for the person with cancer to make bargains with themselves or God in hopes that bargaining will make the cancer diagnosis go away. Guilt is a primary emotion during this stage. Searching for something that you personally did, which could have contributed to the cancer, is all part of bargaining. People tell themselves or God that they promise not to do something they previously did (such as arguing with family members), or to start doing something they have not done (such as going to church regularly) in exchange for their recovery.

Depression and sadness
This stage of grief is one in which the diagnosis of cancer can no longer be denied and those involved may feel a profound sense of sadness. These feelings are normal. This stage can be accompanied by physical changes such as trouble sleeping or excessive sleeping, changes in appetite, difficulty with concentrating on simple daily activities or feeling a constant fear that someone else in the family will be diagnosed with cancer. It is important to talk about depression with a health care professional such as a social worker or counselor, or meet with a support group to help you cope with your feelings.

Acceptance
Acceptance is a stage in which you have accepted the cancer diagnosis and are at a point where cancer has been incorporated as part of your life. You have made an adjustment to your illness. Acceptance does not mean that you will never feel other emotions, but usually families find that they are better able to manage their lives overall upon reaching this stage. Going through the grieving process is the best way to cope with a cancer diagnosis. By giving yourself and your family permission to grieve, you will be able to cope.

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What are the symptoms of grief?

For both the person facing death and survivors after the death of a loved one, it is natural to experience many symptoms of grief. These may include:

Physical symptoms

  • Lack of energy, fatigue
  • Headaches and upset stomach
  • Excessive sleeping or, conversely, overworking and excessive activity

Emotional symptoms

  • Crying
  • Memory lapses, distraction and preoccupation
  • Irritability
  • Depression or, conversely, feelings of euphoria
  • Extreme anger or, conversely, feelings of being resigned to the situation

Spiritual symptoms

  • Feelings of being closer to God or, conversely, feelings of anger and outrage at God
  • Strengthening of faith or, conversely, questioning of faith

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Discussing death

Most people need honest and accurate information regarding their illness, treatment plan, treatment options and prognosis. People communicate their fears and concerns in many ways: crying, yelling, ignoring others, seeking information from others and writing letters. These feelings of sadness, confusion, anger and fear are all acceptable.

It is important to understand that each person and family is different. Given that different cultures have varying beliefs about death, there is no one single right way to discuss death. In general, an open communication style or atmosphere allows the dying person to express his or her fears and desires. This openness does not happen overnight. The ultimate goal in discussing death with a dying person is to optimize his or her comfort and alleviate any fears. If the person is not ready to discuss death, the most helpful step spouses, family and caregivers can take is to wait until he or she is ready. Let the person know you are ready to talk to them whenever they are ready to do so. Forcing information will usually result in anger, distrust and emotional distance from others. Waiting until someone is ready to handle the situation will allow for better communication.

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