Scott Webb (Host): Cancer is a physical diagnosis, but in many ways, a cancer diagnosis can affect our mental health as well. I'm joined today by Kayla Epplin. She's a licensed clinical social worker, certified in oncology social work, practicing at Franciscan Health, and she's here today to help us to learn to cope with cancer and manage our mental health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Kayla, it's nice to have you here today. As I was saying to you, we're going to talk about cancer, but really the emotional side of a cancer diagnosis, not so much the physical side. So when we think of cancer, and we generally do think of that as a physical diagnosis, how could cancer impact emotional health?

Kayla Epplin: it is true that cancer is a physical disease process, but that disease process does not just affect our body. So, we all have what we call the mind-body connection. And this means that we don't operate purely from a physical or purely from an emotional standpoint. So, for example, when our bodies are under a lot of stress, such as with a cancer diagnosis, we feel that stress psychologically and emotionally. And then vice versa, when we have emotional distress, that manifests in the way that our bodies feel. You might hear the phrase, "You're going to worry yourself sick." And there's actually some truth to that. So if you think about a particularly stressful time that you've experienced, you've probably also dealt with tension in your body or stomach upset, headaches, things of that nature. So when we consider the impact of a cancer diagnosis, it certainly extends beyond physical and into our emotional health. And with cancer comes so much uncertainty, so much unknown, which most of us don't feel particularly comfortable with, and that can cause a big disruption to our emotional health.

Host: Yeah. I'm sure that it can. And I was just sort of thinking as listening to you there, thinking about some of maybe the most common emotional responses, right? I'm thinking anger, confusion, you know. But from your perspective as an expert in this area, what are some of the most common emotional responses to this physical diagnosis?

Kayla Epplin: Yeah, absolutely. The anger and confusion, I see that a lot. But I want to preface this first by saying that there's no one right way to respond to a cancer diagnosis. And it is absolutely okay to experience whatever emotions come up, as long as we are making an effort to not let those emotions keep us paralyzed or stuck in that space. But experiencing and allowing our emotions to be there is a very healthy part of this process. And some of the common responses I see are really big fear and anxiety, because as I already mentioned, the unknown of cancer can be such a terrifying place to be.

As you said, I also do see anger. And particularly, that can come up when someone feels like this was something that should have been in their control. Maybe they lived the most perfect, healthy life and they still got cancer. And speaking of control, that is another common theme I see, folks feeling a lack of control and that helplessness that goes along with it. Sadness, depression, loneliness are prevalent along with shock. And I've had several people tell me that they can't believe something like this could happen to them. Sometimes people even describe sort of an out-of-body experience as if this was happening to someone else and they're watching it from the outside.

And so, the last big one I'll mention is grief. We often think of grief as an emotion that's experienced when we lose a loved one, but grief can happen with any perceived loss. And that includes the loss of what life might've been like before cancer.

Host: Yeah, that's interesting. It feels, Kayla, like we get a pass. As you say, there's no right or wrong emotional responses or ways to feel, and it feels like whatever you're feeling, you're entitled to that, of course. But I am wondering, though, the implications of poor emotional health when we're trying to deal with cancer.

Kayla Epplin: Right, right. So first, we know that stress, which includes emotional distress, weakens the immune system. And unfortunately, when someone's already dealing with something like a cancer diagnosis, their immune system is already weakened. So to add the emotional stress on top of that, it can lead to patients becoming even sicker.

 We also know that chronic emotional stress can lead to a more difficult time recovering or healing from treatments and procedures. There's evidence that emotional difficulties can lead to a longer healing time for wounds. And there's also research that points to chronic long-term stress being a factor in the growth and spread of certain cancers.

Now, notice that I did say chronic long-term. So if, you know, you're just experiencing a little bit of emotional distress here and there, that's not what I'm talking about, but over a prolonged period of time. And this doesn't necessarily mean that stress causes cancer, but it certainly can impact the way that the body responds.

Host: Yeah, it absolutely can. And I want to talk about some of the ways that we can cope with cancer, if you will, and especially focus on mindfulness. I've done some podcasts on mindfulness where I've done, you know, deep breathing, and I've been a sort of a participant in the podcast. So, I have a little familiarity with that, but how can that help with coping?

Kayla Epplin: Yeah, absolutely. Mindfulness is kind of a hot topic right now, which is great, because it's applicable in so many different situations. It's actually one of my favorite techniques to teach those that are impacted by cancer. So really, what mindfulness is, is it helps us to be in the present moment with both awareness and acceptance. That acceptance piece is what can be particularly hard for people. And this doesn't mean that we have to like our circumstances or love them, but acceptance really creates freedom from the distress that cancer can cause, because it takes away that stress of fighting against what is. You know, we know that a cancer diagnosis is there. We can't do anything to change that fact, but what we can do is change how we are responding to it right now.

So, mindfulness can be particularly helpful, because as I've discussed a huge emotion that can be present throughout the cancer experience is fear and anxiety. So, that fear and anxiety is really rooted in the future and what is to come. When we practice being in the present moment, it really doesn't give us a whole lot of room or capacity to focus on what is to come, which is where, you know, that fear and anxiety are rooted in. So, we really try and just focus on the here and now.

There are a lot of ways to practice mindfulness. But some of my favorites include guided meditation, deep breathing, taking nature walks, or even just sitting in nature and observing, and even engaging in a hobby that you enjoy. So, almost anything and everything can be done with mindfulness as long as you are allowing yourself to really be engaged in that present moment.

Host: Yeah, that's what I found, you know, that sometimes I find myself just kind of doing some mindfulness exercises, just kind of sitting in the car, sitting in traffic, you know. And sometimes it helps with the stress of being in the car and dealing with traffic, and sometimes it just helps with life in general. And so, there's lots of different things that folks can try, and there's resources, obviously, through Franciscan and videos on YouTube and so forth.

You know, I think, I suspect anyway, one of the most difficult things about a cancer diagnosis is just how to communicate in general, how to communicate our feelings, and especially how to communicate our feelings to loved ones. What are your suggestions?

Kayla Epplin: Yeah, absolutely. Communicating with loved ones can really bring challenges, because a lot of times patients feel like no one really truly gets it unless they have had that cancer diagnosis too. And while this has some truth to it, it's important to realize that loved ones and caregivers also experience a wide range of emotional impact from their loved one's diagnosis. So, communicating about how we are feeling with one another can really bring us closer and help us to feel more connected to each other.

One of the biggest things to remember here is that your loved one cares about you. They want to do whatever they can to help. Now, sometimes they might get it wrong because they are left to guess what it is that you need. This is a common pitfall for a lot of us. We play that assumption game, and sometimes it doesn't go so well. And so, this is why it's important to be direct in your communication. You know, we all have different needs and what works for some of us may not work for others. So, being upfront and honest about how you feel and what you need is always best. And many times when we are struggling with these big emotions, we just need someone to listen and to validate how we're feeling. And if that's what it is that you need, it is okay to tell your loved one upfront before you even say anything else. Tell them that you don't need a solution or you're not looking for a fix, but instead you just need a safe and supportive place to be heard and to let your feelings out. So, I really recommend that direct and honest communication.

Host: Absolutely. How about some resources to help people cope emotionally with this physical diagnosis?

Kayla Epplin: There are many, many great non-profit organizations around the globe with the purpose of assisting those impacted by cancer. Here in Indiana, Cancer Support Community Indiana is a great resource to utilize to receive free services. And we partner with Franciscan Health so that we offer some of these services even on site at some of our Franciscan locations. But cancer support community provides things like individual counseling, support groups, and then other programs to support mental and emotional wellbeing throughout and even beyond a cancer diagnosis.

And then, along with that, I always recommend that patients have a discussion with their social worker or their nurse navigator to see what resources could be most beneficial to them. A lot of times those professionals have a great list of resources specific to whatever type of cancer it is that the patient's dealing with. And this could include services like therapy, counseling, support groups, yoga classes, guided meditation programs, and even peer support.

Host: Yeah, you mentioned therapy there, and that's kind of where I wanted to finish up today. Just kind of talk a little bit about the role therapy plays in coping with cancer and maybe one of the signs that someone may need professional help.

Kayla Epplin: Therapy or counseling is a place where you can go and meet with a trained professional that has knowledge in helping people navigate difficult life events and big emotions. Therapy can be an extremely helpful place because, unlike with our loved ones, these mental health professionals are a third party and they can really see things from an objective point of view.

So, the therapist can serve as your cheerleader, as your unconditional supporter, and even confidant. They keep whatever you say to them private. They're not going to share that with anyone else unless you explicitly give them permission to do so. They can also help you to find coping strategies that will work best for you and your particular situation. And anyone can benefit from therapy at any given time in their lives, but I believe it can be extremely impactful when navigating something as emotionally challenging as a cancer diagnosis.

So to answer your second part of the question, some signs that you might benefit from therapy would include not feeling as though you have the tools to cope on your own. So, maybe you're trying all of your normal coping strategies and those just aren't cutting it. Also if you find that you're having difficulty with functioning, whether that's at work, at school, at home, in any part of your life. Having big changes in behaviors could also indicate that you could benefit from therapy. That could be, you know, maybe you're sleeping more or less than usual. Maybe you're having some big emotional outbursts or crying uncontrollably. If you're having persistent emotional difficulties or problems managing or regulating your emotions, that could be a sign as well. And then, if you're having any feelings of hopelessness or thoughts that you'd be better off dead, it's extremely important to reach out for mental health help.

And then, finally, you do not have to be mentally ill or severely depressed to benefit from therapy. Therapy can be for anyone at any given time in their life, as long as you're open to growing and to receiving that support.

Host: Yeah. That's perfect. You know, I appreciate conversations like this, the ones that really make me think, you know. So, it's like, sure, cancer is a physical diagnosis, but dealing with the emotional side and our mental health and communicating our feelings and all of this given me a lot to think about today, I'm sure for listeners as well. You gave us some great resources there. Thank you so much for your time.

Kayla Epplin: Thank you so much for having me, Scott. It was great to talk with you.

Host: And for more information on cancer support, visit franciscanhealth.org/movingbeyondindi to learn more about moving beyond cancer. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.