Living with Cancer

Helpful Thinking & Decisions

Helpful thinking
In highly stressful situations, thoughts happen very quickly and you may not even be aware of them. Your thoughts at this time can be unbalanced and unrealistic – that is, they may be overly negative, exaggerate your problems and underestimate your ability to manage your emotions. This can leave you feeling more upset and finding it even harder to cope.
Notice your thinking This isn't always easy because thoughts are often quick and automatic. When you're feeling upset, it may help to stop and take note of the thoughts going through your mind.
Write down your thoughts Writing down your thoughts is helpful because it slows down your thinking and makes it easier to focus.
Check your thoughts If your thoughts are making you feel upset, ask yourself if the thoughts are correct, realistic or helpful at this time.
If your thoughts are making you feel upset, ask yourself if the thoughts are correct, realistic or helpful at this time.
Find helpful alternatives If the thought isn't based on the facts, or realistic or helpful, try replacing it with a more helpful one. This may help you feel calmer and less worried.
Coach yourself For thoughts to be helpful they need to be balanced and believable. Encourage yourself through difficulties, rather than undermining yourself. Learn to be kind to yourself. Counsellors can teach you these techniques.
Be realistic
A common belief is that the most important thing in coping with cancer is staying positive. While it can help to be optimistic, this doesn't mean denying the reality that cancer is serious or frightening. Trying to put on a brave face all the time and avoiding anything negative is hard work, drains energy, and generally doesn't work well because the negative thoughts just keep coming back.

Pressure to be positive all the time can lead to people being afraid to discuss fears and feelings, which can make problems worse.

Try to be realistic about what's happening and talk to someone about your fears and concerns so you can better deal with them. Explaining your fears and concerns to those around you may also help you get the support you need.

Dealing with recurring difficult thoughts
It's natural for people affected by cancer to find themselves going over and over the same distressing thoughts about the past or future. Ignoring these thoughts or trying to distract yourself may work well at first, but they'll often return once you're no longer distracted – for example, in bed at night or early in the morning.​
  • Identify where the thoughts come from 
    When you notice unwanted thoughts check if they're the result of an underlying belief, such as ‘I must do things perfectly at all times', ‘the world should be a fair and just place', ‘if I can't do everything I used to do I am useless', ‘I am a burden to my loved ones'.
  • Imagine what you would say to others 
    Holding on to recurring thoughts can lead to sadness. One way to challenge them is to think of someone you love and imagine what you might say to them if they felt the same way.
  • Check the reality 
    Having noticed your thoughts, ask yourself if you're jumping to conclusions or exaggerating the negatives. If so, is there something you can do to change the situation or improve it? 
  • Acknowledge small achievements 
    Check if you're focusing on the difficult things and ignoring the little achievements or happy events that may also be occurring. Sometimes we notice the bad things that happen and don't notice the good. Writing down three good things that have happened to you each day may help. They don't have to be major events – just the everyday things that often go unrecognised.
  • Practice letting your thoughts come and go 
    Thoughts are fleeting. Some we notice and many we don't. Practice letting your thoughts come and go without getting caught up in them, just like clouds floating across the sky

Making decisions
During cancer and treatment you're likely to be faced with the challenge of making difficult decisions. These could include the choice of treatment, how to involve or care for your family, returning to work, and what to do about finances. 
Take your time Even with a cancer diagnosis, there's often time to consider your treatment choices. Generally, people make better decisions - and have fewer regrets later - if they have taken time to make sure they have enough information and considered all the possible consequences. Ask your health care professionals to provide you with details about your treatment choices and the benefits and side effects of each treatment option. Social workers can give you information about financial assistance and community supports that are available.
Write it down Organising your thoughts on paper can be easier than trying to do it in your head. Consider every option available to you. Make sure you have all of the options written down.
List what's important to you Write down all the pros and cons of each option and consider how important each of these are to you. You could rate how important each point is on a scale of 1-5, with five being very important and one being least important. To determine how important a point is, look at how it affects you and others in both the short and long term. Consider the burdens and the benefits of each option.
Talk it over Talk through the options with someone close to you, like your partner or a close friend. As most decisions will affect others in your life, it's also important to talk it through with people who will be affected so that their opinions are considered.
Get expert advice Find out all the facts first, then review your options and the points for and against each one with specialists in that area, for example, someone in your treatment team, a financial or legal advisor or a counsellor. Being certain of the facts may make the decision and consequences less overwhelming.
Expect to experience doubts Being unsure doesn't mean you've taken the wrong path. Reassure yourself that you made the best decision you could with the information you had at the time. Also, decisions aren't always final – it may be possible to change your mind even after you've already started down a particular path.

A second opinion
Getting a second opinion from another specialist may be a valuable part of your decision-making process. It can confirm or clarify your doctor's recommendations and reassure you that you've explored all of your options.

Some people feel uncomfortable asking their doctor for a second opinion, but specialists are used to people doing this. Your doctor can refer you to another specialist and send your initial results to that person. You can get a second opinion even if you've started treatment or still want to be treated by your first doctor. Alternatively, you may decide you would prefer to be treated by the doctor who provided the second opinion.
Dr Lisbeth Lane, Senior Clinical Psychologist, University of Wollongong, Wollongong Hospital, NSW; Kim Hobbs, Social Worker, Gynaecological Oncology, Westmead Hospital, NSW; Dr Megan Best, Palliative Care Physician, Greenwich Hospital, NSW; Deborah Ball, Coordinator of Direct Support Services, Cancer Council SA; Sandy Hutchison, Executive Manager, Cancer Counselling Service, Cancer Council QLD; Jill Adams, RN, Helpline, Cancer Council WA; and Ksenia Savin, Cancer Connect Volunteer and Consumer, QLD.