• Difficulties concentrating and focussing on tasks
• Thinking over and over about your cancer diagnosis and what the future will be like for you and your support persons
• Having a hard time getting certain thoughts out of your mind
• Feelings of worry or anxiety most of the day that do not go away
• Avoiding situations, people or things that make you anxious or trigger anxious feelings
• Withdrawing and not participating in daily tasks and social interactions with others

• Body tension
• Rapid heartbeat
• Increased sweating
• Dizziness
• Trembling
• Loss of appetite
• Nausea or other gut symptoms with no medical cause
• Difficulties sleeping

Anxiety is affected by how you think, which in turn affects how you feel and behave.

It can be helpful to become more aware of your anxiety provoking thoughts. Whenever you are feeling anxious:

• Stop and try to identify the thought that just passed through your mind.
• Write down your thoughts to identify any unhelpful patterns in your thinking. When you are feeling anxious you may have a tendency to make overgeneralisations, think of only the worst possible outcomes or to make assumptions about what another person is thinking. This kind of thinking can make your anxiety worse.

Sometimes when you are anxious you can overestimate the danger of a situation and underestimate your ability to handle it. It can help to think of different ways to look at a situation that is making you anxious, rather than jumping to the worst-case scenario.

People sometimes find that they are worrying for much of the day and night. To help with this, you may want to try ‘worry time’ to think about all of your concerns. Choose a set time each day to actively think about your concerns. You may even want to write them down. If you catch yourself worrying outside this time, write your worry down and remind yourself that you will have time to think about this concern during your worry time. This will help you to have more worry-free time and to gain a clearer picture of your situation.

A common cause of anxiety is not fully understanding cancer treatment or prognosis. Try to obtain the information you need from your treating team about the things that you do not completely understand. Ask lots of questions. Some people find it useful to write down the questions they may wish to ask.

Learning how to relax can reduce the impact of both anxiety and treatment-related symptoms (such as nausea). There are many different relaxation techniques. Two that you might want to try include:

Slow Breathing

• Slow breathing is a very effective way to become more relaxed.
• Simply breathe in slowly and deeply, all the way to your belly. Then let your breath out in a slow and controlled manner. Some people like breathing in through their nose, and out through their mouth. Do whatever is most comfortable for you.
• You can practice this regularly (10-15 minutes each day) to help with general relaxation and wellbeing.

Progressive Muscle Relaxation

This relaxation involves noticing tension in the muscles of your body, and relaxing this tension in each part of your body, one part at a time. Start with your head, and work ‘progressively’ through your arms, body, legs and feet. Repeat this as many times as needed.

Consider attending a relaxation or mindfulness meditation class or listening to an audio recording of a guided relaxation exercise.

Sometimes when we are feeling anxious we can neglect our physical health. Looking after our body can help with managing anxiety. You can improve your general health by:

• Decreasing caffeine and alcohol use
• Having a well-balanced diet
• Engaging in regular exercise
• Maintaining good quality sleep

If anxiety feels overwhelming and persists for a long time, it can be helpful to speak to a professional about how you are feeling. Explore your options listed at the bottom of this page.

Cancer and cancer treatment can cause a number of changes to your body.

Changes may include:

• Scars from surgery
• Hair loss due to chemotherapy or radiotherapy
• Hormonal changes
• Weight changes
• Loss of a body part
• Disfigurement
• Skin and tissue changes
• Adjusting to differences in how your body feels, moves and functions for example fatigue or loss of strength
• Sexual changes and feelings around intimacy

Some people find these physical changes lead to differences in the way they see their body and feel about their body. Some people feel more negatively towards their body. They may feel self-conscious about changes, or a loss of confidence in their body and what it can do or see their body as weak and vulnerable.

Others may experience changes to their body as positive. Positive changes may include a greater awareness and appreciation of your body and its abilities or greater motivation to look after yourself.

It is normal to feel:

• Anxious
• Less confident
• Angry
• Grief and loss about changes
• Sad or helpless
• Shocked and disappointed
• Or a combination of all of these emotions
• Some people with cancer feel they are no longer the person they used to be or worry about intimate and sexual relationships.

Changes in the way you think and feel about your body may also lead to changes in what you do, for example some people find themselves covering up parts of their body when they feel self-conscious or feel nervous about going out.

• Your body will take time to heal and recover from cancer treatment. Give yourself some time to adjust to changes and allow yourself to take it at your own pace
• Look after your body through eating well, exercising, sleeping and taking time to relax and engage in activities you enjoy
• Reach out and discuss changes and concerns with family and friends (your support team) as you will often find they can reassure you about how these changes may affect your relationship with them
• If you feel safe to do so share your worries about how you are looking and feeling with your intimate / sexual partner. In this way they will have some understanding of how you are feeling and can gain some understanding from your perspective of what is going on for you
• Reach out to other cancer survivors to share your experience and hear about other people’s experiences
• Try not to avoid looking at or dealing with body changes or activities such as going out, looking in the mirror or shopping for clothes. Avoiding these things may be a relief in the short term, but it may make things more difficult in the long term. Everyone will have an individual response and you will know when you are ready to make this step
• It can be helpful to remind yourself of other important parts of your life and unique aspects of your personality as a whole. We often tie our appearance to our identity, so it is important to remember that we have our own strengths and desirable qualities that continue to exist even in the face of changes to our appearance

It may be important to speak to your doctor, nurse or social worker about changes you are experiencing and how they can support you. Discussing how to take positive action can be empowering. Health services may have resources available to support people undergoing body changes, including wig services and scalp cooling.

You may also find you would like support from a mental health professional to work through any changes and how you feel about them. Explore your options listed at the bottom of this page.

• Ongoing sadness or low mood for most of the day
• Feeling close to tears or experiencing intrusive or continual crying
• Feeling ‘numb’ or not feeling anything much at all
• Feelings of helplessness, or hopelessness
• Feelings of guilt or worthlessness
• Difficulties concentrating, remembering and making decisions
• Loss of interest or pleasure in most activities that you used to enjoy
• Unintentional weight loss or weight gain
• Loss of energy or fatigue
• Loss of sexual interest
• Difficulty going to sleep, early waking, sleeping too much, or lying awake for hours
• Feeling restless, irritable or agitated
• Being slowed down enough for others to notice
• Thoughts of self-harm, thoughts that the life you have is not worth living or wishing you were dead

• Loss of physical abilities
• Poorly controlled pain
• Recurrence of cancer
• Poor cancer prognosis
• Advanced stage of cancer
• Additional medical problems

• Lack of family / friend / carer support
• Unemployment
• Past history of depression
• Family history of depression or suicide
• Previous suicide attempts
• Drug or alcohol abuse

It is important that you seek information about your cancer from your treating team. Inform them of any changes in your level of pain or other physical symptoms. Your treating team may help you to better understand your cancer. They may be able to assist you with better symptom management which in turn may improve your mood.

Depression may be affected by how we think, which in turn affects how we feel and behave.

People who are depressed often have a number of unhelpful thinking patterns about themselves, their relationships and their situation. It may be helpful to keep a journal of your thoughts and identify what could be a trigger to these thoughts. Understanding your thinking patterns can help change the way you experience your situation.

Planning can be helpful. You may feel uncertain about planning too far in advance. Try to make a list of what you will do tomorrow and each day of the following week. Each day mark off your list of achievements. Reschedule the tasks you have not completed for the next day. Keeping a list of tasks will help you concentrate your thoughts beyond what you are experiencing in this minute and help you focus on other thoughts.

Do something nice for yourself every day such as spending time reading, having a special treat, visiting a local café for a hot drink, walking to a local park, listening to music, speaking to a friend, day -dreaming of a past holiday or any other activities that you enjoy.

Learning how to relax can help people manage low mood and treatment related symptoms (such as pain).

There are many different relaxation techniques. Two that you might want to try include:

Slow Breathing

• Slow breathing is a very effective way to become more relaxed.
• Simply breathe in slowly and deeply, all the way to your belly. Then let your breath out in a slow and controlled manner. Some people like breathing in through their nose, and out through their mouth. Do whatever is most comfortable for you.
• You can practice this regularly (10-15 minutes each day) to help with general relaxation and wellbeing.

Progressive Muscle Relaxation

This relaxation involves noticing tension in the muscles of your body, and relaxing this tension in each part of your body, one part at a time. Start with your head, and work ‘progressively’ through your arms, body, legs and feet. Repeat this as many times as needed.

Consider attending a relaxation or meditation class or listening to an audio recording of a guided relaxation exercise

Improving your general health by engaging in regular exercise such as a short walk around the block or to the local cafe, having a well-balanced diet, maintaining good quality sleep and reducing caffeine/alcohol use can all assist in managing depression.

Seek social support and speak about how you are feeling. Support can assist people in coping with difficult situations and helps them feel less isolated.

If your depression symptoms persist for a long time (more than 2 weeks), it can be helpful to speak to someone professional about how you are feeling. Explore your options listed at the bottom of this page.

People who have:

• Fatigue before starting treatment
• Depression or sleep problems
• Multiple or long-term health problems
• Low physical activity or fitness

Fatigue can be caused by cancer, cancer treatments, medications or other reasons.

Increase your energy supply by:

• Doing physical activity such as housework and exercise as it may help to reduce or prevent fatigue.
  • Start with what you can easily do. If you have not been active previously, ask your doctor for an exercise referral to a Physiotherapist and or Exercise Physiologist
  • Find a form of exercise you enjoy – walking/ swimming/ walking in water/ riding a bike, moving to music, Tai Chi
  • Pace yourself!
  • Slowly increase the time and intensity of exercise so you feel a bit puffed
  • Start with 5 minutes and increase slowly by 5 minutes each day towards a goal of 30 minutes a day.
• Keep doing your usual activities, as much as you can without getting too tired and taking breaks. For example, if you are cleaning – clean one room at a time and return to complete the next area after you have had sufficient rest (replenish your energy)
• Eat foods that have good energy and protein.
• Cut up your ingredients for dinner, have a rest and then return to cook the food
• If you are mowing the lawn, do one section or area at a time. It is about planning and managing your energy level.

View this video resource for more information: Doc Mike Evans – a short cancer fatigue overview video

• Ask your General Practitioner or cancer clinician for help with your tiredness
• Check for other conditions you may have that can also cause fatigue
• Learn to work with the energy you have
• Do not push yourself to exhaustion

Increase your energy:

• Many people find an individual or group exercises or support program helps
• Sometimes you will become more motivated to participate in exercise if you are with others. For example, walking to the local café/park/beach with a support person, walking groups, or scheduled exercise classes

View the video resources listed below for more information:

• Peter MacCallum Cancer Centre – Session on managing cancer-related fatigue
• Alberta Health Services – Living well with cancer-related fatigue
• Alberta Health Services – Exercise for cancer-related fatigue
• University of Michigan Comprehensive Cancer Center – Nutrition for cancer fatigue
• Alberta Health Services – Pacing yourself with cancer-related fatigue

• See your General Practitioner to check for health conditions that may add to your fatigue
• See an occupational therapist for help managing day-to-day activities
• See a psychologist to manage the mental and emotional aspects of fatigue

Use energy saving methods:

• Do things more slowly, for shorter times
• Plan your day to include rest and activity

Increase your energy:

• A dietitian can help you to improve your nutrition with healthy foods
• An exercise specialist can help you to build your strength and energy with an exercise program

View this video resource for more information: Mayo Clinic – 9 ways to manager your cancer fatigue

Many health conditions can cause or add to fatigue. See your GP to check health conditions that may add to your fatigue:

• Ongoing pain, low mood (depression), stress (anxiety) and sleep problems
• Taking medications that cause drowsiness
• Having infections, viruses or low red blood cells
• Dehydration (not drinking enough water)
• Other health conditions

• Further treatment
• Further disability, pain or suffering
• Impact on quality of life
• Being unable to fulfil obligations
• Impact of a recurrence on loved ones
• Loss and grief about not being able to live out lifetime goals
• The possibility of death and the process of dying

• Follow-up appointments or scans
• Physical symptoms or changes
• Anniversaries of major cancer events such as diagnosis
• Hearing about cancer stories in the news, celebrities, or other people’s cancer experience
• Seeing others who have cancer and having treatment when you go for appointments

You might write them down or tell them to a friend or family member. Remind yourself that it’s very normal and understandable to be worried about your cancer coming back or progressing.

Be aware of times when your fear will be higher and plan how you will manage your fears at that time. For example, when you have an upcoming scan, you might write your worries down, do things that are important to you, practice your relaxation, and make sure you eat and sleep well.

Write a list of questions for your cancer team.

Ask your doctors what symptoms you need to watch out for, how to check symptoms (if applicable), and how/when to respond to new symptoms. Try to keep to their guidelines, and remind yourself that not all physical symptoms are signs of cancer.

Do things that are important to you, even if you are feeling fearful or worried.

People around you might not want to tell you they are also worried about the possibility of your cancer returning or progressing. Let them know how you’re feeling and that you’d just like them to listen and hear your concerns.

Do regular relaxation such as calming breathing, or mindfulness meditations. Try to do 5-15 minutes of relaxation each day and immediately when you are having thoughts of recurrence.

Avoid foods or drinks that increase your anxiety such as caffeine or alcohol. Continue exercising as you usually do. Try to keep to healthy sleep habits.

It can be helpful to speak to a mental health professional about how you are feeling. Explore your options listed at the bottom of this page.

Grief can lead to:

• Rumination where you go over and over your loss
• Difficulties concentrating
• Difficulties making decisions
• Difficulties remembering things
• Confusion

Grief can feel like you are losing control of your mind.

Common thoughts associate with grief may include:

• “I’ll never get over this”
• “I can’t cope”
• “This is not fair”

Grief can lead to:

• Changes in sleep patterns
• Changes in appetite
• Dizziness, headaches, muscle aches, nausea
• Pain
• A generally unwell feeling
• Exhaustion and fatigue

• Crying
• Keeping busy or the opposite – loss of interest in usual activities
• Snapping or feeling impatient with others
• Talking about the loss or avoiding it
• Withdrawal from friends and family

Notice when your thoughts about pain have become extreme and may be unhelpful (e.g. “I’ll never achieve anything with this pain”). Try to rephrase these thoughts so that they are more realistic (e.g. “I notice the pain right now, but also know I can still do some of the things that are important to me”).

Focus on your other sensations by noticing 5 things you can see, 5 things you can hear, 5 things you can smell and 5 other (pleasant and/or non-painful) sensations you can feel.

Try to make time to do small things that you enjoy. Plan for this in advance and schedule this in. If it helps, involves significant others including friends or family members in your plans.

• Add in rest periods
• Build up slowly. Do not do more activity than you have planned, even on a good day
• If you have a bad day, try to keep to your plan but be kind to yourself
• If your pain flares up, go back one level and pace back up again
• Reward yourself when you achieve small steps or goals

Try to get up at the same time each day. This will help your body clock know when to wake up and when to sleep.

Try to eat a well-balanced diet and at regular times, and not in the hours before bed.

Avoid caffeine (e.g. tea/coffee), energy drinks, and other stimulants like nicotine in the evenings.

Avoid too much alcohol at night, especially just before bed. They can be relaxing, but actually make the quality of sleep very poor.

In the evening, only do activities that are calming and help you wind down (e.g. listening to music, audiobooks, or a meditation).

Exercise in the daytime (not before bed) helps you to build a drive for sleep.

Avoid daytime napping, or if you must nap, try to nap at a regular time and briefly (e.g. 30 minutes)

In the evenings, reduce the light in your room (e.g. have only one small lamp on and try not to use bright screens).

Try not to do other activities in bed, you want your body to associate bed with sleep.

Don’t miss good opportunities of sleepiness in evening. Similarly, don’t lie in bed for long periods of time if you’re not sleepy, stay up and do relaxing activities until you feel sleepy.

Explore ways to reduce stress and improve your mood (e.g. self-care, seeking support from family or friends, speaking to a therapist). Helping yourself to be in a good emotional state can improve sleep.

This is one of the best treatments for night time sleep problems and can be accessed by seeing a Psychologist.

There are a number of medications that may help with sleep, you can discuss with your treating doctor or GP.

Examples of over-the-counter sleep aides are anti-histamines, valerian, chamomile, lavender, and certain vitamins. Discuss with treating doctor if you plan to try these to ensure there is no conflict with any treatment medications.

• Headache
• Problems with sleeping (too much or too little)
• Muscle stiffness and tension (jaw clenching, neck pain)
• Gastrointestinal problems
• Change in sex drive
• Increased blood pressure

• Feeling stuck
• Desire to smoke
• Up and down mood
• Anxiety
• Restlessness
• Feeling unmotivated
• Irritability
• Agitation
• Short temper/quick to anger
• Crying

• Panic attacks
• Persistent low mood
• Worrying all the time
• Feeling you’re under constant pressure
• Drinking or taking drugs to deal with your stress
• Overeating
• Withdrawing from family and friends

• What are your realistic concerns?
• Do you need to ask for more information from your treating team, or need details of a treatment plan?
• What areas of your life are affected by your diagnosis?
• Is there additional support I can utilise? (e.g. financial, burdens of childcare, domestic responsibilities)

Stress is normal at times of great change or trying to adjust to new information or physical changes. Be kind and compassionate to yourself.

• Who are you able to share your concerns with?
• Are there family, friends, colleagues you can talk to about how you are feeling?

Some behaviours, such as drinking alcohol or smoking, may give us short-term relief, but can actually increase our stress over the longer-term. When you get the urge to engage in these behaviours try choosing another activity, such as exercise or a relaxation practice, which may be more helpful.

Physical activity may help increase the production of endorphins (happy hormones) helping us feel better, as well as reducing the negative effects of stress.

Your distress and fitness level can be improved with almost any form of exercise. The most important thing is to pick an activity that you enjoy, and is easy to access.

The practice of focused attention has been found to reduce the stress response. Guides or classes for mediation are available through a number of providers. Explore the relaxation and mindfulness resources listed at the bottom of this page.

Sleep allows our brains to recharge and our bodies to rest. Sometimes physical discomfort or worry can interfere with our ability to get to sleep or stay asleep. We know that prioritising sleep, and reducing behaviours that negatively impact sleep (e.g. caffeine intake) significantly affects our stress response.

Eating regularly and a well-balanced diet are important ways of managing stress.

When life is difficult it is important that you take time out to engage in activities that you enjoy, and remind yourself of what you value and what makes you happy.

If your stress is interfering with your ability to function and is ongoing, you may want to find a mental health professional. Explore your options listed at the bottom of this page.

• Know your own signs of scanxiety
• Label it and acknowledge it as scanxiety
• See the people you like –if possible, avoid other stressful situations
• Do regular exercise, meditation and relaxation
• Eat a healthy diet. Sugar and caffeine will make anxiety worse
• Prepare yourself with information you need for the scan, such as a referral letter or fasting requirements
• Wherever possible schedule your scan in the morning for fewer delays

• Bring along a support person
• Use distraction. Try to focus on something else such as trying to list all the movies you saw in the last year or remembering family members birthdates
• Practice meditation
• Medication can help
• Talk to the technician about your anxiety

• Do things you enjoy (make plans and keep busy)
• Talk to your support persons or cancer support groups
• Meditate and practice relaxation
• Help someone else out. Helping others makes us feel good about ourselves
• Use helpful self-talk (Try not to predict the outcome, remind yourself that you are resilient  and that you can cope)

We have an internal body clock that is set to various routines and external triggers like sunshine. Learn to work with your body clock. Set up habits that promote good sleep.

• Get up at the same time every day
• Go to bed at the same time – consistency builds quality
• Build a ritual around sleep to train yourself, for example check phone for the last time, read for 20 minutes, tidy your room, stretch, meditate, sleep… whatever suits you

Anything you can do to make your room quieter, darker or more comfortable will help, but of course it isn’t always easy, but at least think about:

• Right temperature – and the right clothes for you
• Dark – close the curtains, or even cover the window if you can
• Quiet – if you need to use ear plugs

And also beware of alcohol – whilst it may relax you, it will also wear off in the middle of the night and wake you to go to the toilet

Try anything that will calm you down – relaxation exercises, reading, a warm bath… anything you find helpful to wind down

And avoid social media or work in bed – it fires up your brain

• Effective communication – honesty is always best. Never underestimate kindness in interactions. Listen, not to comment, but to truly understand. If people feel heard, they are more willing to meet you halfway
• Schedule time to talk – when you’re both calm and free of distractions
• Don’t take other people’s anger personally – in 99% of cases, they are just stressed and letting off steam. However, you should never tolerate violence or aggression
• Schedule time for fun things
• Respect other people’s boundaries and protect your own – tolerate time apart and try not to live in each other’s pockets, especially during times of isolation when you are stuck in the house together

• State the problem
• Truly attempt to understand the other person‘s perspective
• Engage in discussion
• Listen as much as you talk
• Don’t rush it
• Be optimistic
• Be kind

• Be creative and bold
• Make contact but don’t expect too much too soon – often the other person needs a little time
• Remember that initiating repair is a form of love

If you have the energy and space, think about your friends and family who might benefit from some connection and initiate contact.