The Emotional Stages of People with Cancer: Shock, Blame, Hope, and More

The emotional stages people with cancer go through aren’t linear. Understanding the process can help you feel less alone and find the support you need.

You may have heard of the five stages of grief. Psychiatrist Elisabeth Kübler-Ross popularized them in her 1969 book, “On Death and Dying,” inspired by her work with people with terminal illnesses.

According to Kübler-Ross, the five stages are denial, anger, bargaining, depression, and acceptance. These stages can happen in any order; not everyone will experience each stage.

If you’ve recently received a cancer diagnosis or are undergoing treatment, you may find yourself experiencing something similar.

Read on to learn the common emotional stages of people with cancer, plus how to cope.

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What are the emotional stages of cancer diagnosis?

Every person who receives a cancer diagnosis will experience it differently.

“Receiving a diagnosis can come with a flurry of emotions, some stronger than others for many people,” says Gabriel Cartagena, PhD, a clinical psychologist. “These stages are unique for every individual and often nonlinear. Some days may be heavier than others.”

These emotions can also be unpredictable.

“There are a wide variety of emotional reactions a person can experience after a cancer diagnosis,” says Erisa M. Preston, PsyD, a licensed clinical psychologist. “It’s not uncommon for someone to cycle through some or all of the phases multiple times while going through their cancer journey.”

Some people may not experience each emotional stage, which can occur in any order. Still, being aware of common emotions can help people feel less alone, develop coping skills, and seek support.

Shock, disbelief, and denial

Preston says this phase often comes first.

“Even when cancer is suspected as a possibility, there is a suddenness of finding out that your life will be drastically altered,” Preston says. “This can be shocking and unsettling. One moment, you are a person without cancer, and the next moment, you are forever a person with cancer.”

Preston says this phase may come with brain fog and cognitive sluggishness because the brain is trying to process this new information.

Fear and anxiety

The unknown can be frightening. 

“People wonder how much they’ll be able to do and worry about their lives, their loved ones, and themselves,” says Silvi Saxena, LSW. 

Any preconceived notions of cancer can add to the fear.

“Cancer is often called the big C because sometimes even saying the word cancer can be scary,” Preston says. “People grow up hearing about how cancer was the cause of loved ones’ deaths and how brutal the treatment was for them. Having this information tucked away in our lifelong experiences makes a cancer diagnosis potentially terrifying because a person begins to come to terms with their own mortality.”

People may experience racing thoughts and start researching their diagnosis to determine what it all means.

Anger, guilt, or blame

During this phase, you may have questions swirling around your head.

“Many individuals might begin to ask the ‘why’ of the situation,” Cartagena says.

Some examples include:

• How did I get here?
• Was there anything I did?
• What could I have done differently?
• Why is this happening to me?

While it’s understandable that someone would experience this emotional stage, Cartagena says it’s essential to remember that cancer is not a failing on your part.

“Cancer is neither merit-based nor logical,” Cartagena says. “Its origin and progression doesn’t often make sense.”

Sadness and loneliness

Saxena says people may experience sadness and loneliness.

“Cancer changes your lifestyle and can impact the relationships you have,” Saxena says. “It is a lot of grief processing when you are processing cancer diagnoses because you’re losing the way of life you once knew.”

Cartagena says even people with large support systems may feel alone.

“Those around you can be supportive, but it’s difficult for them to fully understand the breadth of your experience,” Cartagena says. “It’s difficult for someone to put themselves in your shoes.”

Loss of control

“Any major medical diagnosis often comes with the recognition that your body is going through a process that you are not entirely able to control,” Preston says. “Cancer is no exception to this.”

Ideally (and importantly), you and your care team engage in shared decision-making. Preston stresses you always have the right to consent. Still, it’s common to feel a loss of control.

“There’s a large amount of having to lean into your doctor’s advice, listen to their recommendations, and do what they say because they’re the experts and you are not,” Preston says. “There’s a certain amount of surrender that comes with this kind of diagnosis.”

It may take time to acclimate to your illness and figure out which parts of your care and living are within your control. For instance, you can make balanced food choices and potentially manage your symptoms at home.

You may go through a range of emotions in this stage, including fear.

Acceptance

Before getting into what acceptance is, Cartagena says some might benefit from understanding what it isn’t.

“The process of acceptance is not a magical endpoint one might wake up to one day,” he says. “It’s not suddenly feeling as though the diagnosis is fair, just, or OK — and it’s not giving up.”

What is it, then?

Cartagena says it’s a shift and a balancing act of taking steps toward managing what you can control, like focusing on what’s important to you in the here and now. It also involves validating all of the above stages.

“Acceptance involves acknowledging the loss of control, sadness, fear, anger, and shock and identifying what remains important to you despite the pain they often bring,” Cartagena says.

Hope

Many also experience hope, regardless of what stage the cancer is in.

“Depending on the message a person hears from their doctor, hope is often part of the cancer diagnosis,” she says. “Part of this is because many cancers are now very treatable with modern medicine.”

People with advanced cancer also maintain hope that their treatment allows them to stay as healthy as possible for as long as possible.

Preston says this phase may include:

• purposeful, positive thinking
• repeated mantras and hopeful statements
• more frequent prayer (or spiritual connection)
• planning for the future, including the immediate future

How to cope with the emotional stages of cancer diagnosis

Preston says that understanding the emotional stages of cancer can normalize it.

“From an emotional standpoint, it’s important to know that you’re not alone in your experiences, although cancer can feel like a scary, lonely, overwhelming process,” Preston says.

You’re not alone, and there are ways to cope through self-care and professional help.

Give yourself grace

Saxena emphasizes there’s no need to pretend “everything is fine.”

“You may feel like you have to act like it’s any other day, but it’s not,” Saxena says. “Give yourself a break, and don’t make things harder on yourself by guilting yourself into doing all the things you do in a day, even if that’s all you can control. Giving grace to yourself means accepting yourself even if you don’t get to everything you hoped for.”

Preston agrees, calling for people to practice radical self-acceptance.

“You may be scared, frustrated, angry, sad, indignant, disappointed, or any number of different emotions,” Preston says. “Rather than trying to push those emotions away or pretend they don’t exist, accept that they’re a normal part of the process.”

Self-compassion is critical here, too.

“You can forgive yourself for not having the perfect response, not having the ability to keep up with everything, and for not being who you were before cancer,” Preston says. “Repeat multiple times a day: ‘I am doing the best I possibly can in this situation with the resources and information I currently have available to me.’”

Build a support system

Finding people to help, such as family, friends, a support group for people with cancer, and your medical team, is crucial.

“People can help you regulate all your feelings so you’re not dealing with everything on your own,” Saxena says.

Cartagena stresses that this one will look different for everyone, and it’s crucial to zero in on what support means to you.

“Find ways to reconnect with the support systems that are meaningful to you,” Cartagena says. “If this is spiritual, think of accessible ways to start up important connections, such as sermons online. If this is social, identify a single supportive individual from your network you might be able to spend time with, slowly increasing time spent as you feel more comfortable reconnecting.”

Self-care

Again, there’s no one-size-fits-all definition to self-care — it’s about what genuinely helps you (and may change over time).

“It’s important to recalibrate how we look at self-care as not just something we do to feel an immediate improvement in mood or situation, but rather as something we do to take care of ourselves, which may have an immediate or delayed outcome,” Preston says.

Self-care may involve meal prepping or planning the week while you’re feeling well enough, or it may mean relaxing and watching a movie. Cartagena reminds people that rest is a powerful form of self-care.

“Rather than push yourself past your limits even though you’re fatigued or in pain, pace yourself to do the activities that you enjoy,” he says. “Take periodic breaks from social or physical events when necessary.”

Learn emotional regulation strategies

Developing emotional regulation skills can help when you’re feeling overwhelmed. It’s not about eliminating emotions but coping with them.

“There are so many things you can do to tolerate your emotional experience rather than trying to avoid it,” Preston says.

They include:

• mindfulness or meditation
• guided imagery
• breathing techniques
• radical self-acceptance
• reframing your thoughts 

The best coping strategy for you depends on the moment and what you hope to accomplish.

“Are you struggling with racing thoughts and anticipatory fear? Try meditation or mindfulness so you can learn to stay in the here and now,” Preston says.

“Is your body constantly tense from the treatment or stress of the situation? Try breathing and relaxation exercises. Are you struggling to find hope, positivity, or strength to keep moving forward? Try guided imagery, particularly one that focuses on your cancer journey.”

Preston recommends guided imagery from Hayhouse for chemotherapy and fatigue. 

When to seek professional help

Self-care, family, friends, and other resources can be helpful for people going through the emotional stages of cancer. And people may benefit from professional mental health care.

“Sometimes, the emotions and pain can be so overwhelming that you may need to consider talking [with] a professional who specializes in medical trauma,” Saxena says.

If you experience thoughts of suicide, are unable to focus on anything other than your diagnosis, or find joy in anything, a professional can help.

Your treatment team may be able to refer you to a professional who specializes in people with cancer, and the hospital or treatment facility may have them on staff.

How to cope when someone you love has cancer

Loved ones may go through emotional stages of their own.

“Having a loved one with cancer can introduce a sense of shock, loss of control, and the onset of grief,” Cartagena says.

Cartagena recommends:

• being compassionate with yourself and feeling every and any emotion
• identifying your capacity to help and skills to help your loved one (and protect against burnout)
• identifying important parts of your life outside of the cancer diagnosis or your loved one’s well-being — like hobbies, so that you can nourish yourself
• seeking support, such as from a licensed mental health professional, to process your experience and support your loved one

Also, Saxena advises against entering “problem-solving mode” and staying there.

“You may feel like you want to offer solutions or fix it, but you can’t. Accepting that you also can’t control this experience for them will make sure they know you are there for them and not yourself,” Saxena says.

Frequently asked questions

How does cancer affect you emotionally?

Cancer can provoke various emotional reactions, but people will experience them differently.

Common emotional stages of cancer include:

• shock, disbelief, and denial
• fear and anxiety
• anger, guilt, and blame
• sadness and loneliness
• loss of control
• acceptance
• hope

The process is not linear, and some patients may not experience all of these phases. Others may experience them multiple times in different orders.

Can cancer cause personality changes?

Cancer can prompt different emotional stages, like anger and anxiety, which a person may not typically feel or display. These emotions are valid, and support is available.

A 2019 review suggests personality disorders can worsen with cancer. Older research from 2010 found higher levels of neuroticism and lower optimism in people who had cancer, but there’s no definitive data showing cancer causes personality changes.

How do you help someone with cancer emotionally?

Saxena says showing up, holding a person’s hand, and listening are ways to support a person with cancer. It’s also essential to care for yourself by feeling your feelings and reaching out for support, such as seeing a therapist to help a loved one.

How can you find emotional strength during cancer?

Cancer can prompt many emotions, and they’re all valid.

Experts share that it’s essential to acknowledge your feelings instead of trying to power through them like everything is normal. Giving yourself grace and permission to feel your emotions can help you find emotional strength and resolution.

It’s also important to lean on a support system. This can include:

• family and friends
• a spiritual or religious community
• your medical team
• a licensed mental health professional
• clubs, support groups, and online communities

If you need help coping with a cancer diagnosis, your healthcare team may be able to refer you to a mental health professional.

Takeaway

The emotional stages of a cancer diagnosis don’t fit in neat, tidy boxes. Instead, the process can bring on a flurry of emotions in no particular order. You may feel some and not others.

Giving yourself grace is important: life has changed, and you don’t have to pretend it hasn’t. Developing coping skills like mindfulness and leaning on a support system can also be useful.