Fay J. Hlubocky, PhD, MA, is a licensed clinical health psychologist with expertise in psychosocial oncology and a health care ethicist at the University of Chicago Medicine in the Department of Medicine, Section of Hematology/Oncology, the Supportive Oncology Program, and the Maclean Center for Clinical Medical Ethics in Chicago, Illinois, USA. Dr. Hlubocky is the 2022 Cancer.Net Associate Editor for Psychosocial Oncology. Dr. Hlubocky’s clinical research and educational efforts center on the impact of the psychosocial aspects in cancer care involving patients, caregivers, and oncologists across the cancer trajectory. She has training and experience in trauma-informed care in mental and behavioral health, and she has held certification as a clinical trauma professional. Dr. Hlubocky’s disclosure information can be found in her biography linked to above. You can follow Dr. Hlubocky on Twitter.
For any person with cancer at any phase in the cancer experience, whether newly diagnosed or a 20-year survivor, the events associated with the crisis in Ukraine may negatively impact their overall psychological well-being. Witnessing these events, either firsthand as a person with cancer in Ukraine, as a refugee with cancer in another country, or at home in the United States through the internet or television, may create additional distress and undesirable feelings, especially as you may already be coping with the emotional effects from the cancer itself.
Although everyone experiences different reactions to war and trauma, it is expected that the core emotions of fear, anxiety, sadness, and grief may arise in the immediate short term following the events in Ukraine. In addition, you may feel anger, denial, disbelief, and depression over these traumatic events. Others may feel a lack of control, powerlessness, or helplessness. Fears associated with the future may arise. You may feel the urge to cry at any moment and lack the desire to sleep or eat. The stress associated with life disruption and separation from family, home, and country may heighten these emotions.
Furthermore, cancer- or treatment-related symptoms and side effects, such as pain or fatigue, may also intensify due to this distress. Although these emotions are common, if they impact your ability to function, additional long-term psychological support may be needed to help you cope.
Prioritizing your mental health and finding support during the war in Ukraine
Most importantly, despite any disruption in your care, prioritizing your mental health as a person with cancer is paramount. Whether you are in a hospital, shelter, or refugee center, a good first step is to think through what you can do to take control of your situation and your health. Problem-solving, planning, and self-management can help you gain control to find solutions and respond productively during this stressful event.
It is also vital for you and your family to maintain communication with your medical team, such as your oncologist, nurse, or psychologist, for guidance on next steps, especially as hospitals become inoperable in Ukraine. Many oncologists maintain virtual or phone contact with their patients to provide care and recommendations, including referrals to cancer centers in other countries. Also, it is critical that if you were receiving treatment for a mental health condition prior to the war, adhering to your psychological treatment plan and taking medications on time will help address this additional distress.
If you did not receive psychological care previously, seeking support now is crucial to aid in coping. Virtual support resources are readily available (see below). If you have left Ukraine and are in another country, meet with the doctors at the shelter or refugee center clinic in that country. They will assist you with finding a doctor, hospital, or medication, and they can temporarily address your immediate needs associated with distress or cancer-related symptoms, such as pain.
How to cope with the emotional effects of the war in Ukraine
To cope with these complex emotions and foster resilience—the ability to rise above adversity, adapt, and thrive in the face of a significant life stressor—there are many strategies you can take. First, ask for help from your doctor, family, friends, or neighbors. It is not a sign of weakness but, rather, a sign of strength to ask for help with distress as you continue with your cancer journey during this crisis. In fact, seeking help can be empowering and can help build confidence and optimism. We all need help at some point in life.
Next, prioritize self-care. Although challenging, maintaining a sleep routine is important. Even brief 15-minute naps taken daily can be restorative. Close your eyes whenever you can to rest and maintain your strength. Also, practice stress-reducing techniques, including meditation or visualization, prayer, journaling, drawing or sketching, listening to music, and deep breathing techniques. A “breathing break” taken several times during the day can be calming, energizing, and enhance your focus. Simply inhale deeply through your nose and exhale slowly from the mouth. Talking with others about your feelings can also help place the situation in perspective. And although news can be informative, limit your exposure to media and internet coverage about the war, as constant checking can heighten anxiety.
Finally, taking positive actions, such as naming the gifts you are grateful for, can help you manage suffering and emotional pain. Remind yourself that there is hope despite this current darkness. Past research studying the war survivor experience informs us that despite the psychosocial challenges you are currently facing, the outcome of this traumatic life experience can eventually result in greater meaning and life purpose.
Where people with cancer can find help during the war in Ukraine
Remember that you are not alone. Please know that the global cancer community stands with you and your family. We recognize that your situation is under constant change and that even reading this post might be difficult under the dire circumstances either in Ukraine or in your new host country. We are here to provide hope and guidance via several resources listed here.
First, within Ukraine, the Ukrainian Psycho-oncology Association (UPOA) posted via Facebook that psychologists remain virtually available to provide you with psychological support. Also, your host country has psycho-oncology societies or associations with members willing to help, including in Poland, Czech Republic, Slovakia, and Romania.
In the United States, Cancer.Net has compiled several resources available in Ukrainian, Polish, Romanian, and Russian to help people with cancer navigate their care during the crisis in Ukraine. You can find these resources on a different page. In addition, our team here at the American Society of Clinical Oncology (ASCO) has dedicated efforts to provide information and resources to people with cancer and physicians in Ukraine and neighboring countries. You can find this information on a separate ASCO website.
ASCO has also partnered with the American Cancer Society (ACS) to assemble a group of volunteer clinicians available to provide guidance to you in Ukrainian and additional languages. You can email ACS at Ukraine.Support@cancer.org or call the following numbers based on the country you are in, and ACS will connect you with a clinician who can answer your cancer questions:
Finally, ACS has cancer resources in Ukrainian, Polish, Russian, and English to provide support for people with cancer and their caregivers who are impacted by this conflict.
Remember that there are several ways for you to get help and that the global cancer community is here to support you. We are here to hold your hand.