Emotional experiences across the cancer journey: A psycho-oncological perspective for patients, caregivers, and oncology nurses

Cancer is not merely a biological disease defined by uncontrolled cellular proliferation; it is a multidimensional life experience that simultaneously affects the individual's body, emotions, thoughts, relationships, values, and sense of meaning. Although advances in early detection and treatment have prolonged survival, these achievements have also rendered long-term psychosocial needs and emotional burdens more visible.¹ At the same time, growing evidence highlighting the mind–body connection and elucidating the relationships, mechanisms, and pathways between psychosocial factors and cancer has underscored their relevance to cancer development, progression, prevention, and treatment.^2,3 From this perspective, cancer care must aim not only to add years to life but also to add life to years, necessitating a biopsychosocial, psychosexual, and spiritual approach to treatment and care. Nursing science conceptualizes the human being as “more than the sum of its parts” and advocates for care that is person-centered, individualized, and holistic.⁴ Within oncology settings, nurses occupy a unique position to recognize emotional distress, respond to subtle cues, and support patients and caregivers across different phases of the cancer trajectory. However, the literature indicates that nursing practice often prioritizes physical care and treatment, while emotional concerns remain insufficiently recognized or addressed in routine care due to factors such as workload, time pressure, and role ambiguity.^5,6

Cancer is experienced as a dynamic and often prolonged journey that unfolds from diagnosis through active treatment, survivorship, possible recurrence, and, for some individuals, end-of-life care. Throughout the entire course of this journey, emotional experiences are not linear; each patient, each family, and each culture navigate this process in a unique way. Patients and their families oscillate between fear and hope, uncertainty and adaptation, vulnerability and resilience.^7,8 Nevertheless, the literature consistently reports high levels of unmet needs, psychosocial problems, and psychiatric morbidity among both patients^1,4,9,10 and caregivers.10, 11, 12

The cancer journey often begins with pre-diagnostic uncertainty. A bodily change noticed by the individual or the suspicion raised by diagnostic tests may give rise to intense anticipatory anxiety. In particular, the period between biopsy and pathology results is frequently described, based on the author's clinical observations, as one of the most distressing phases of the entire journey. Once the diagnosis is confirmed, shock, disbelief, denial, fear, and intense anxiety are common reactions. This moment represents a threshold at which individuals come into direct contact with their own vulnerability and mortality. The question “Why me?” may intertwine with diverse cognitive and emotional responses, including guilt, anger, or fatalistic acceptance. Such reactions can be understood as natural efforts to preserve psychological integrity.⁴ At this stage, the manner in which bad news is delivered significantly shapes the patient's emotional experience.¹³ Expressions such as “my world collapsed” or “the ground slipped from under my feet” are commonly used to describe this moment. Clinical experience suggests that patients may be traumatized not only by the cancer diagnosis itself, but also by how the diagnosis is communicated. Empathic communication, active listening, and approaches that allow space for emotional expression are critical in mitigating the long-term psychological impact of the diagnostic encounter.¹⁴ Nevertheless, the roles of oncology nurses in accompanying patients during this phase, fostering a sense of safety, and facilitating coping with uncertainty often remain insufficiently visible.

During active treatment, emotional distress often intensifies as patients contend with surgery, chemotherapy, radiotherapy, and ongoing hospital-based care. During this phase, emotional distress, including anxiety, depressive symptoms, fear, anger, and hopelessness, is frequently reported.⁹ Patients commonly experience a diminished sense of control over their bodies. Hair loss, weight changes, organ loss, and alterations in physical appearance affect not only the body but also self-concept and body image. In particular, hair loss may become a visible symbol of illness for many patients, triggering feelings of shame, stigma, and social withdrawal. Changes related to sexuality and intimate relationships represent another domain of high emotional burden, yet one that is often difficult to articulate.⁷ For many patients, the belief that “nothing will ever be the same again” evolves into a shared internal narrative. At this stage, emotional regulation becomes a continuous task rather than a one-time process of adjustment. This underscores the need for systematic screening of emotional distress and the integration of psychosocial support into routine oncology care.

Although the completion of active treatment is often perceived as the end of the cancer process and the beginning of a “return to normal,” for many patients the survivorship phase represents one of the most emotionally complex stages. During this period, unmet psychosocial needs are common, and symptoms of anxiety, depression, and post-traumatic stress are reported.¹⁵ One of the defining experiences of survivorship is the fear of cancer recurrence.¹⁶ Routine follow-up visits, bodily sensations, or environmental triggers may readily reactivate intense anxiety.⁷ Consequently, survivorship does not imply a simple return to pre-cancer life. However, this does not suggest that survivors inevitably emerge from the cancer experience solely with loss or psychological harm. Rather, some individuals report positive psychological changes, described as posttraumatic growth.¹⁷ Based on the author's clinical observations, some survivors begin to pursue goals they had previously postponed or felt unable to attempt, rediscover the value of life, reorganize their relationships, and show greater self-care and more deliberate life choices. Such changes may contribute to psychological maturation, inner strengthening, and the realization of previously unrecognized potential. Nevertheless, this transformation is neither universal nor guaranteed. From a nursing perspective, conceptualizing survivorship as a period of reconstruction—rather than merely a state of being disease-free—may support patients in experiencing this phase as a more conscious and meaningful stage of life. Accordingly, survivorship should be viewed not as the endpoint of psychosocial care, but as a critical phase in which support must continue in an adapted and evolving form.

Disease recurrence or progression to an advanced stage represents a new psychological breaking point for patients and their families. The return of cancer is often experienced as the collapse of newly restored hope, control, and future orientation. Emotional responses such as disappointment, helplessness, and anger tend to re-emerge—frequently with greater intensity than at the time of the initial diagnosis. In advanced disease, the accumulation of multiple losses may lead to layered and fluctuating grief responses. As patients confront the finitude of life, existential concerns related to meaning, legacy, unfinished business, and what will be left behind come to the forefront.¹⁰

In end-of-life care, hope is redefined in ways that differ from earlier phases of the cancer journey. Rather than being centered on cure or survival, hope often shifts toward symptom relief, pain control, meaningful relationships, and the experience of a dignified life and death. Spiritual needs become more prominent during this period and, for many patients, constitute a central resource for coping.¹⁸ Within this context, psychosocial and palliative approaches converge, and nursing care aims not only to alleviate symptoms but also to preserve human dignity throughout the end-of-life process.

Parallel to the patient's experience, caregivers carry a profound, persistent, yet often invisible emotional burden throughout the cancer journey. From the moment of diagnosis, caregivers are required to cope with uncertainty, fear, and a state of ongoing vigilance. The course of the disease, responses to treatment, and the unpredictability of the future may foster a continuous sense of hypervigilance. The caregiving role can conflict with other life roles—such as being a partner, parent, employee, or adult child—leading to role strain and confusion. Over time, this strain may give rise to feelings of guilt, inadequacy, and anger. Influenced by cultural and traditional values, caregivers may be inclined to suppress negative emotions, prioritize the patient's needs over their own, and avoid rest, pleasure, or self-care even during limited personal time. Indeed, the literature consistently reports high levels of unmet needs, chronic stress, anxiety, depressive symptoms, sleep disturbances, and emotional exhaustion among caregivers.10, 11, 12 In advanced disease and end-of-life care, the experience of grief for caregivers often begins before the patient's death. During anticipatory grief, caregivers must cope not only with the impending loss of a loved one but also with uncertainty about how their own lives will change.¹⁹ In the absence of adequate psychosocial support, this burden may extend beyond bereavement and compromise long-term adjustment and well-being. Therefore, recognizing caregivers not merely as extensions of the patient, but as individuals with distinct emotional needs, is an essential component of comprehensive oncology care.

Oncology nurses occupy a central yet emotionally demanding position within this context. Their sustained presence across diagnosis, treatment, recovery, recurrence, and end-of-life care places them in close proximity to suffering, uncertainty, and loss. While this relational closeness enables therapeutic engagement and trust, it also exposes nurses to an increased risk of burnout, compassion fatigue, and secondary traumatic stress.²⁰ These risks cannot be attributed solely to individual resilience; rather, they are shaped by structural factors such as heavy workloads, time pressure, staffing shortages, role ambiguity, and limited institutional support. Clinical supervision, team-based reflection, psychosocial skills training, and supportive organizational policies can enhance nurses' capacity to recognize and manage their emotional burden. Supporting nurses’ emotional well-being is not an auxiliary concern but a core requirement for the sustainability of psychosocial oncology practice. From this perspective, psychosocial care should be understood as a bidirectional process—one that encompasses not only the needs of patients and caregivers, but also the protection of the nurse as a human being providing care.²¹

Consultation–liaison psychiatry, and psycho-oncology in particular, represent an interdisciplinary field within cancer care that places the individual's biopsychosocial integrity at its center, addressing and intervening in the experiences of patients, caregivers, and health professionals alike.²² As one of the primary carriers of psycho-oncological care in clinical practice, oncology nurses play a pivotal role in identifying emotional distress, implementing psychosocial screening tools, facilitating early detection of individuals at risk, and ensuring timely referral to multidisciplinary teams. Effectively sustaining this role requires supportive structures at both individual and institutional levels. Strengthening nurses' psychosocial care competencies, fostering interprofessional collaboration, and ensuring accessible support services for both patients and caregivers constitute the core elements of this process. Psycho-oncology services extend beyond patient care to include the protection of oncology nurses' own emotional well-being. In this sense, psycho-oncological care not only enhances the quality of patient- and caregiver-centered support but also plays a protective role in sustaining nurses' psychological well-being and professional functioning.

In conclusion, the cancer journey encompasses a series of interconnected emotional transitions experienced by patients, caregivers, and oncology nurses. For patients, the threat to bodily integrity necessitates a renegotiation of self-perception, life plans, and assumptions about the future. For caregivers, this journey represents a largely invisible domain of labor in which physical, emotional, and relational burdens are carried simultaneously. For oncology nurses, cancer care constitutes a distinctive field through which the essence of nursing is both encountered and deepened. A psychosocially sensitive, person-centered approach—one that acknowledges emotional vulnerability, relational dynamics, and existential concerns—is essential for creating care environments that uphold dignity, resilience, and shared humanity across the entire cancer trajectory. Strengthening the psycho-oncological perspective within oncology nursing holds the potential to foster more humane, sustainable, and transformative care experiences for all stakeholders involved in the cancer journey.

“The most beautiful people I have known are those who have known trials, have known struggles, have known loss, and have found their way out of the depths.

They possess an appreciation, a resilience, a sensitivity, and an understanding of life that fill them with compassion, gentleness, wisdom, and a deep loving concern.

Beautiful people do not just happen; they come into being.”

— Elisabeth Kübler-Ross

Declaration of generative AI and AI-assisted technologies in the writing process

During the preparation of this editorial, the author used generative AI tool (ChatGPT) solely for translation purposes. The intellectual content, structure, and interpretations are entirely the author's own. The author reviewed and revised the manuscript in full and takes complete responsibility for the content of the publication.

Funding

This study received no external funding.

Declaration of competing interest

The author declares no conflict of interest.