Caring for Your Mental Health When You Have Stage 4 Colon Cancer

by Lara DeSanto Health Writer

The toll of metastatic colon cancer isn’t just physical—this cancer has a profound impact on your mental health, too. On top of managing your cancer symptoms and treatment side effects, you’re likely also dealing with the stress and uncertainty of navigating an advanced cancer. So how do you stay afloat and keep moving forward? We spoke to the experts to learn what mental health challenges you may expect, along with helpful tips to manage those stressors and get the support you need.

cancer hospital

Depression Is Common

Because metastatic colon cancer is often life-limiting, it can be a heavy mental burden, says Tom A. Abrams, M.D., a gastrointestinal oncologist at Dana-Farber Cancer Institute in Boston, MA: “Patients naturally feel unmoored when they get that news.” In fact, people with this cancer have an increased risk of depression, says Nina Decker, LCSW, a clinical social worker at Cedars-Sinai Medical Center in Los Angeles who has worked with colon cancer patients. The onslaught of changes cancer brings can be a major contributing factor here too, she says, whether that affects your life goals, finances, or the role you play in your family.

cancer patient depressed

Anxiety Can Feel Overwhelming

When you’re dealing with metastatic colon cancer, it’s not uncommon for anxiety to feel a like constant companion. “Anxiety is generally about fears of worsening of disease; uncertainty about the course of your health and what you’ll be able to do in your life; and concerns about how effective the treatment will be and for how long,” Decker explains. For some, advanced cancer can become more like a chronic illness, with treatment lasting years, tying you to weekly or biweekly treatments. “It may feel like the world has gone on without you—there can be that feeling of aloneness, too,” Decker says.

cancer and COVID-19

COVID-19 Doesn’t Help Things

If you’re living with advanced colon cancer during the COVID-19 pandemic, managing your mental health during this time can be especially challenging. For example, self-care activities you may have relied on pre-pandemic are now more complicated, if not life-threatening. Those who before could take a walk or get a manicure or go to the movies to destress now may fear getting too close to others due to their immunocompromised state, Decker says: “Distraction options have really narrowed, which puts people in a vulnerable position.”

fingers on keyboard

Gather the Facts to Fight the Fears

When you’re facing all these challenges, how can you cope? For one, knowledge can be empowering in the face of fear, says Decker—but Dr. Google can also be dangerous with a condition like metastatic colon cancer. “Avoiding Internet sites that are not approved by your oncology team and avoiding social media that’s not controlled by you is important, because reading all kinds of anecdotal things that may or may not be true heightens anxiety,” Decker explains. “Instead, focus on the facts.” Gathering accurate information from your health care team and other reliable sources about your condition can reduce stress, she says.

thought patterns

Adjust Your Thought Process

Learning to identify harmful thinking patterns can also combat anxiety and depression, Decker says. But it’s not as easy as “just think positive,” she says. “People often are told ‘positive people get positive results,’ but then they feel like they’ve failed when they’re not feeling positive,” she says. “Instead, identifying thought patterns that take you down a rabbit hole can be helpful.” Start to notice when you tend toward black-and-white thinking or catastrophizing—for example, getting one bad scan and thinking it’s the end of your life, Decker says. Then, consider talking to a therapist who can teach techniques to stop and replace these patterns, like examining evidence for unhelpful thoughts and looking for alternative explanations.


See a Therapist

Speaking of therapists, they—and other mental health professionals—can be an invaluable source of support when you’re living with metastatic colon cancer, says Dr. Abrams. “It’s nice to talk to someone whose feelings you don’t have to worry about,” Decker adds. “They also sometimes have a unique perspective, especially if they’ve worked with other cancer patients, in terms of normalizing different feelings at different cancer stages.” And again, therapists can help you practice new coping skills, like identifying those negative thought patterns, which you may not be able to see as well when you’re in the thick of it.


Try Meditation

Meditation can help you find moments of calm within the storm of cancer, and research shows it helps reduce anxiety and depression too, per the National Institutes of Health. To learn about the practice and try from home, you can download free apps like Calm or Headspace, Decker says. “Meditation can help people get in touch with their body and feelings, slow down their breathing, and stop the chatter of fears in their head,” she says. But don’t wait until the anxiety hits to attempt it, she says. Instead, try doing a short meditation at the same time daily to build a practice you can rely on.

cancer patient with family

Combat Depression With Connection

Support from loved ones is major when you’re facing an illness like advanced colon cancer, says Dr. Abrams. So enlist your crew for help, whether that’s a weekly phone call with a good friend or having a family member cook your meals. Connecting with others with cancer can also be a powerful experience. More and more support groups are online now due to COVID-19, which actually makes them more accessible to many people dealing with cancer, Decker says. “Being able to participate and hear from others with cancer, even though we all have unique stories, normalizes it and really helps.”

woman napping

Don’t Forget Self-Care and Rest

Finding moments that spark joy and peace in your life or help you recharge is a crucial part of mental health care during cancer treatment. “Self-care is very important for people with metastatic colon cancer,” says Dr. Abrams. “Patients need to take time to concentrate on themselves, find things that are going to please them and not worry as much about other obligations. It’s really important to have flexibility built into your schedule so you can feel OK to take a day off to sleep in if you’re tired, and not feel guilty about taking a nap or leaving work early.”


Physical and Mental Health Are Linked

Managing your colon cancer symptoms and treatment side effects—whether that’s nausea, fatigue, pain, diarrhea, or another issue—can positively impact your emotional state, too, Decker says. “When we feel better because those symptoms are managed, then we are more open to other ideas, perspectives, distractions, support groups, and more.” Your oncology team can help you find solutions to provide relief to your symptoms and side effects, says Dr. Abrams: "As soon as you start getting side effects, you should report them to your doctor, because the earlier you intervene, the better your results are going to be.”

cancer patient spouse

The Bottom Line

If you’re living with advanced colon cancer, finding ways to cope and build a web of support around yourself can help ease the mental load. You can also seek out resources and community via the Cancer Support Community or American Cancer Society, Decker says. And in a time when you already have so much on your plate, it’s important to be kind to yourself. “Practice as much self-compassion as you can,” urges Decker. “Ask for help if you need it, whether mental health, or through church or friends, whether you are the patient or the loved one. You deserve support.”

Meditation Facts: The National Institutes of Health. (2016.) “Meditation: In Depth.”

Lara DeSanto
Meet Our Writer
Lara DeSanto

Lara is a former digital editor for HealthCentral, covering Sexual Health, Digestive Health, Head and Neck Cancer, and Gynecologic Cancers. She continues to contribute to HealthCentral while she works towards her masters in marriage and family therapy and art therapy. In a past life, she worked as the patient education editor at the American College of OB-GYNs and as a news writer/editor at