When patients first see Aliya Hafeez, M.D., a psychiatrist in Moffitt’s Behavioral Medicine department, they inevitably bring a sense of anxiety along with their cancer diagnosis. Some are dealing with existing mental health issues and need help integrating their medications into this new cancer treatment protocol.  All need help managing emotional distress while on their cancer journey.

But few know how well Dr. Hafeez can relate. Originally diagnosed with stage three breast cancer in 2009, her cancer returned as metastatic stage 4 in August, 2018. Hafeez currently splits her week between chemo, recovery and seeing patients. And she says common central issues weave throughout most patients’ experience – including her own.

“The number one thing is fear,” says Hafeez. “As soon as you are diagnosed, your mind goes to the question – am I going to die?  That’s a legitimate fear. One thing I say to my patients all the time is that death was a certainty even before this diagnosis.” Fear, she says, is just one of the emotions that normally come with cancer – and it’s OK for patients to feel all of those emotions, rather than to feel pressured to be positive all the time.

Whether working with Hafeez or other psychiatrists, psychologists and social workers within Behavioral Medicine, the goal is always the same: to help the patient process all those emotions that normally come with a cancer diagnosis. “Healing really begins in the mind, by giving patients another option of how to think about their cancer.”

Hafeez says her work with fellow cancer patients usually follows six steps:

• Calming their emotions. It’s important to acknowledge a patient’s fear and anxiety, says Hafeez. “But if they are paralyzed by it, I’m not going to be able to help them.” Medication can help, if the patient is willing.
• Connect and hear the patient’s story. You’ve been diagnosed with cancer, what do you think happens now? “Our culture has given us a certain story about what the cancer journey looks like. But we know better – every patient’s story is different and unique,” says Hafeez.
• Challenge the central beliefs and assumptions in the patient’s story. “A lot of patients come into this thinking they have no choice but to go through chemo - but hating chemo,” she explains. “If you go into chemo treatments thinking, ‘This is a poison and it's going to make me sick,’ then it's not going to help as much as it can. If you go in wanting chemo to heal you, you need to look at it as your friend. The power of belief is that strong. Beliefs guide not only emotions but the choices patients will make throughout their cancer journey.”
• Help patients tolerate uncertainty. That’s really hard to do, Hafeez admits. Patients naturally gravitate to two disparate ends of the belief spectrum: “Either ‘God has my back and I’m going to survive,’ or ‘I’m going to die.’ It’s really hard to hold onto the ground in between, which is that we really don’t know what’s going to happen. But psychologically, that’s the healthiest position because it’s the truth.”
• Encourage a broader view of healing. While the best modern medicine is essential, it’s also important for patients to appreciate the body’s incredible power to heal itself. Hafeez encourages patients to adhere to their physician’s treatment plan, but supplement it with measures that promote healing and emotional well-being. For her, this includes everything from diet, exercise, Reiki therapy and acupuncture to considering the people who surround you (are they supportive or focused on their own fear?). She even uses visualization, imagining her cells as cartoon “minions” armored up to direct the chemo to its cancerous targets and not healthy tissues.
• If possible, reframe your approach to living. “I think cancer is an opportunity to make more conscious choices in life, for what you can create, do and accomplish. It can also bring an element of fearlessness - that life is short and we don’t have time to waste. None of us do.”

One more approach that sustains Hafeez is a sense of gratitude for what she views as a unique opportunity to learn and to help others.  She’ll participate in a series of talks at Moffitt’s support group for patients with metastatic breast cancer in early 2019. “Most people just look at cancer as this awful illness,” she says. “But I see the opportunity in this, in terms of my psychological growth, my spiritual growth, in terms of my level of compassion and empathy and my ability to really contribute to my own healing and to help others.

“If you focus on gratitude, you don't focus as much on fear.”