A cancer diagnosis is scary in itself, but the shame or stigma that accompanies some cancers can cause increased emotional distress for patients. Social workers at NYU Langone Health’s Perlmutter Cancer Center listen to people with cancer and connect them with resources to help them cope during and after cancer treatment.

Conversations about lung cancer, for example, often raise questions about smoking history, implying it is the patient’s fault. Cancers that are caused by the human papillomavirus, such as oropharyngeal or cervical cancer, carry the shame and stigma of being caused as a result of sexual contact. Head and neck cancers are often diagnosed in people with a history of drinking and smoking.

“People with cancer can pick up on attitudes from people that suggest if they had chosen different behaviors they wouldn’t be where they are, and obviously that could create quite a bit of guilt and shame,” says Bill McDermott, LCSW, social work manager at Perlmutter Cancer Center. “Social workers try to help people with cancer realize that it’s not unusual to have those feelings and help them work through whatever guilt and shame that they have.”

Social workers at Perlmutter Cancer Center see people at the infusion center during their first chemotherapy or immunotherapy treatment. McDermott says this helps patients realize that even if they don’t have any immediate needs, they have access to a social worker at any time over the course of their treatment. By meeting the patient early in their treatment, the social worker is often able to determine how much follow-up a patient might need.

A person who is not interested in a support group at the beginning of their treatment might change their mind as treatment progresses and after treatment is completed. Social workers usually work one-on-one with people, but group sessions can also provide benefit by helping people realize that others might share feelings of guilt or shame. Because many issues arise when treatment is finished, post-treatment is when a support group can be most helpful, McDermott says.

“People often don’t understand that the most difficult time emotionally occurs after treatment is over,” McDermott says. “During treatment, friendships develop between patients, and they build relationships with the staff. After treatment, it’s as if the rug is pulled out from under them.”

People treated for cancer need to know that they are not alone and that help is available, McDermott says. As a general rule, he says, people who work in oncology are there because they want to be there, and that comes through in the way patients are taken care of. McDermott and other social workers tell people that although cancer is a difficult experience to endure, there are many services available to help them through the treatment and alleviate what they are going through. He also emphasizes that it is important for people to be able to ask for what they need.

“When someone is diagnosed with cancer, it’s like entering a foreign country where you don’t know the language,” McDermott says. “Social workers act as tour guides and help guide them through the process.”

It is important to recognize the impact that shame can have on someone who receives a cancer diagnosis, McDermott says. Shame carries feelings of distress, exposure, mistrust, powerlessness, and worthlessness.

“Once people understand where the shame is coming from—and this can take quite a bit of work—they are in a position to start challenging these beliefs and thoughts,” McDermott says. “As with many of the emotions that people fear when they have cancer, the goal is not to prevent it from surfacing but to learn how to manage it.”