Loss, Grief, and Bereavement in the Setting of Cancer

Linda Emanuel, MD, PhD; Frank D. Ferris, MD; Charles F. von Gunten, MD, PhD; Jaime H. Von Roenn, MD

Disclosures

March 29, 2011

In This Article

Editor's Note: This text has been excerpted and adapted from Emanuel LL, Ferris FD, von Gunten CF, Von Roenn J, editors. EPEC™-O: Education in Palliative and End-of-life Care for Oncology (Module 4, Loss, Grief, and Bereavement. Copyright The EPEC™ Project, Chicago, Ill, 2005). The EPEC™-O curriculum was produced by The EPEC™ Project, with major funding provided by the National Cancer Institute and with supplemental funding provided by the Lance Armstrong Foundation.

Loss and Cancer

All cancer patients and their families experience loss. Loss, grief, and bereavement are a significant part of the cancer experience. Competence in caring for these aspects of the cancer experience should be a high priority for the cancer care team.

Despite the fact that patients routinely face illness-related losses, and despite the frequency with which physicians and other health professionals encounter bereaved patients and families, medical education has historically provided minimal training in addressing issues of loss and grief with patients and families.

Cancer patients face losses from the onset of their illness, starting with the loss of their expectations for their future. Loss results in grief responses; mourning a loss and learning to live life without what is lost are part of creative adaptation. Patients can respond creatively to multiple major losses, but adverse responses to grief can occur. These include anxiety, depression, and associated pathological manifestations.

Family members, caregivers, and members of the cancer care team also experience and respond to losses. This article describes experiences of loss and grief. Methods for screening and assessment, as well as management of uncomplicated and complicated grief, are presented. Finally, approaches to follow-up with bereaved family members are offered.

Loss Terminology

Loss. Loss is the condition of being deprived of something or someone. Loss may be anticipated, real, or perceived; primary or secondary.

Grief. Grief is the experience of a loss. Grief is a personal and normal response to loss. It has emotional, intellectual, spiritual, physical, behavioral, and/or social components.

Mourning. Mourning is the act of grieving -- the outward expression of a loss. Mourning can involve private expressions of grief as well as socially or culturally defined customs such as rituals and traditions.

Bereavement. Bereavement is the state of living with a loss. Grief and bereavement are part of the process of adjusting to a loss.

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