How can you maintain a positive attitude and keep your head up during cancer treatment? First off, it's important to say that you don't always have to be positive. In fact, allowing yourself to grieve and allowing yourself time to vent your anger, frustration, and fears with a good friend is just as important as staying positive. You honor yourself when you allow yourself to express the emotions you feel - whether positive or negative.

And the next time you feel an urge to kick the person who tells you "All you need to beat cancer is a positive attitude," you can instead inform them that there really isn't any good evidence that cancer patients with a good attitude live longer.

But let's face it. It simply feels better to find the glass half full. And anyone facing cancer certainly deserves as much happiness as possible. What this article is about is giving you a few tips to help you see the glass as half full -- when you are only seeing it as half empty. We all know how our mood can change when we answer the phone or a friend or family member drops in, so let's begin with relationships. 

1. Surround Yourself with Positive People and Positive Energy

You're probably already thinking of those friends and family members who bring a smile to your face simply by being present. When you're feeling the weight of the world on your shoulders, they walk in like a ray of sunshine and almost effortlessly lighten your load.

These positive friends are there to support you when you need it, don't back away when you want to talk about your deepest fears and bring out the best in you, giving you a gentle push when you need it. They inspire you to be courageous when you are feeling afraid (and anyone who claims they aren't afraid during cancer treatment has an issue with honesty,) and make difficult decisions and choices less daunting.

In addition to the positive people in your life, surrounding yourself with positive energy such as inspirational books and uplifting music can add an extra touch of buoyancy to keep you afloat as you face the tsunami known as cancer treatment.

2. Minimize the Time You Spend with Negative People and Eliminate Toxic Relationships

I would wish this article to be 100 percent percent positive, but one step in necessary first.  Before lightening the mood, it's important to weed out what is - what amounts to - weeds in our lives. Some may be annoying but are best left alone. Others can choke out the light, and bury all of the beauty. 
 Sometimes it's hard to avoid contact with negative-minded people -- for example if it's your mother or another relative.  For women, this can be particularly challenging if you are the one who usually plays the mediator or referee in family dynamics. It's surprising how difficult it can be for some people to put themselves first -- but when you are fighting for your life, you don't really have a choice.

We all know of negative people, and know how negative remarks can sting. How much more this can hurt when your defenses are down after your diagnosis of cancer. Think of someone in your life who you can ask to be your spokesman, your "bodyguard" per se. That person who can say "no" for you when you have a hard time saying no. Someone who can politely say "it's time leave" when you don't feel strong enough to do so yourself.  

For people with cancer, especially some forms of cancer such as lung cancer, the blame can be cast on the patient, and comments alluding to this can feel like you are being kicked when you are already down.  Check out these ideas for coping with insensitive remarks when you have cancer.
There are people that you may need to avoid completely, and if you've ever had a relationship that would qualify as "toxic" you may understand where the term "emotional vampires" originated. 

3. Learn to Reframe

Cognitive reframing is simply changing the way you look at a situation or think about a thought. The situation doesn't change, but you do. In lay terms, it means finding a way of shifting your perspective so that instead of seeing the glass half empty, you can see the glass half full.  An example or two might help explain this:

•  If you are scheduled to have 8 chemotherapy sessions, how can you respond when you are half-way through?  You can groan and talk with a tone of dread about how you still have to face 4 more sessions. Or instead, you can more lightheartedly say, "Wow - I've made it through 4 sessions and I only have 4 left!"  
• Or, instead of grieving the loss of your beautiful or still full head of hair, you can tease those around you that unlike them, you don't need to shave your legs (for a woman) or face (for a man) for several months.

With nearly any circumstance you can do a little reframing, though sometimes it requires a little humor. You may not always "believe" your reframed situation, but by simply saying it out loud you may find yourself feeling more positive. (Honestly, it was really nice to have perfectly smooth legs without taking a minute to shave or suffering a single nick for many months - though it took a while to believe it.) Next time you find yourself stressed or down, try out these strategies for reframing the situation or thought.

4. Consider a Mantra

We might joke about people "chanting," but self-affirmation is one method of coping when an illness threatens our very integrity. Some people with cancer have found that they can help turn their negative thoughts in a positive direction by repeating a mantra or phrase. For example, you may want to learn how to use a mantra meditation for stress relief. Similarly, affirmations - statements you repeat to reprogram your subconscious mind to visualize a situation in a more positive light may be helpful. Here are some examples of positive affirmations to get you started, as well as some guidelines on creating your own affirmations.

5. Nurture Yourself by Enjoying Your Passions - Old and New

What makes you happy? What are your passions? Amidst the flurry of diagnosis, second opinions, and treatments, it's easy to forget that, as one of my children would say; "You have a life." Take a moment to close your eyes and step back from the world of cancer, and dream of things you would enjoy doing.  Your thoughts may surprise you. If you're having difficulty picturing yourself feeling passionate about something again, think back over the last several years of your life. What were the highlights? Not what were supposed to be the highlights, but what truly brought you the most joy. Now think of things you have never done, but at some point in your life have thought you would enjoy. What's wrong with pursuing a new passion now? After all, you've just been learning a new language (medicalese) and are playing a starring role in your own soap opera of Specialist Hospital. A fun exercise may be asking a close friend what kind of passion or hobby they believe would bring you pleasure. Again you may be surprised at a quick and lost remark you made a decade ago but have long since forgotten; along with the dream.

6. Just Do It - For You

Building on the last tip, is there something outrageous (but safe and legal) that you've always wanted to do? There's no time better than the present. Why you can even play the "cancer card" to lessen any resistance offered up by your family and friends. After all, who can deny a cancer patient?  (You may have to brush your way through your own resistance as well.) You could start small. Maybe by ordering the lobster on the menu, even though the price isn't listed. Imagine the hobbies or passions you may never have otherwise pursued, if you'd never allowed yourself to indulge yourself.. Whatever you do, splurge on you. Whatever you do: Just. Do. It.

7. Nurture Your Sensual Self

Nurturing your sexuality during cancer treatment doesn't necessarily mean sex . This doesn't necessarily have anything to do with sex at all or even relationships. For women, what makes you feel sensual? Do you love the way a beautiful silk nightgown feels against your skin? Have you ever gone all out and purchased lingerie that makes your skin want to sing? What else makes you feel sensual; womanly as a woman, or manly as a man? Is there a particular scent? Perhaps candles? Erotic or Celtic music, or maybe just those favorites from your adolescent and early adult years that never cease to make you feel youthful and alive? Cancer and it's treatments can make sexuality challenging at times, but if you want to enjoy your sexuality/sensuality in this way, it's met its match.  As a last thought, if you are facing cancer as a single person - or even if you are married - how about sending yourself a love letter? I'm sure there are special and wonderful things about you, your heart and your thoughts, that only you know. It can't hurt to let yourself know, in writing, can it?

8. Have a Slumber Party (They Aren't Just for Girls) and Laugh Lots

Growing up, when and where did you speak of your deepest secrets, greatest dreams, and hidden fears? For girls, it may have been slumber parties, or in your dorm room at college. For guys the setting is different - perhaps in the bowling alley or on the golf course. But the intimacy, at least adapted by gender, is similar. Who can you gather together for a laugh fest or even a real slumber party? A time where you can laugh until your soda comes out through your nose? I'm not sure how anyone can make it through cancer treatment without a sense of humor. Keep in mind that it may need to be you that begins the laugh fest. Loved ones are often afraid to share their off-color thoughts and tidbits of cancer humor unless you set the stage.  But once you do... Cancer is a serious, scary disease. But sometimes a little humor -- and especially a full blown laugh fest -- is the best medicine the oncologist could order. We don't need lab coats to know there is something to laughter medicine.

9. Find the Silver Linings

Even in the worst of circumstances, there are usually a few silver linings. Can you think of any friendships you have that have grown as a result of your cancer diagnosis, or people you would never have met? Certainly, we aren't "given" cancer in order to find these silver linings, and when all is said, I'm sure you would rather not have had the "opportunity" to look for silver linings. But given the clouds, why not look for the silver linings? It will likely bring you a few smiles.

10. Give Back

Only someone who has "been there" can truly connect with another facing cancer, and leave them with the blanket of a feeling that says; "I'm not alone." If you are more than a few weeks into treatment, you may have already heard mention of a 3-day walk or other fundraiser for cancer. It may be hard enough to even walk to the mailbox some days, and if you've heard the word "advocate" you may have already begun to search for a cave in which to hide.
But being too tired to walk, run, cycle, rock climb, dance, scrapbook, or even knit for cancer may be a special blessing in itself. After all, these activities, though honorable and commendable, aren't likely to touch the heart of the quiet, bald woman, who is self-consciously and tearfully walking down the grocery store aisle nearby. A simple touch. A knowing smile. A gentle hug.  And then leaving her to continue on her way with her chin just a tad bit higher. Just like a diamond, things such as these that seem small may shine in the heart of another facing this disease for a long time to come. 
_{Sources:
American Heart Association. Reframe Your Thoughts. Updated 12/18/14. http://www.heart.org/HEARTORG/Caregiver/RealityCheck/ReframeyourThoughts/Reframe-your-Thoughts_UCM_301802_Article.jsp}

A positive attitude is important to overall health, but a new study suggests a bright outlook could play a major role in how someone handles cancer treatments.
Researchers from The Ohio State University Comprehensive Cancer Center say that patients who had psychosocial issues such as anxiety, depression, low optimism, or lack of social support before a hematopoietic stem cell transplant (HSCT) had a higher risk for hospital readmission and stayed longer when they were readmitted compared to those in better overall mental health.
The transplants are most commonly used in patients with blood cancers. Readmission after the procedure has been linked to poor quality of life and survival prospects.
The researchers say that mental health screenings should be performed before the procedure. It could provide at-risk patients with assistance prior to and after the procedure as a way to prevent readmissions.

Read more: ‘Toxic masculinity’ leads to mental health problems for men »

Distress takes its toll

Dr. Daniel Richardson, first author of the report, pointed out that the research looks into the effects of distress on patients with risk factors who undergo the transplant.
It did not examine if positivity would lead to better outcomes, he noted.
“We saw in our study that patients with depression, bipolar, or anxiety (as a group) were more likely to be readmitted to the hospital following HSCT than those who did not have these conditions, about 1.7 times more likely,” Richardson told Healthline.
HSCT is an intense process, especially for patients with psychosocial risk factors. About 35 to 40 percent of HSCT patients have a high risk for depression and anxiety after treatment, Richardson added.
A few studies have shown that HSCT patients with psychiatric or psychosocial risk factors are at a higher risk for psychological complications. This includes higher rates of depression, anxiety, and post-traumatic stress disorder (PTSD).
In fact, those experiencing PTSD were higher by 10 to 15 percent, Richardson added.
That literature is not as clear when it comes to outcomes, though. Some have shown poorer outcomes but others do not show a difference.
Read more: Cancer treatment leaves survivors with PTSD scars »

Emotional health studied

The study focuses on HSCT patients, but what effects does our mental health have on other types of cancers, or cancer in general?

“There have been some studies showing that patients with depression and anxiety have worse overall outcomes in all types of cancer in general, and are at a higher risk of infection across the board, but understanding why they are at higher risk for infection is another issue,” Richardson said. “It is speculated that it has to do with cortisol and the influence of anxiety and depression raising cortisol levels and thus producing a relative immunocompromised state.”
The link between psychosocial risks and outcomes is clear, but the mechanism driving it is not, Richardson noted.
It’s not known to what degree emotional health impacts outcomes, which specific treatments are more effective, or which diseases put people more at risk, he added.
The American Cancer Society reports that personality traits have not been proven to cause cancer. There is no reason to think that emotions can cause or perpetuate cancer based on research of how cancer starts and grows, the ACS says.
The organization does advocate for support and therapy to help patients and survivors deal with the complex realities they face.
Read more: Another side effect of cancer: Suicidal thoughts »

Screening a useful solution

Dr. Charles L. Shapiro, co-director of the Dubin Breast Center at Mount Sinai Hospital in New York, said studies have shown that some outcomes have been worse for cancer patients who are depressed.
That is why his institution screens patients for depression and anxiety at the onset of cancer treatment in an effort to alleviate the depression and improve outcomes. Physical activity reduces the risks of depression and fatigue, which can also help.

“I believe there is a lot evidence suggesting that pre-cancer personality traits, coping skills, and resiliency affect an individual’s perception of side effects, quality of life, and even clinical outcomes,” Shapiro told Healthline.
The evidence is typically only based on data from one point in time.
Last year, a study was done on 12,700 New Zealanders who had breast and colon cancers. Of them, about 630 people had received psychiatric services. The researchers say that survival was worse in the group that had been treated for mental health, especially those with schizophrenia or bipolar disorder.
That’s not to say those issues are the sole cause of poor outcomes. Late-stage diagnosis, communication with clinicians, and comorbidities can be factors as well.
Read more: Depression in the face of a terminal illness and death »

Are we doomed?

Even if a person does have a mental health issue, studies have yet to definitively say that the cancer patient will experience a negative outcome from treatments.
For anyone going into cancer treatment, how well they take care of themselves plays a large role in outcomes.
Richardson said patients tend to benefit in general from social relationships and counseling, and should take steps to maintain and improve their emotional status.
“From what I have observed in over three decades of experience, mental health issues in themselves do not necessarily contribute to poorer outcomes,” Katherine Puckett, PhD, chief of the Division of Mind-Body Medicine at Cancer Treatment Centers of America, told Healthline.

People with pre-existing mental health issues may already have quality-of-life challenges —limited support and unhealthy habits, to name a few — that could make it more difficult to go through cancer treatment with optimal outcomes.
“The outcomes of people with mental health issues who are receiving psychological/emotional and concrete support may be as positive as those of anyone else,” Puckett said.
Read more: Early detection key to treatment of endometrial cancer »

Can positivity cure cancer?

There’s no proof that being positive can alter cancer’s progression, though studies suggest optimism boosts longevity and overall mental healthhr — something Puckett has witnessed in her work.
“People are often told that they have to be positive to get through cancer treatment,” she said. “While there may be health benefits to being positive, I have found … that it’s most helpful to make room for all feelings to be expressed.”
“So often I have heard a loved one say to a cancer patient who is crying, ‘Stop crying. You know you have to be positive,’” Puckett added. “However, when we make space for people to express all of their feelings, rather than bottling them up inside, it is then easier for them to be optimistic. It is OK to allow tears to flow — these can be a healthy release.”