Cancer patients are living longer than ever before, but the mental health impact of living under the shadow of a diagnosis is an under-recognised area.
With many UAE workers far from home and often without a support network of family and friends, cancer can be as much a mental challenge as a physical one.
Rose Nona, a Sri Lankan maid living in Jumeirah, was given one year to live after a thyroid cancer diagnosis in 2001.
After being forced to sell her house near Colombo to pay for treatment, she defied the odds to make a full recovery, moving to Dubai to work with a British family in 2008.
In 2016, her cancer returned, this time in her breast, but she has faced difficulties dealing with the mental challenge of a second diagnosis.
“The treatment was stressful, but I was angry and fed up with life,” said Rose, a single mum of two boys.
“After the first cancer I was very down and thought I was going to die. I trusted in god, and survived.
“This second cancer has totally changed my life.”
Her employer took out health insurance, but as the policy had not been in place for six months before she was diagnosed, it refused to pay for her chemotherapy.
The British family for whom she works paid more than Dh70,000 towards the costs and helped her through the ordeal.
The insurance company eventually backed down and also agreed to pay some of her treatment costs.
“I was scared that If I died, who would look after my parents and my own children once I was gone?” said Rose.
“My dad died when my second cancer developed, he was very down mentally and couldn’t deal with me having cancer again.
“It was difficult to deal with. The mental pressure was very great, and I could not have got through this without the support of my family here.
“I am still fighting for life, and if I hear someone is in a dark place I will try to help them.”
Rose was offered no mental health support or counselling under her health insurance plan - very few cover any sort of face-to-face treatment - and relied upon family and friends to get her through the dark times.
Social networks of other cancer patients have also helped her to deal with the mental stress of living under the threat of cancer.
Mary, a Syrian working in Abu Dhabi, has had a similar experience.
She discovered she had stage three cancer in her right breast in December, 2017.
She has been given a 75 per cent of making a full recovery after undergoing a traumatic period of chemotherapy and radiotherapy.
That 25 per cent of doubt casts a long shadow over every decision she now makes about her future. “I knew nothing about cancer except seeing people dying from it,” she said.
“I saw more than 20 doctors and they were all telling me different things, it was very confusing.
“I finally found a doctor who ensured I got the right treatment, from the right place.”
Although Mary only had cancer diagnosed in one breast, doctors advised her there was a good chance of it returning in her other breast so suggested a double mastectomy.
Her health insurers refused to pay for a second operation and breast reconstruction as it was considered a non-urgent surgery, leaving her facing a bill of Dh115,000 to cover the procedure herself.
She was also offered no advice on how to access mental health services during her treatment, despite being on her own in the UAE with no family to support her.
“My mental health has never even been a consideration,” she said.
“Some doctors do not appreciate the anxiety they put cancer patients through when they get things wrong or are insensitive.
“My biggest fear is the cancer returning, not because I’m afraid to die – but I can’t face any more chemotherapy.”
Mental health professionals at the Camali Clinic in Dubai said the way a cancer diagnosis is delivered can help patients deal with the moment.
“How that information is shared and received can have a big impact on how the information is digested,” said Shaima Al Fardan, a clinical psychologist at the clinic.
“Emotions like shock, denial, anger and depression don’t always happen at once, but people often flip between each until they accept the diagnosis.
“Their mortality has been shaken, so they lose a sense of security.
“I’ve seen cancer patients struggle even after their treatment has finished, the threat of mortality is constantly hanging over some people, even in recovery.”