{"id":8329,"date":"2025-11-20T22:03:45","date_gmt":"2025-11-20T22:03:45","guid":{"rendered":"https:\/\/www.nf-patients.eu\/magazine\/?p=8329"},"modified":"2025-11-20T22:03:47","modified_gmt":"2025-11-20T22:03:47","slug":"how-to-cope-with-receiving-a-malignant-tumor-diagnosis","status":"publish","type":"post","link":"https:\/\/www.nf-patients.eu\/magazine\/how-to-cope-with-receiving-a-malignant-tumor-diagnosis\/","title":{"rendered":"How to cope with receiving a malignant tumor diagnosis"},"content":{"rendered":"\n

Davide Ferraris is a clinical psychologist from Italy who is Project Manager for EU-Navigate in the Italian Delegation and an expert in psycho-oncology, as well as palliative care. He provides psychological support to cancer patients, family members and caregivers at LILT (the Italian League for the fight against cancer) in Milan Monza Brianza. He has been in touch with Neurofibromatosis patients since 2017 now.<\/em><\/p>\n\n\n\n

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Davide Ferraris is a clinical psychologist who specialized in psycho-oncology and palliative care.<\/figcaption><\/figure>\n\n\n\n

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Can you tell us a bit about yourself?  <\/strong><\/em><\/p>\n\n\n\n

I\u2019m Davide Ferraris, 38 years old, born in northern Italy, though I spent several formative years living in New York as a professional dancer. Those years shaped how I understand bodies and non-verbal expression in ways I didn\u2019t expect would matter for clinical work, but they absolutely do. I studied Political and Social Sciences at UCSC in Milan, then got my B.Sc. in Psychology from SFU between Milan and Vienna and completed my M.Sc. in Clinical Psychology at the University of Bergamo. Now I\u2019m a clinical and health psychologist specializing in psycho-oncology and palliative care, currently training as a psychotherapist at the Scuola di Psicoterapia Integrata (SPI), registered with the Ordine degli Psicologi della Lombardia. <\/p>\n\n\n\n

Here\u2019s something interesting about my path: I actually started in oncology as a social worker, not as a psychologist. I was supporting cancer patients and families facing socio-economic di\ufb00iculties, helping them navigate the practical chaos that comes with diagnosis. Housing issues, financial crises, access to care. That ground level experience taught me something crucial: you can\u2019t separate the psychological from the social and financial burden people are living. It\u2019s all interconnected. <\/p>\n\n\n\n

Then I transitioned into clinical psychology, and my real formation happened at the National Cancer Institute in Milan, working with the Associazione Paradigma. That\u2019s where I learned cancer isn\u2019t just cellular pathology. The research calls it an \u201cexistential plight”, a profound disruption of who you think you are, your sense of self, your future, your body, everything. <\/p>\n\n\n\n

What is your current role?<\/strong><\/em><\/p>\n\n\n\n

Right now I coordinate psycho-oncology services at LILT Milano Monza Brianza. We operate across a network of spaces: Casa LILT Monza and multiple prevention centers throughout the Milan and Monza Brianza territory, all focused on early diagnosis. At Casa LILT Monza, we\u2019ve recently established what\u2019s probably the newest specialty in cancer care: tertiary prevention through psycho-oncology and rehabilitation. We\u2019re working at the intersection of secondary and tertiary prevention, catching cancer early through screening, but also preventing psychological and physical complications from becoming chronic. We offer integrated rehabilitation including physiatrist care, physiotherapy, onco-yoga, and psychological support. <\/p>\n\n\n\n

What different approaches do you use in your daily work?<\/strong><\/em><\/p>\n\n\n\n

In terms of how I actually work therapeutically, I use what\u2019s called an integrated approach, but what that really means is I don\u2019t believe any single method can hold everything cancer throws at you. I pull from multiple evidence-based approaches to meet the needs of each specific person.  Some examples of what\u2019s in my toolkit: <\/p>\n\n\n\n

Eye Movement Desensitization and Reprocessing<\/strong> (EMDR<\/strong>), a method specifically for medical trauma. I\u2019m certified EMDR Level 1, which means I work with major traumatic experiences, the big \u201cT\u201d traumas like diagnosis moments, devastating news, surgical trauma. This is what I use to process the shock of diagnosis, those frozen moments when someone\u2019s world fell apart. <\/p>\n\n\n\n

Metacognitive Interpersonal Therapy (MIT)<\/strong> helps me understand how someone\u2019s metacognitive functioning, their ability to understand their own and others\u2019 mental states, shapes their experience of illness. How they\u2019re making sense of what\u2019s happening, how they\u2019re relating to others in the midst of crisis, what meanings they\u2019re constructing about cancer. <\/p>\n\n\n\n

The Dynamic Maturational Model of attachment (DMMA)<\/strong>, which helps me see how early attachment patterns, the strategies people developed to manage danger and comfort in childhood, influence how someone relates to their body, to doctors, to caregivers, to the whole healthcare system. These attachment strategies, whether more Type A (dismissing, compulsively self-reliant) or Type C (preoccupied, compulsively comfort-seeking), or mixed A\/C patterns, become the template for how you respond when you\u2019re vulnerable and need care. <\/p>\n\n\n\n

Acceptance and Commitment Therapy<\/strong> (ACT) <\/strong>for helping people reconnect with what actually matters to them when everything feels like it\u2019s falling apart. When all your energy is going into fighting your own thoughts and feelings, you have nothing left for living. <\/p>\n\n\n\n

And sensorimotor psychotherapy<\/strong> for the body-held fear and trauma that talk therapy alone can\u2019t reach. Because cancer doesn\u2019t just live in your thoughts, it lives in your chest tightness, your shallow breathing, your chronic muscle tension. <\/p>\n\n\n\n

No single approach can hold all of this. You need different tools for different moments in someone\u2019s journey. <\/p>\n\n\n\n

Since when have you been in contact with NF patients? <\/strong><\/em><\/p>\n\n\n\n

I started encountering NF patients during my training at the National Cancer Institute in Milan, but my work with this group really deepened when I opened the first psycho-oncology service at LILT Milano Monza Brianza, and later in my private practice. Having dedicated spaces for psycho-oncological care meant NF patients, who often struggle to access specialized support, could finally reach me. <\/p>\n\n\n\n

My deeper involvement also came through European rare disease research networks, particularly through EU-Navigate<\/strong> where we\u2019re specifically looking at how navigation can help older patients with complex, chronic conditions, and NF fits that profile perfectly. <\/p>\n\n\n\n

What struck me immediately was how the literature didn\u2019t quite prepare me for the clinical reality. Yes, the numbers are striking, systematic reviews show depression prevalence of 20% to 40% in NF1 patients compared to 6% to 8% in the general population, anxiety disorders in 30% to 50%. Those are levels that often exceed what we see in common cancer populations. But sitting across a 32-year-old man with NF1 who won\u2019t look at mirrors anymore in my studio, that\u2019s different than reading statistics. Or a young father with NF2 progressively losing his hearing, terrified he won\u2019t be able to hear his children\u2019s voices, that he\u2019ll become isolated from his own family. <\/p>\n\n\n\n

What I recognized from my VIDAS and Paradigma training was this same existential crisis I\u2019d seen in cancer and end-of-life care, this fracturing of identity, this \u201cwho am I becoming?\u201d. But with NF, there\u2019s an additional layer. For cancer patients, that moment of not recognizing yourself is often tied to diagnosis or treatment. For NF patients, it\u2019s daily, visible, progressive reality. Your body becomes increasingly unfamiliar, unpredictable, almost like an adversary you\u2019re trapped with. <\/p>\n\n\n\n

What are some specific challenges you encounter when supporting NF patients compared to other cancer patients? <\/strong><\/em><\/p>\n\n\n\n

Let me tell you about Marco, not his real name, but a real person. He\u2019s 32, NF1, came to my clinic after his third neurofibroma surgery. His opening words were: \u201cI hate my body.\u201d Not \u201cI\u2019m scared of cancer.\u201d Not \u201cI\u2019m worried about dying.\u201d Just \u201cI hate my body.\u201d That\u2019s the core challenge with NF patients, and it\u2019s qualitatively different from what I see with most cancer patients. The research backs this up, studies show NF patients have anxiety and depression levels that often exceed common cancer populations, with prevalence rates of 20% to 40% for depression in NF1 compared to 6% to 8% in the general population. But those numbers don\u2019t capture what it\u2019s actually like in the room. <\/p>\n\n\n\n

The brutal visibility <\/strong><\/p>\n\n\n\n

With Marco, the issue wasn\u2019t just having NF, it was living in a body that advertises it. Caf\u00e9 au lait spots, cutaneous neurofibromas that people stare at on the metro. Research documents significant stigma and social isolation in NF populations, but experiencing it is different. <\/p>\n\n\n\n

There was this incident, he was on the subway, and a woman literally pulled her child away from him with this look of disgust. That moment was frozen in him like a trauma. We processed it with EMDR using Isabel Fernandez\u2019s protocols for medical trauma. We targeted the image, the belief \u201cI\u2019m disgusting,\u201d the shame burning in his chest. This was a major traumatic experience, a big \u201cT\u201d trauma, that needed reprocessing because it had fragmented his sense of self and safety in the world. <\/p>\n\n\n\n

But we also needed body-based work because the self-hatred had become embodied. Chronic muscle tension, restricted breathing, collapsed posture. My dance training from years ago helps me see this, how emotional experience gets choreographed into the body\u2019s habitual patterns. Sensorimotor therapy to help him find even small areas of his body that didn\u2019t feel like enemy territory. <\/p>\n\n\n\n

The genetic burden <\/strong><\/p>\n\n\n\n

This is something that blindsided me initially. The profound guilt around potentially passing NF to children. One couple I work with, the husband has NF2, they want children but are paralyzed. Using Metacognitive Interpersonal Therapy, we mapped how they were each understanding their own mental states and each other\u2019s. His narrative: \u201cI\u2019m defective, I\u2019ll break our children.\u201d This wasn\u2019t just a thought, it was a core identity state that affected how he imagined the future. Her narrative: \u201cI have to fix him or we can\u2019t move forward.\u201d These metacognitive patterns were creating distance between them while they were desperately trying to protect each other. <\/p>\n\n\n\n

One patient told me: \u201cEvery time I look at my daughter, I\u2019m searching for spots. Waiting to see if I\u2019ve cursed her too.\u201d That\u2019s a particular kind of suffering that standard cancer protocols don\u2019t address. <\/p>\n\n\n\n

Lifelong uncertainty with no endpoint <\/strong><\/p>\n\n\n\n

Most cancer patients I\u2019ve worked with, from my VIDAS days through Paradigma to now, have some trajectory. Treatment, remission, recurrence, palliative care. There\u2019s usually an endpoint. NF patients have a lifelong \u201cit could happen anytime.\u201d That neurofibroma could transform. New symptoms could appear. Surgery might be needed. The MRI in six months might show something. It never really ends. <\/p>\n\n\n\n

This is where ACT becomes essential. You can\u2019t eliminate the uncertainty, it\u2019s the reality of the condition. So we work on psychological flexibility: can you carry this uncertainty while still building a life? Can you plan that trip, start that relationship, have children, even with the \u201cwhat if\u201d thoughts riding along? <\/p>\n\n\n\n

\u201cMarco, what matters to you beyond trying to feel safe? If you weren\u2019t spending all your energy trying to control the uncontrollable, what would you actually be doing?\u201d. He wanted to travel. Hadn\u2019t in years. \u201cWhat if something medical happens?\u201d We worked on willingness: Can you plan a trip while having that thought? The anxiety can be a passenger; you\u2019re still driving. <\/p>\n\n\n\n

But there\u2019s resilience too: Sofia, 28, NF1. Severe anxiety, avoiding social situations. We used mindfulness to catch the catastrophic thoughts: \u201cEveryone sees me as a freak.\u201d Combined with ACT: \u201cCan you go to that dinner while having that thought?\u201d And EMDR for the diagnosis moment itself, when the doctor told her at 19 years old what this meant for her life. That was a major trauma that had remained unprocessed, fragmenting her sense of future and possibility. Over months, not quick, never quick, she started reclaiming life. Joined a photography group. Last I heard, she\u2019s doing self-portraits. Actually looking at herself, studying her own face. Not running anymore. Research shows psychological resilience factors, gratitude, optimism, adaptive coping, can buffer distress in NF. These aren\u2019t just soft concepts; they\u2019re measurable protective factors. <\/p>\n\n\n\n

How can people cope with receiving a malignant tumor diagnosis? What is your advice for those people? <\/strong><\/em><\/p>\n\n\n\n

I\u2019m going to be straight with you because most advice people get after diagnosis is worse than useless, it\u2019s actually harmful. \u201cStay positive!\u201d \u201cYou\u2019ve got to fight!\u201d Research shows these injunctions increase distress through what we call experiential avoidance, trying to suppress your internal experience, which paradoxically amplifies it. Here\u2019s what I actually tell people, drawn from years at VIDAS, my training at Paradigma, and thousands of hours in clinical practice: <\/p>\n\n\n\n

First: Your reaction is completely normal <\/strong><\/p>\n\n\n\n

About 20% to 30% of newly diagnosed cancer patients meet criteria for clinically significant PTSD symptoms. The ground just collapsed under you. All your certainties revealed as illusions. You fragment. There\u2019s the you from before, healthy, planning for the future. And the you now, marked by illness, future uncertain. You\u2019re torn between these versions of yourself. This isn\u2019t \u201chandling it badly.\u201d This is normal human response to abnormal situation. <\/p>\n\n\n\n

I remember from my VIDAS home visits, people would apologize for crying, for being scared, for being angry. \u201cI should be stronger.\u201d No. You should be human and authentic. This is what being human in crisis looks like. And it is okay the way it is. The storm is over your head but you can stay here, without doing anything specific. This is freedom of choice and liberation from sense of guilt or shame. <\/p>\n\n\n\n

Second: Get psychological support early. There\u2019s a window <\/strong><\/p>\n\n\n\n

Studies show psychological support provided early, within the first month, can prevent long-term psychological morbidity. Effect sizes of 0.3 to 0.7, which in practical terms means the difference between developing chronic PTSD or integrating the experience adaptively. <\/p>\n\n\n\n

Elena came to me two weeks post-diagnosis. Breast cancer. Panic attacks, couldn\u2019t look at her body, intrusive images. Her oncologist wanted to start treatment first, deal with mental state \u201clater.\u201d No. We did three EMDR sessions targeting that moment she heard \u201cmalignant,\u201d the big \u201cT\u201d trauma. The doctor\u2019s expression, the words, the sensation of everything falling away. Her panic attacks dropped by 80% in two weeks. Suddenly she could think clearly enough to understand treatment options, make informed decisions. That\u2019s the impact of getting in early, before trauma consolidates into chronic patterns. <\/p>\n\n\n\n

Third: Notice when you\u2019re avoiding your experience <\/strong><\/p>\n\n\n\n

Research in ACT shows experiential avoidance predicts worse outcomes across the board. One patient, 51-year-old man with colon cancer, put it perfectly: \u201cI\u2019m using all my energy to NOT think about cancer, so I have zero energy left for actually living.\u201d We worked on psychological flexibility. Not eliminating di\ufb00icult thoughts but changing your relationship to them. \u201cCan you have the thought \u2018I might die\u2019 and still call your daughter? Can you carry that fear and still make dinner, still go for a walk?\u201d. Not positive thinking. Willingness. Letting di\ufb00icult experiences be present without fighting or fixing them. Meta-analyses show this improves quality of life. <\/p>\n\n\n\n

Fourth: Work with your body, not just your mind <\/strong><\/p>\n\n\n\n

This is something my dance background helps me to see. Cancer diagnosis creates massive physiological dysregulation. Your body holds the terror, chest tightness, shallow breathing, chronic tension. Neuroimaging shows the fear circuits lit up.  Talk therapy alone often doesn\u2019t reach this. I use sensorimotor tracking: \u201cWhere do you feel the fear? What happens if you breathe into it?\u201d. One patient, 44-year-old woman with ovarian cancer, described \u201ca black stone in my chest.\u201d We worked with that sensation over weeks. The stone shifted, lightened. Her distress dropped from 9 out of 10 to 3 out of 10. Physical shift mirrored psychological processing. <\/p>\n\n\n\n

Fifth: The paradox, death awareness can restore life\u2019s meaning <\/strong><\/p>\n\n\n\n

Research in existential psychology shows mortality awareness, when processed adaptively, correlates with increased value clarity, deeper relationships, enhanced present-moment awareness. When you know time is limited, nothing is taken for granted. Every day becomes more precious. Priorities shift, the superficial falls away, what\u2019s essential becomes clearer. This isn\u2019t romanticizing. It\u2019s what research on post-traumatic growth shows, 30% to 70% of survivors report positive changes. Not despite the trauma, but through processing it rather than avoiding it. <\/p>\n\n\n\n

Sixth: Face the existential questions directly <\/strong><\/p>\n\n\n\n

Cancer forces you to reckon with questions you\u2019ve probably avoided: What meaning does my life have? What truly matters beyond social expectations? How can I live fully now instead of waiting for a future that might not come? These questions terrify. They take your breath away. But research in meaning-centered psychotherapy shows directly addressing existential concerns produces significant improvements in spiritual wellbeing, quality of life, reduced anxiety, effect sizes around 0.4 to 0.6. <\/p>\n\n\n\n

Seventh: You need other people <\/strong><\/p>\n\n\n\n

Social support is one of the strongest predictors of psychological adjustment, with effect sizes often exceeding 0.5. We\u2019re social animals. No one heals alone. As Aristotle understood and as modern attachment theory confirms, we\u2019re wired through evolutionary motivational systems. The attachment system that drives us to seek connection when vulnerable. The caregiving system compels us to respond to others\u2019 needs. The cooperation system helps us work together. The ranking system helps us understand social hierarchies and our place within them. The autonomy system supports independent functioning. The social play system brings joy and lightness. The defense and security system activates when we\u2019re threatened. Cancer activates all these systems simultaneously. Your attachment system is screaming for connection while your autonomy has been stripped away. You need care but may feel shame about needing it. Understanding these innate motivational systems helps us make sense of the complex, sometimes contradictory emotions that arise. <\/p>\n\n\n\n

But be specific about what helps. Studies show unsolicited advice increases distress. Emotional validation and practical assistance reduce it. Tell people what you need: \u201cI need you to sit with me without trying to fix anything.\u201d \u201cI need help with meals, not pep talks about staying positive.\u201d <\/p>\n\n\n\n

What advances or changes do you hope to see in the field of psycho-oncology in the next few years? <\/strong><\/em><\/p>\n\n\n\n

Five years from now: my concrete hope <\/strong><\/p>\n\n\n\n

Someone gets a cancer diagnosis. Within 24 hours: Automatic psychological appointment scheduled, access to a psychotherapy activated, connected to peer support group, family support activated, integrated rehabilitation options offered, distress screening starts care plan.<\/p>\n\n\n\n

My hope is that psychologists use integrated, evidence-based approaches: Eye Movement Desensitization and Reprocessing (EMDR) for major traumas, Acceptance and Commitment Therapy for values, Metacognitive Interpersonal Therapy for metacognitive work and meaning-making, sensorimotor therapy for body-held fear and Dynamic Maturational Model-informed understanding of attachment patterns, all tailored to this specific person. <\/p>\n\n\n\n

I also want the oncologist to understand trauma and adjust communication accordingly. I want the nurse to recognize dissociation and know how to ground someone. Physical therapists and psychologists should coordinate. Onco-yoga instructors should informed, attachment-aware, existentially sensitive. I\u2019m working toward this. One patient at a time. One Virgilio volunteer trained. One \u201cParliamone Qui\u201d session. One EU-Navigate research finding that might change policy. One presentation to healthcare administrators. One article arguing for a system change. <\/p>\n\n\n\n

Thank you for the interview!<\/strong><\/em><\/p>\n\n\n\n

<\/p>\n\n\n\n

Davide Ferraris gave a much longer interview, read the full version here:<\/p>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

Davide Ferraris is a clinical psychologist from Italy who is Project Manager for EU-Navigate in the Italian Delegation and an expert in psycho-oncology, as well as palliative care. He provides psychological support to cancer patients, family members and caregivers at LILT (the Italian League for the fight against cancer) in Milan Monza Brianza. He has been in touch with Neurofibromatosis patients since 2017 now. Can you tell us a bit about yourself?   I\u2019m Davide Ferraris, 38 years old, born in northern Italy, though I spent several formative years living in New York as a professional dancer. Those years shaped how\u2026<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advgb_blocks_editor_width":"","advgb_blocks_columns_visual_guide":""},"categories":[1],"tags":[],"acf":[],"author_meta":{"display_name":"magazineditor","author_link":"https:\/\/www.nf-patients.eu\/magazine\/author\/magazineditor\/"},"featured_img":null,"coauthors":[],"tax_additional":{"categories":{"linked":["Uncategorized<\/a>"],"unlinked":["Uncategorized<\/span>"]}},"comment_count":"0","relative_dates":{"created":"Posted 5 months ago","modified":"Updated 5 months ago"},"absolute_dates":{"created":"Posted on 20\/11\/2025","modified":"Updated on 20\/11\/2025"},"absolute_dates_time":{"created":"Posted on 20\/11\/2025 22:03","modified":"Updated on 20\/11\/2025 22:03"},"featured_img_caption":"","series_order":"","_links":{"self":[{"href":"https:\/\/www.nf-patients.eu\/magazine\/wp-json\/wp\/v2\/posts\/8329"}],"collection":[{"href":"https:\/\/www.nf-patients.eu\/magazine\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nf-patients.eu\/magazine\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nf-patients.eu\/magazine\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nf-patients.eu\/magazine\/wp-json\/wp\/v2\/comments?post=8329"}],"version-history":[{"count":6,"href":"https:\/\/www.nf-patients.eu\/magazine\/wp-json\/wp\/v2\/posts\/8329\/revisions"}],"predecessor-version":[{"id":8406,"href":"https:\/\/www.nf-patients.eu\/magazine\/wp-json\/wp\/v2\/posts\/8329\/revisions\/8406"}],"wp:attachment":[{"href":"https:\/\/www.nf-patients.eu\/magazine\/wp-json\/wp\/v2\/media?parent=8329"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nf-patients.eu\/magazine\/wp-json\/wp\/v2\/categories?post=8329"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nf-patients.eu\/magazine\/wp-json\/wp\/v2\/tags?post=8329"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}