Early Cancer Deaths Highlight Growing Grief Crisis

Twilight grief, a form of loss that can begin months or years before a cancer diagnosis turns fatal, is increasingly recognized by clinicians as a distinct emotional challenge for patients and families.

What twilight grief looks like

Psychologists define twilight grief as the mourning of future hopes and roles that may never materialize because of a chronic or terminal illness. Maureen Sessa, PsyD, a health psychologist at the Neuroscience Institute of Hackensack University Medical Center, describes it as a shared experience that can start at diagnosis and stretch through the disease’s trajectory. Felicity Harper, PhD, a clinical psychologist on the Supportive Oncology Multidisciplinary Team at the Barbara Ann Karmanos Cancer Institute, calls it “pre‑loss” or “living loss,” noting that patients often confront the reality that planned milestones are now out of reach.

Typical triggers include noticeable physical changes, such as significant weight loss, and the gradual decline that accompanies treatment. Sessa says, “In my own experience, this often came up when patients lost a significant amount of weight throughout their cancer journey. Such drastic changes brought up feelings of loss and reflection about end‑of‑life.” Shifts in relationships—when a spouse becomes a caregiver or a child assumes the role of advocate—also fuel the sense of loss.

Patients may find themselves grieving the loss of independence, the inability to drive, or the discontinuation of cherished activities. These concerns often surface as a lingering sadness that can be mistaken for depression or anxiety.

How it differs from anticipatory grief

Although the terms are sometimes used interchangeably, twilight grief and anticipatory grief describe slightly different phenomena. Sessa notes that twilight grief can begin at the moment of diagnosis and persist as the illness evolves, while anticipatory grief more commonly refers to the feelings loved ones experience as death becomes imminent.

The overlap can cause confusion. Both conditions may feature low mood, loss of interest, changes in sleep or appetite, and frequent worry. However, twilight grief often includes a unique focus on the loss of future possibilities—retirement plans, travel dreams, or long‑held personal goals—that are no longer attainable.

Signs that you may be experiencing twilight grief

Symptoms can resemble clinical depression but often carry a distinct flavor of mournful anticipation. Sessa lists low mood, loss of interest in previously enjoyable activities, and altered sleep or appetite as common indicators. Physical signs of anxiety—racing heart, shortness of breath—may also appear.

Socially, reactions vary. Some patients withdraw, finding the grief overwhelming, while others become hyper‑active, trying to cram as much as possible into each day. Harper adds that many feel intense sadness, cry frequently, or wonder why they are so affected, leading to feelings of isolation.

Strategies for coping

Both psychologists recommend several practical steps. First, acknowledging the feelings is key. Harper observes that many patients feel “confused” about their sadness, and recognizing twilight grief as a normal response can reduce self‑judgment.

Connecting with a mental‑health professional experienced in oncology is another vital move. Health psychologists, oncology social workers, and psycho‑oncologists are often embedded within cancer centers, offering specialized support.

Joining a support group—whether online or in person—can lessen the sense of isolation. Organizations such as the American Cancer Society and CancerCare provide free programs that bring together people facing similar challenges.

Focusing on present‑day meaning, rather than solely on what has been lost, can also bring comfort. Harper points out that grief and gratitude can coexist, encouraging patients to spend time on relationships, hobbies, creative pursuits, or spiritual practices that still hold value.

When symptoms of depression or anxiety linger for two weeks or longer, or when thoughts of self‑harm arise, immediate professional help is essential. The Suicide & Crisis Lifeline can be reached by dialing or texting 988, and patients should alert their oncology team promptly.