When Can I Start Giving Back for the Help I Received?

In order to maximize your own recovery, you should wait a year or so before you formally become involved in a program to help other cancer survivors.

Many situations will arise where you are called on for advice or support by newly diagnosed patients or families of a cancer patient. You may feel obligated to help because

• people helped you when you were sick

• you empathize with the distress of a newly diagnosed patient

• you do not want the caller to feel abandoned

Whether or not you make yourself available and how deeply you become involved must be decided on a day-by-day and case-by-case basis. Factors to consider include

• how comfortable you feel with your own situation

• how many physical or emotional problems of your own you are dealing with

• how many people are calling on you

• how many other responsibilities you have

• how tired you are

• how much time you have

• how great the needs of the person requesting help are

• how you feel after you help others

Wait a few weeks or months to help others if, right now, talking to others leaves you exhausted, fearful, or distraught and unable to sleep. You must balance your physical and emotional needs against the needs of your family and the needs of the person requesting help. For a while you have to protect yourself from too much avoidable emotional stress. Other people may not recognize that you have depleted reserves, that you are still dealing with your own issues, or that helping others is especially draining if you do not have much distance from your own cancer experience.

Dealing with someone else’s cancer is a complicated task. For everyone’s sake, bear in mind that you are not a mental health professional and should not burden yourself with a situation better handled by someone with training. It is possible that you are still dealing with unresolved issues related to your own cancer that could be reopened by the relationship with a newly diagnosed patient. You need to be aware of your own stage of emotional recovery in order to best serve someone else.

The best way you can help everyone is to take care of yourself. There will be plenty of opportunities to help others when the time is right for you.

Won’t I Feel Guilty If I Don’t Help Someone Else?

Your top priority at this time is to recover as safely and quickly as possible. If someone else’s needs are too great for you to handle now, letting someone else take care of the person’s needs is the best decision you can make for everyone’s sake. You can help others by referring them to services and people who are in a position to help.

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What Is the Goal of Pain Treatment?

The goal of pain management is to make your pain manageable so that you can continue your life in a meaningful way.

Optimal pain management means minimizing physical pain and minimizing any adverse response to or consequence of the pain.

In some cases, it means learning how to accept a certain level of pain and making adjustments in your lifestyle.

How Does Self-relaxation Work to Relieve Pain?

When you learn self-relaxation or meditation, you learn to focus on something, such as a mental image of a calm lake, to distract you from pain signals. Through various techniques, you can learn to decrease tension in your muscles. This allows you to achieve a state of deep relaxation that provides immediate comfort and helps replenish your physical and emotional energy stores.

How can focusing on something stop you from feeling pain? Your perception of pain is affected by your attention to it. For example, an ice skater who sustains a gash during competition may be unaware of the cut until the performance is completed and the dripping blood is noticed. This same skater might scream with pain when receiving a routine vaccination. Or, while reading an exciting book, you may not notice the sound of the bathtub overflowing in the next room. And yet, at night you may be unable to sleep because of the sound of a dripping faucet. Although you cannot always control the source of pain, you can control your attention to it.

Studies are in progress to determine whether regular relaxation measurably improves the immune system and prevents medical problems, such as heart disease and cancer.

You can learn relaxation techniques from qualified counselors and psychiatrists. There are also books, pamphlets, and audio-tapes on self-relaxation and meditation. Information on stress management and counselling can be obtained from the Cancer Information Service.

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Is It Common to Have a Fear of Recurrence?

Almost all cancer survivors have some fear of recurrence. If you rarely think about your cancer or the possibility of recurrence, you are very lucky, as long as you are diligent with the advised follow-up for your cancer. If you are so confident of your continued cancer-free state that you skip advised checkups and tests, you are probably more afraid than confident. Delayed or missed checkups are missed opportunities to stay well.

Most cancer survivors harbor a certain fear of recurrence. For some it is a daily, debilitating fear. For most it is a repressed fear that surfaces only in the face of unavoidable reminders of vulnerability, such as checkups, anniversaries, a new pain, a cough, or a bump.

Fear of recurrence is a fear that can be managed.

Why Is the Fear of Recurrence So Intense?

The intensity of your fear reflects now only how much you believe you could have a recurrence but what it is you fear. The fear of recurrence is very intense because of the impact of the meaning of recurrence, not necessarily because of how strongly you believe you will experience recurrence. People who are usually confident that they will stay well can experience intense fear under threatening circumstances, because the tiny shred of doubt touches on a deep and powerful fear.

Fear of recurrence can be more intense than fear of a first cancer. Most people who have not had cancer feel, on some level, that it could not happen to them. Even acknowledging that they know and believe that it could strike them tomorrow, a part of them feels safe. They have the adaptive, normal, healthy emotional protection of a sense of immunity.

Having had cancer, you know, intellectually and emotionally, that you really could develop cancer again. Cancer is no longer something that happens only to other people. It is easier to believe that you will never get cancer than to believe that you will never have a recurrence.

Fear of recurrence is powerful because you know what it is like to have cancer, to be a patient, to decide on treatment, and then to undergo treatment. You know too well that a cancer diagnosis involves job stress, family stress, financial stress, and inconvenience, at best, or great debility or death, at worst. You fear not just cancer but all the pain and losses that accompany it.

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During cancer treatment you may have been too sick or too busy to appreciate certain aspects of what was happening to you. For example, you may not have cared about your inability to drive, loss of fertility, or limp, because you were focused on your fight to stay alive. Now that you have survived your treatment, you recognize the implications of the losses that you sustained earlier. These losses can make you feel angry.

You may feel angry that you “lost” time that you were hoping to use building or capping your career, raising your family, or relishing retirement. You may be angry that you were traumatized physically or emotionally by your cancer or its treatment. You may be angry that the stress of cancer has strained or crushed relationships that might have survived if not for the cancer.

In addition to old losses that you are experiencing only now, you may be experiencing new losses and problems, many of which seem unfair, such as canceled insurance, lost job opportunities, new complications from your past cancer or cancer treatment, or the need for ongoing treatments for residual non-cancer medical conditions. Your cancer is gone, but now you may have a seizure disorder, heart or kidney problems, chronic cough or shortness of breath, or debilitating fatigue. More doctor visits, more tests, more expense, more uncertainty. More patienthood. You may be thinking, “Haven’t I suffered enough?”

How angry each loss makes you feel is affected as much by how you see it as by what it actually is. Life is about ongoing challenges and losses, temporary or permanent, expected or unexpected, insignificant or life altering. The changes accompanying cancer are consistent with the overall rhythm of life.

As you anticipate leading a normal life again, you may be facing extra work and extra hurdles just to return to where you were before you were sick. You may expect your colleagues at school or work to be alive to your needs and provide the necessary leeway to help you ease back. Unfortunately, you may be expected to perform at least up to full force, in order to prove that you are ready to work. You may feel angry for being, in essence, punished for going through the trauma of cancer.

Lastly, you may feel disproportionate anger toward people and circumstances when things do not go well at work or at home. Since your cancer was not a person, any anger you may feel toward your cancer may end up getting directed at someone or something that also makes you angry. For example, you may feel explosive anger toward someone who turned you down for a job. It may be not that the job was so important but that you can express anger to a person but not to cancer. Besides, the person could have chosen to hire you, so you may feel anger that, with a choice available, things did not turn out well. Your cancer left no choice. Another example is anger at a loss, such as the loss of fertility. You may have had no intention or desire to have any more children, but the fact that the decision was made for you angers you.

Not only does anger come from many sources; it is often mixed with grief, anxiety, and fear. To further stir the pot, you may feel that anger makes no sense if your priorities have changed. Things that you consider relatively unimportant in the grand scheme of life should not make you angry, and yet they do. You really believe that a job rejection or someone’s inappropriate comment is relatively unimportant, and yet it triggers anger. It is natural that these things affect you. Even when you have settled in to your new priorities, and when job rejections or inappropriate comments bother you less, you may still have a reaction because the issues remain important in the short run.

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Newspapers and Television Make It Seem That Everything Causes Cancer. Is This True?

It is nerve wracking continually to hear about new things that may be related to cancer. Reports giving conflicting information and advice make it hard to know what to believe. Many cancers are felt to be caused, at least in part, by environmental exposures. From a practical point of view, pay more attention only to those exposures about which you can do something.

Can I Travel?

Your readiness to travel depends on

• your destination

• the length of your stay

• the mode of transportation

• your current condition

• the availability of medical care at your destination

• the timing of your follow-up tests and visits

• the need for pre-travel vaccinations

People have traveled around the country even during intensive cancer treatments by advance planning with their oncologists. Arranging follow-up evaluations and treatments to be administered by willing oncologists at your destination allows you to travel without interruption in your cancer treatment or follow-up. Similarly, you can arrange for a local doctor to be available to you during your trip.

What Can I Do to Maximize My Safety and Comfort during Travel?

Plan ahead. Bring

• a written list of your medications

• a written summary of your condition (diagnoses, treatments received)

• your medications, with extra doses in case your return gets delayed

• written prescriptions, in case your medication gets lost or damaged

• over-the-counter medications that work for you

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