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Life After Cancer A Roadmap for Cancer Survivors

Coming to Grips - Life After Cancer
David Spiegel, MD, Patricia Fobair LCSW, MPH, and Ernest H. Rosenbaum, MD

The Will to Live
Strategies for the Transition to a Healthier Survivorship
Asking the Hard Questions
Renegotiating Relationships with Family and Friends

The Will to Live
David Spiegel, MD
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The diagnosis of cancer carries with it an inevitable sense of threat to life, although at least half of all cancer patients will not have their lives shortened by the disease. However, for all cancer patients, the illness is a challenge to our plans and expectations, to our emotional, physical, and financial resources. One can face the disease better by taking stock of sources of support, meaning in life, and your resolve to carry on through treatments that can be difficult. Resolving to pursue treatment vigorously and live as well as possible is an important part of treatment. Learn to hope for the best but prepare for the worst, and this means coming to a deeper appreciation of one's will to live. The will to live varies depending on the time of day, week or month and what is currently going on in one's life. It is a kind of summation of what you have to live for, as well as your future goals and your desire for survival. Depression, physical debility, financial and psychological stresses can undermine your will to live. If you are being treated for an illness, the response and recovery are also vital components of the will to live.

To maintain a fighting spirit, one must maintain optimism and hope. How you deal with reversals and disappointments at times when treatment response is not what you and your doctor had hoped can make a major difference in your will to live.

Acceptance of things beyond our control is often difficult to achieve, and to live with. Although you cannot predict in advance your outcome and fate, both physically and emotionally, you can have an impact on your future life recovery and survival by keeping a fighting spirit - your will to live.

Strategies for the Transition to a Healthier Survivorship
David Spiegel, MD, Patricia Fobair LCSW, MPH, and Ernest H. Rosenbaum, MD
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Clearly, a physical cure does not mark the end of the healing process. Only by examining the impact that a cancer illness has on a person's life can strategies be devised to ease the difficult transition from a state of illness to one of well-being.

Survivors often liken their cancer experience and their efforts to resume a normal life to that of returning war veterans. Their sense of balance has been lost. The immediate crisis of fighting for your life itself is over and now comes the time to assess the damage. The post treatment period brings with it a myriad of emotions similar to post-traumatic stress.

It is not unusual to feel a strange mixture of elation and anxiety. The disease has been eradicated, but there is still a second war to be fought, a struggle which is less tangible but still threatening with physical, psychological and social ramifications.

Asking the Hard Questions
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Contemporary society values those who can assimilate quickly and who can bounce back from tragedy without skipping a beat. The message survivors receive from all sides is, You're so lucky to be alive. Now get on with your life.

That's great in theory, but the reality is that once cancer has touched your life, nothing will ever be the same. Relationships are tested, employment issues surface, and priorities are reevaluated. Perhaps the most important factor is that a survivor has faced his or her mortality and emerged transformed, keenly aware of how fragile life is.

Only when survivors and those close to them have acknowledged all that has happened can they move forward. Only then can they derive meaning from their experience. This is the challenge facing all survivors.

The obstacles you may encounter when you finish treatment are totally unexpected but usually can be overcome. Denying that you have changed or that you feel differently about every aspect of your life will only delay the recovery process. It's important to stay in touch with your feelings and to ask yourself some hard questions.

You probably won't be able to answer these questions right away, but asking them is a good place to start your new life as a survivor.

Who am I now that I've had cancer?
Will I get it again?
Can I survive another bout with cancer?
What is the best way to spend my time?
Does my career really make me happy?
Do my relationships still work?
Am I contributing to society?
Will I ever feel secure in my future?
Do my friends and family understand and support me in what I am going through?

Coming to grips with the answers to these questions will help give you the needed perspective on your steps toward well-being.

Renegotiating Relationships with Family and Friends
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Once I was given a clean bill of health, the doctor told me, "You're out of the jungle but you're in the woods." I went home and I was cured and nobody wanted to hear about cancer anymore. I wasn't supposed to say the word or even think about it. I pretended along with everyone else that I never had cancer and that way everything was okay.- Derek, 29-yearold Hodgkin's disease survivor.

It is common for family members and friends to react with uncertainty to your new status as a survivor. They may have pulled away from you as a self-protective mechanism during your diagnosis and treatment. Those close to you probably prepared themselves emotionally for the possibility of your death. This process of distancing - therapists call it anticipatory grief is understandable. But once you recover, loved ones realize an incorrect assumption has been made, so expectations have to be adjusted. This reaction is called the Lazarus syndrome, named for the biblical figure who rose from the dead.

Once you are past the acute stage of the illness, family members and friends may feel it is safe to allow their suppressed emotions to surface. Guilt, resentment, anger, denial, and fear are often by-products of the crisis brought about by cancer. As a survivor, you have to encourage honest and open expression so that bonds can be re-established.

Keep in mind that how a family has dealt with a crisis in the past is a good indicator of how that family will deal with a cancer illness. Also bear in mind that cancer is a family event; that cancer changes all relationships and that change can be positive and often permanent.

The following suggestions will help you mend any ties that might have been damaged:

For the Family

Share your feelings with family members, by talking, recording an audiotape or DVD, or in writing
Reach out to other survivors through support groups
Go for individual, couples, or family counseling
Give yourself and those close to you time to sort through feelings
Express feelings about your illness in an atmosphere of acceptance; you don't have to approve or agree - just listen.
Discuss hopes - what you want - more than resentments

With Friends
Let go of negative emotions
Embrace friends who support your recovery
Take the initiative with those who have been uncomfortable with your illness Mention your illness as a means of giving them permission to talk about it with you
Allow friends to re-enter your life
Sever friendships that don't work anymore
Mourn your losses

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