Stress

Stress is a normal reaction to cancer. After all, you're dealing with a lot: treatment, family, your job, money, and day-to-day living. Sometimes, you may not even notice that you are stressed. But your family and friends probably see a change.

Anything that makes you feel calm or relaxed may help. So try to think of things that relax you and that you enjoy doing. Some people try deep breathing, listening to tapes that have nature sounds, or listening to music. See below for more ideas on how to relieve stress.

Hope

While you may be sad or depressed about your cancer recurrence, you do have reasons to feel hopeful. Science has advanced and cancer treatments have improved. So more people are surviving cancer than ever before. Nearly 10 million people who have a history of cancer are alive today.

In other words, cancer is becoming a disease that doctors can manage. To help build your sense of hope:

• Plan your days as you have always done.
• Don't limit the things you like to do just because you have cancer.
• Look for your own reasons to have hope.

Gratitude

Some people see their cancer coming back as a "wake-up call." They may realize the importance of enjoying the little things in life. They go places they've never been. They finish projects they had started but put aside. They spend more time with friends and family. They mend broken relationships.

It may be hard at first, but you can find joy in your life. Take note of what makes you smile. Pay attention to the things you do each day that you enjoy. They can be as simple as drinking your morning coffee, sitting with a pet, or talking to a friend. These small, day-to-day activities can give you comfort and pleasure.

You can also do things that are more meaningful to you. Everyone has special things, both large and small, that bring meaning to their life. For you, it may be visiting a garden in your city or town. It may be praying in a certain chapel. Or it could be playing golf or some other sport that you love. Whatever you choose, embrace the things that bring you joy when you can.

Anxiety

Cancer takes a toll on both your body and your mind. You are coping with so much now. You may feel overwhelmed. Pain and medicines for pain can also make you feel anxious or depressed. And you may be more likely to feel this way if you have had these feelings before.

Here are some signs of anxiety:

• Feeling very tense and nervous
• Racing heartbeat
• Sweating a lot
• Trouble breathing or catching your breath
• Having a lump in your throat or a knot in your stomach
• Feeling fear.

Feeling anxious can be normal. But if it begins to disrupt your daily life, tell a member of your health care team. They can suggest someone for you to talk to. Or they can give you medicines that will help. Some of the nondrug choices for pain may work for your anxiety as well (see above).

Fear

It's normal to feel scared and worried. You may be afraid of pain or other side effects, either from the cancer or the treatment. You may worry about looking different as a result of your treatment. You may worry about taking care of your family, paying your bills, and keeping your job. You may be afraid of dying.

It's hard to deal with the fear of so many unknowns. Some people say it helps if you know what to expect in the future. Ask your health care team questions, so you can understand more about your cancer and treatment choices. Also, update your will and other legal papers, if you haven't already done so. Then you won't have to worry about them.

Fear can be overwhelming. Remember that others have felt this way, too. It's okay to ask for help.

Sadness and Depression

Sadness is a normal response to any serious illness. You may feel sad that you have to go through treatment again. You may feel sad that life won't be quite the same from now on.

It's okay to feel blue. You don't need to be upbeat all the time or pretend to be cheerful. Many people say that they want the freedom to just give in to their feelings sometimes. But others say that it helps to look for what is good in life, even in the bad times.

Depression can happen when sadness or despair seems to take over your life. Some of the signs listed on the next page are normal at a time like this. But if they last more than 2 weeks, talk to your doctor. Some symptoms could be due to physical problems. This is why it's important to let your doctor know about them.

Anger

You may also feel angry or frustrated. It's normal to ask, "Why me?" You may be mad at the cancer, your doctors, or your loved ones. If you are religious, you might even be angry with God. If you feel angry, it's helpful to remember that you don't have to pretend that everything is okay.

Try to figure out why you are angry. Anger sometimes comes from feelings that are hard to show. These might be fear, panic, frustration, worry, or helplessness.

It's not always easy to look at what is causing your anger. But it's healthy to try. Being open and dealing with your anger may help you let go of it. It's also good to know that anger is a form of energy. You can express this energy through exercise, art, or even just hitting the bed with a pillow.

Guilt

It's normal for some people to wonder whether they did things that caused their cancer to recur. People feel guilty for a number of reasons:

• They worry about how their family and friends feel.
• They envy other people's good health and are ashamed of this feeling.
• They blame themselves for certain lifestyle choices.
• They feel guilty that their first treatment didn't work.
• They wonder if they waited too long to go back to the doctor. Or they fear that they didn't follow the doctor's instructions the right way.

But it's important to remember that the treatment failed you. You didn't fail the treatment. We can't know why cancer returns in some people and not others. So, it's important for you to try to:

• Focus on things worthy of your time and energy.
• Let go of any mistakes you think you may have made.
• Forgive yourself.

You may want to share these feelings with your loved ones. Some people blame themselves for upsetting the people they love or worry that they'll be a burden to others. If you feel this way, take comfort knowing that many family members say that it is an honor and a privilege to care for their loved one. Many consider it a time when they can share experiences and become closer to one another. Others say that caring for someone else makes them take life more seriously and causes them to reevaluate their priorities.

If you don't feel that you can talk openly about these things with your loved ones, getting counseling or joining a support group may also help. Let your health care team know if you would like to talk with someone about your feelings.

Loneliness

You may feel lonely, even when lots of people support and care for you. Here are some common feelings:

• You feel like no one else understands what you're going through, even those you love and care about.
• You feel distant from others. Or you find that your family and friends have a hard time dealing with your cancer.
• You realize that you aren't able to take part in as many events and activities as you used to.

Although it may be harder some days than others, remember that you aren't alone. Continue to do the things you've always done as best you can. If you want to, tell people that you don't want to be alone and that you welcome their visits. More than likely, your loved ones have feelings like yours. They may feel isolated from you and lonely if they are unable to talk with you.

Denial

You may feel that this is not happening to you. It's tough to accept that the cancer has come back. Feeling that you need more time to absorb everything is natural. You may need more time to adjust to the news. But this can become a serious problem if it lasts longer than it should. It can keep you from getting the treatment you need or talking about your treatment choices. As time passes, try to keep an open mind. Listen to what others around you suggest for your care.

Ways You Can Cope

Your feelings will come and go, just like they always have. If you have some strategies to deal with them, you have already taken a step in the right direction.

Know that many other people have been where you are. Some do better when they join a support group. It helps them to talk with others who are facing the same challenges. You may prefer to join an online support group. That way you can chat with people from home. Be sure to check the privacy issues before you join.

If support groups don't appeal to you, there are many experts who are trained to give cancer support. These include oncology social workers, psychologists or health psychologists, counselors, or members of your faith or spiritual community. For more information, see the Resources section.

Ways You Can Cope

You may be able to continue many of your regular activities, even though some may be more difficult than before. Whatever you do, remember to conserve your strength for the things you really want to do. Don't plan too many things for one day. Also try to stagger them during the day.

Here are some things other people with cancer say have helped them cope. As you can see, even the little things help!

Back to Top Setting Goals

Cancer treatment can take up a lot of your time and energy. It helps to plan something that takes your mind off the disease each day. Aim for small goals each day, such as:

• Exercising
• Completing tasks you've been wanting to do
• Making phone calls
• Having lunch with a friend
• Reading one chapter of a book or doing a puzzle
• Listening to music or a relaxation tape.

Many people with cancer also set longer-term goals. They say that they do much better if they set goals or look forward to something special. It could be an anniversary, the birth of a child or grandchild, a wedding, a graduation, or a vacation. But if you set a long-term goal, make sure you are realistic about how you will achieve it.

Remember, too, that being flexible is important. You may have to change your plans if your energy level drops. You may have to adjust your goals if the cancer causes new challenges. Whatever your goals, try to spend your time in a way that you enjoy.

Back to Top Family and Friends

Your loved ones may need time to adjust to the news that your cancer has returned. They need to come to terms with their own feelings. These may include confusion, shock, helplessness, anger, and other feelings.

Let family members and friends know that they can offer comfort just by:

• Being themselves
• Listening and not trying to solve problems
• Being at ease with you.

Being able to comfort you can help them cope with their feelings.

Bear in mind that not everyone can handle the return of cancer. Sometimes a friend or family member can't face the idea that you might not get better. Some people may not know what to say or do for you. As a result, relationships may change, but not because of you. They may change because others can't cope with their own feelings and pain. If you can, remind your loved ones that you are still the same person you always were. Let them know if it's all right to ask questions or tell you how they feel. Sometimes just reminding them to be there for you is enough.

It's also okay if you don't feel comfortable talking about your cancer. Some topics are hard to talk about with people you are close to. In this case, you may want to talk with a member of your health care team or a trained counselor. You might want to attend a support group where people meet to share common concerns.

Family Meetings

Some families have trouble expressing their needs to each other. Other families simply do not get along. If you don't feel comfortable talking with family members, ask a member of your health care team to help. You could also ask a social worker or other professional to hold a family meeting. This may help family members feel that they can safely express their feelings. It can also be a time for you and your family to meet with your entire health care team to solve problems and set goals. Although it can be very hard to talk about these things, studies show that cancer care is a smoother process when everyone remains open and talks about the issues.

People Close to You

Often, talking with someone close to you is harder than talking with anyone else. Here's some advice on talking with loved ones during tough times.

Spouses and Partners

• Try as much as you can to keep your relationship as it was before you got sick.
• Talk things over. This may be hard for you or your spouse or partner. If so, ask a counselor or social worker to talk with both of you together.
• Be realistic about demands. Your spouse or partner may feel guilty about your illness. They may feel guilty about any time spent away from you. They also may be under stress due to changing family roles.
• Spend some time apart. Your spouse or partner needs time to address their own needs. If these needs are neglected, your loved one may have less energy and support to give. Remember, you didn't spend 24 hours a day together before you got sick.
• Body changes and emotional concerns may affect your sex life. Talking openly and honestly is key. But if you can't talk about these issues, you might want to talk with a professional. Don't be afraid to seek help or advice if you need it.

Children

Keeping your children's trust is very important at this time. Children can sense when things are wrong. So it's best to be as open as you can about your cancer. They may worry that they did something to cause the cancer. They may be afraid that no one will take care of them. They may also feel that you are not spending as much time with them as you used to. Although you can't protect them from what they might feel, you can prepare them for these feelings.

Some children become clingy. Others get into trouble at school or at home. It helps to keep the lines of communication open. Try to:

• Be honest. Tell them you are sick and that the doctors are working to make you better.
• Let them know that nothing they did or said caused the cancer. And make sure that they know that they can't catch it from you.
• Reassure them that you love them.
• Encourage them to talk about their feelings.
• Tell them it's okay to be upset, angry, or scared.
• Be clear and simple when you talk, since children can focus only briefly. Use words they can understand.
• Let them know they will be taken care of and loved.
• Let them know that it's okay to ask questions. Tell them that you will answer them as honestly as you can. In fact, children who aren't told the truth about an illness can become even more scared. They often depend on their imagination and fears to explain the changes around them.

Teenagers

Teenagers have some of the same needs as those of younger children. They need to hear the truth about an illness. This helps keep them from feeling needless guilt and stress. But be aware that they may try to avoid the subject. They may become angry, act out, or get into trouble as a way of coping. Others simply withdraw. Try to:

• Give them the space they need. This is especially important if you are relying on them more to help with family needs.
• Give them time to deal with their feelings, alone or with friends.
• Let them know that they should still go to school and take part in sports and other fun activities.

If you have trouble explaining your cancer, you might want to ask for help. A close friend, relative, healthcare worker, or trusted coach or teacher could help answer your teenager's questions. Your support group, social worker, or doctor can also help you find a counselor or psychologist.

Adult Children

Your relationship with your adult children may change now that you have cancer again. You may have to rely on them more. And it may be hard for you to ask for support. After all, you may be used to giving support rather than getting it.

Adult children have their concerns, too. They may start to think about their own mortality. They may feel guilt, because of the many demands on them as parents, children, and employees. Some may live far away or have other duties. They may feel bad that they can't spend as much time with you as they would like. Often it helps to:

• Share decision-making with your children.
• Involve them in issues that are important to you. These may include treatment choices, plans for the future, or activities that you want to continue.
• If they aren't able to be there with you, keep them updated on your progress.
• Make the most of the time you have. Share your feelings with them.

Try to reach out to your adult children. Openly sharing your feelings, goals, and wishes will help them adjust. It will also help prevent problems in the future. Remember, just as parents want the best for their children, children want the best for their parents. They want to see your needs met effectively and with compassion. Your children don't want to see you suffer.

Back to Top Looking for Meaning

At different times in life, it's natural for people to look for meaning in their lives. And many people with recurrent cancer find this search for meaning important. They want to understand their purpose in life. They often reflect on what they have gone through. Some look for a sense of peace or a bond with others. Some seek to forgive themselves or others for past actions. Some look for answers and strength through religion or spirituality.

Being spiritual means different things to different people. It's a very personal issue. Everyone has their own beliefs about the meaning of life. Some people find it through religion or faith. Some find it by teaching or through volunteer work. Others find it in other ways. Having cancer may cause you to think about what you believe - about God, an afterlife, or the connections between living things. This can bring a sense of peace, a lot of questions, or both.

You may have already given a lot of thought to these issues. Still, you might find comfort by exploring more deeply what is meaningful to you. You could do this with someone close to you, a member of your faith or spiritual community, a counselor, or a trusted friend. Or you may find that talking to others at gatherings and services at places of worship is helpful.

Or you may just want to take time for yourself. You may want to reflect on your experiences and relationships. Writing in a journal or reading also helps some people find comfort and meaning. Others find that prayer or meditation helps them.

Many people also find that cancer changes their values. The things you own and your daily duties may seem less important. You may decide to spend more time with loved ones or helping others. You may want to do more things outdoors or learn something new.

Back to Top A Time To Reflect

This is a hard time in your life. Living with cancer is tough, especially when it has come back. You battled the disease once, and now you must face it again. But you're more experienced this time around.

Use this knowledge to your advantage. Try to remember what you did before to cope. Reflect on what you might have done differently. By looking back in this way, the hope is that you may find new strength. And that this strength can help carry you through each day, and through the coming weeks and months.

Back to Top Resources

Federal Resources

Administration on Aging
Provides information, assistance, individual counseling, organization of support groups, caregiver training, respite care, and supplemental services.

Phone:	1-202-619-0724
Visit:	www.aoa.gov

Centers for Medicare and Medicaid Services
Provides information for consumers about patient rights, prescription drugs, and health insurance issues, including Medicare and Medicaid.

Toll-free:	1-800-MEDICARE (1-800-633-4227)
Visit:	www.medicare.gov (for Medicare information) or www.cms.hhs.gov (other information)

Equal Employment Opportunity Commission
Provides fact sheets about job discrimination, protections under the Americans With Disabilities Act, and employer responsibilities. Coordinates investigations of employment discrimination.

Toll-free:	1-800-669-4000
TTY:	1-800-669-6820
Visit:	www.eeoc.gov

U.S. Department of Labor
Office of Disability Employment Policy
Provides fact sheets on a variety of disability issues, including discrimination, workplace accommodation, and legal rights.

Toll-free:	1-866-ODEP-DOL (633-7365)
TTY:	1-877-889-5627
Visit:	www.dol.gov/odep/

Private/NonProfit Organizations

American Cancer Society
National Cancer Information Center
Available to answer questions 24 hours a day, 7 days a week.

Toll-free:	1-800-ACS-2345 (1-800-227-2345)
Visit:	www.cancer.org

CancerCare
Offers free support, information, financial assistance, and practical help to people with cancer and their loved ones.

Toll-free:	1-800-813-HOPE (1-800-813-4673)
Visit:	www.cancercare.org

Kids Konnected
Offers education and support for children who have a parent with cancer or who have lost a parent to cancer.

Toll-free:	1-800-899-2866
Visit:	www.kidskonnected.org

National Coalition for Cancer Survivorship
Provides information on cancer support, employment, financial and legal issues, advocacy, and related issues.

Phone:	1-877-NCCS YES (1-877-622-7937)
Visit:	www.canceradvocacy.org

National Employment Lawyers Association
Can help find a lawyer experienced in job discrimination cases.

Phone:	1-415-296-7629
Visit:	www.nela.org

NeedyMeds - Indigent Patient Programs
Lists medicine assistance programs available from drug companies. NOTE: Usually patients cannot apply directly to these programs. Ask your doctor, nurse, or social worker to contact them.

Visit:

www.needymeds.com

Patient Advocate Foundation
Offers education, legal counseling, and referrals concerning managed care, insurance, financial issues, job discrimination, and debt crisis matters.

Toll-free:	1-800-532-5274
Visit:	www.patientadvocate.org

The Wellness Community Provides free psychological and emotional support to cancer patients and their families.

Toll-free:	1-888-793-WELL (1-888-793-9355)
Visit:	www.wellness-community.org

* For a complete list of resources, see the fact sheet, "National Organizations That Offer Services to People With Cancer and Their Families" at www.cancer.gov, search terms "national organizations." Or call 1-800-4-CANCER (1-800-422-6237) to ask for it.

Back to Top For more information

The following free booklets may be helpful if your loved one is receiving cancer treatment:

• Chemotherapy and You: A Guide to Self-Help During Cancer Treatments
• Coping with Advanced Cancer
• Eating Hints for Cancer Patients
• If You Have Cancer: What You Should Know About Clinical Trials
• Pain Control: A Guide for People With Cancer and Their Families
• Radiation Therapy and You: A Guide to Self-Help During Cancer Treatments
• Taking Time: Support for People With Cancer
• Thinking About Complementary and Alternative Medicine: A Guide for People With Cancer
• When Cancer Returns

These booklets are available from the National Cancer Institute (NCI.) To learn more about the specific type of cancer you have or to request any of these booklets, visit NCI's Web site (www.cancer.gov). You can also call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) to speak with an information specialist.

Back to Top