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When Cancer Comes Back

Wendy Baer shares advice for patients facing cancer again.

By Wendy Baer

Story Photo

Illustration by Brian Stauffer

Recently, a patient—I'll call him John—who had just completed chemotherapy for lymphoma came in for his mental health appointment with three questions written down on a piece of paper.

1. How do I go on living knowing that my cancer could come back at any time?
2. Should I change my job?
3. How do I control my worry about the next set of labs and CT scans?

John's questions are common for a cancer survivor; asking them out loud and getting mental health care to address his anxiety showed courage. While there is not one right answer to each question, the questions provide a framework in how to think going forward with life after cancer treatment, and how to cope if cancer comes back.

At the end of treatment, everyone hopes that cancer is gone, forever. However, recurrence is a reality for many people and few things are as discouraging as having cancer come back. Just when you thought you could focus on work, friends, travel, now you are back getting scans, blood draws, and meeting with doctors. I advise people at that vulnerable time to go forward with the goal of living well and making the most of today. That may sound simple, but if cancer teaches us anything, it’s the importance of not taking time for granted.

The first thing I remind people with recurrent cancer is that they have managed cancer before, so they can manage it again. Even if it doesn't feel like it at the moment, they have coping skills. Just as they did the first time, they can sit down with a trusted family member and their medical team to make a plan for managing the cancer. Once there is a plan in place, most people feel much less anxious. John had thought about changing his job because cancer made him realize "life does not last forever and things might change at any time." He dedicated time to think about what he really wanted out of his life and realized that a more service-oriented job would be a better fit for him. Given his insurance benefits and financial situation, he decided to stay in his current occupation for the present, but he signed up for evening teaching classes at a community college. His plan is to do some volunteer tutoring at a local middle school, then decide if he will make a career change to teaching.

John actively decided not to let cancer stop him from a fulfilling career; rather, he used cancer as his springboard to think about and plan for meaningful work.

Should a cancer experience stop anyone from searching out their dream job? Absolutely not. The whole reason to fight cancer is to go on living as well as possible. The reality of cancer recurrence can be anxiety about follow-up scans and tests, poor sleep, irritability, and trouble concentrating. Stress management skills are critical during this time. I suggest patients do what they can right now to make themselves feel as well as possible. It may be as simple as taking time to get outside, buy fresh flowers, see a funny movie, listen to an old album, or have lunch with a friend.

John decided the best way to tolerate his return to the cancer center was to make plans for a fancy fish dinner the night before the appointment, "I'd much rather think about the ocean and seafood than
lymphoma."

I often urge people to not beat themselves up for what are very normal emotions and reactions. Worst case scenarios inevitably go through our minds because that's how our minds are wired. So, let those thoughts come, notice them, take three long, slow deep breaths, and then let them go again. Next step? Make a plan....

Cancer should not invade every moment of the day. The goal is to contain cancer, not just physically, but mentally. Choose a time of day (mornings are best to protect sleep) to do all the calling, scheduling, worrying, and planning. After that, cancer thoughts and worries that come up during the day get stashed in a mental box and dealt with the next morning. Then, pay attention to small pleasures that have nothing to do with cancer. Knowing what matters to you and making the most of each day will mean that you are living as well as possible.

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