Why the emotional toll of cancer often starts after treatment
It can seem counterintuitive with appointments and treatment slowing to suddenly feel confusion, anxiety, or a heightened emotional response. This transition is the first time there’s mental and emotional space to think about what happened for many cancer patients.
Five common emotional challenges for cancer survivors
Why do I feel more anxious now that cancer is treatment is over?
Data from the World Health Surveys estimates more than a third of individuals treated for cancer in a hospital experience a common mental health condition. Many cancer survivors find they don’t have the resources (time, financial, or otherwise) to immediately address their mental health concerns and complete cancer treatment.
Usually following a diagnosis of cancer, there’s a swarm of providers and an oncology support team around you focused on medical interventions. It can be difficult or overwhelming to add therapy or mental health into the demands of your schedule. A nap or crash out can rightfully sound more supportive than discussing feelings with a stranger. Depending on your treatment center, it can also be difficult to access social work or counseling providers. So for these and a myriad of other reasons, addressing mental health can be take a lower priority. You and your team shift into triage mode, and accomplishing what’s absolutely necessary.
With a little more headspace as treatment appointments lessen, there can be a sense of isolation as you settle into the next phase of life with less interaction from care providers and social supports. These pauses or vacuums of space can bring emotions and thoughts to the forefront. As a mental health provider, we often reassure clients feelings and symptoms sometimes become greater (or inflamed) when there’s less mental stimulation, and not because they’re doing anything wrong. Low motivation, feeling foggy, connecting with anger, tears, and racing thoughts are all common experiences when humans experience distress. Some of these symptoms can overlap with treatment side effects, making it difficult to identify mental health support is needed.
After a round of cancer treatment concludes, this is often the time where the realities of the “new normal” present themselves. Often there’s a return to work or places you frequented prior to your cancer diagnosis and needed to step away from. There can be contrast in appearance or abilities following treatment, which can bring previously unrecognized grief. It can also be unsettling to notice cognitive shifts due to chemo brain. You can truly be grateful to be alive, and feel a range of other feelings. This can be confusing and sometimes difficult to communicate to others.
How do I deal with cancer recurrence without letting it ruin my life?
There’s no one size fits all approach to managing fear of recurrence. Scanxiety can interfere with functioning before, during, and after receiving scans to determine if treatment is progressing or if there is a recurrence. You know more than others how quickly life can change. There are coping skills which can be developed to help lessen symptoms like difficulty sleeping, trouble focusing, feeling more irritable, and changes in appetite.
There’s great value in looking to mentors or other peer supports in developing coping habits and acknowledging the great discomfort. Some find mindfulness techniques helpful in shifting focus to from the past or future (where anxiety flourishes) to the present. Some develop boundaries regarding who is informed of upcoming appointments or sharing updates. The fear of recurrence is an unfortunate reality, but there are ways to modify its intensity and impact on everyday life.
Some cancer survivors also report hypervigilance or an increased sense of responsibility. This is often experienced by feeling a heightened attention to diet and exercise. Creating healthy habits is important. It makes sense to want to control variables within our control. But this can bring anxiety when we take on an excess of responsibility, and distract us from living the life we want to live.
Who am I now that I’m not a cancer patient?
Your professional, family, or other identities (gender, sexuality, cultural, activity related, etc.) likely took a back seat comparatively to your identity as someone impacted by cancer while you were navigating treatment. With time you will get back in contact with these other aspects of your identity, and what makes you unique.
It can often feel like an abrupt shift “back into the real world.” There’s a return to roles and places, but your experience may be vastly different from your peers. You may not have the energy or interest in things which once occupied your time. Which can be guilt inducing if you feel you owe something to a workplace or community which provided previously helpful support.
Widening your community to contain others impacted by cancer can also be valuable. We often see this with those in the adolescent and young adult (AYA) community where there experience with social milestones and events can feel worlds apart from their peers. Their conversations regarding financial planning, fertility, health, and independence can vary greatly. This can be isolating if there aren’t other cancer survivors or resources to connect with. You aren’t just your cancer diagnosis, but it would be unhelpful to not consider that part of your identity.
After experiencing cancer, it’s common to evaluate meaning, relationships, friendships, and careers. This can be overwhelming and doesn’t have to be done all at once or by yourself or all at once.
How does therapy support long term cancer survivorship?
Despite there being common themes and concerns cancer survivors face, like identity shifts and a need to process medical trauma, everyone’s experience is different. This uniqueness is one of the reasons therapy can be helpful in creating personalized relief and supports. Therapists (or counselors) who have experience with communities impacted by cancer can be especially helpful as they have greater understanding of the specifics of oncology.
Working with a therapist is different from seeking support from friends or family in many reasons, including their commitment to objectivity, confidentiality, and mental health education. There can be a relief in voicing fears, complicated emotions, or frustrations to someone supportive, when you don’t have to comfort or tend to the other individual.
You might find it helpful to have therapy support in cancer survivorship regarding the following areas:
Processing medical trauma
Making sense or meaning from events or experiences
Clarifying values and purpose
Support in developing boundaries with “well-meaning” individuals
Experiencing grief, survivor’s guilt, or shame
Navigating symptoms of depression, anxiety, or PTSD
Developing additional coping skills for recurrence anxiety
It can also be helpful to have support with a therapist for all the underlying habits, identities, and relationships which were a part of your life before a cancer diagnosis, and can come up again. Another “therapy truth” can be that stress tends to heighten existing concerns.
What local support is available for Seattle survivors?
Additional emotional and wellness supports in Seattle (and often greater Washington) include:
These organizations tend to provide a variety of individual counseling sessions (often time limited), group processing or skills sharing, nutrition, and sometimes physical fitness assistance. You can also ask your provider or primary hospital system if they have resources locally or nationally to share.
Therapists like myself, will list some variation of cancer survivor therapist in their profile, and there is option to sort for “cancer” in your search criteria on provider directories like Psychology Today. There are options for in person sessions or telehealth options for those who would would find traveling for appointments a burden.
Conclusion
Cancer survivorship is difficult, and it’s not meant to be navigated alone. I wish you all the support you need and much joy to come.
If you’re seeking post-cancer emotional support in Washington, contact me at Kelly@KellyHemphillCounseling.com for a consultation to see how we can work together.