The moment a practitioner gives information to a third person without your permission he or she is no longer treating you as a responsible adult person. This is wrong. If you allow a practitioner to do this, you are putting yourself into a helpless, dependent position and giving up responsibility for yourself. It might seem the easiest way out but, believe me, it’s not in the long run. ,”,ù

You may know that your practitioner has already had discussions with friends or relatives in your absence. They are probably doing this in a well-meaning but misguided attempt to ‘protect’ you. Unfortunately the reality remains regardless of whether or not you know about it. Hiding the truth from you won’t make it go away—it will just make the whole situation harder for you to grapple with.

fe$ guarantee that if you are in this situation your imagination is running wild: ‘It must be really terrible if they can’t tell me.’ I say again—your imagination will usually come up with something much worse than the truth. If you insist on being told, you are likely to get a new lease of life. You will be able to direct your energies positively into battling with a real, rather than an imaginary, situation. You will be able to share your fears and concerns freely with your loved ones. Your friends or relatives who have been given the information will feel great relief when the heavy burden is lifted from their shoulders. They also will then be able to direct their energy much more positively.

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Do I Need to Participate in a Support Group?

Having completed treatment, you may think, “Why would I need a support group now?” After a diagnosis of cancer, the initial challenge is to get through treatment. The longer-term challenge is to find a place for your cancer history in your life so that it enhances, not detracts from, the rest of your life.

If you are having any concerns, anxieties, worries, fears, or depression after you complete your treatments, a support group might be an excellent place for working through these normal negative feelings as efficiently and painlessly as possible.

If you feel very healthy, physically and emotionally, and sense that your life is getting back to normal easily, you probably do not need a support group. It might be nice to go to give advice to others who are having a more difficult time than you.

If you are feeling lonely, one of the best remedies is a good support group. In general, people who attend a support group are motivated to find healthy ways to cope. You may find the advice of other survivors not only practical but also inspirational. Sharing with other cancer survivors helps dissipate loneliness and the sense of alienation that often accompanies surviving. Listening to other people who have faced and overcome some of the problems you are facing will help diminish any “Why me?” or “Nobody understands” feelings.

Won’t It Be Depressing or Scary to Be with Other Cancer Patients?

All support groups are different. Even the same support group is different at each meeting, depending on the individuals who attend that day and the topics discussed. The person in charge of the meeting, the facilitator, can make a major difference in the flow and tone of the meetings.

At many support groups, you cannot tell the patients from the friends and family members by how they look. There is often lots of laughter and joking, as well as exchange of practical information and genuine support. Try attending a support group for two or three sessions before you decide whether it will be helpful for you.

Do Support Groups Work?

Many well-documented scientific studies show a correlation between support group attendance and improved quality of life. A 1989 study of women with metastatic breast cancer showed a significant improvement in survival time in those who received weekly supportive group therapy. If the group is good, and you feel comfortable in it, you will doubtless enjoy improved quality of life and, possibly, length of life.

How Do I Find Out about the Local Support Groups?

To find out more about the support groups in your area, call

• the Cancer Information Service

• your local Cancer Council, Foundation or Society

• your hospital’s oncology department

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Is It Important to Treat Chronic Mild Pain?

It is vital that chronic pain be evaluated and treated. Most people can withstand severe pain for a short-while, especially if they know that it will end. The effect of chronic pain is different from that of acute (short-term) pain. Even mild pain depletes your physical and emotional reserves and can cause you to feel tired, irritable, and depressed. Sleep can be disturbed, which often intensifies your perception of pain. Pain extracts a psychological toll by reminding you of your cancer experience, keeping your fears and anxieties close to the surface, and making it more difficult for you to deal with everything.

Is Pain Ever Expected after Cancer Treatment?

Many conditions (such as a bone fracture) and treatments (such as surgery) are expected to cause pain. However, just because pain is an expected normal aftereffect it does not mean it should go untreated. Pain should be evaluated thoroughly, its cause determined, and the best treatment found. Medications can be prescribed when indicated. Nonpharmacological measures for pain control can be pursued.

If I Have Pain, Do I Have to Report It at My Checkups?

Absolutely. Pain is a subjective phenomenon. Your doctor will not know how much pain you have by your exam or test results. Your doctor can assess and treat your pain only if you tell him or her about it.

A retired teacher presented herself graciously at her checkups. Well groomed and always smiling, she focused on her progress. Her doctor, satisfied with her normal exam and test results, reassured her that she was indeed doing beautifully. She never gave her doctor a clue that she had nighttime pain that interfered with sleep and fed her unvoiced anxiety. It was only when the woman’s daughter called the doctor to discuss the problem that it was addressed.

Your doctors can help you with a problem only if you tell them about it.

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What Can I Do to Decrease Any Fear That My Environment Is Putting Me at Risk for Recurrence?

Get knowledge about the real risk to you from your diet, work exposures, and home environment. Then take any steps you can to reduce your risk. Our current level of knowledge holds more questions than answers about the risk of diet and environmental exposures. Yesterday’s advice is contradicted today, and today’s advice is contradicted tomorrow. Advice that may help your cancer risk may increase risks of other medical problems. At this time a practical approach is to

•follow advice that has been well substantiated and has withstood the test of time

• make changes that do not involve too many adverse effects (do not allow yourself to get malnourished by dietary changes that are too restrictive)

• make changes that bring you reassurance and comfort, not anxiety and strain

What Can I Do to Decrease My Fear of Recurrence If It Is Based on the Statistics about My Type of Cancer?

Statistics can cause you to feel increased fear of recurrence, even if they are favorable. That is because statistics present you with a specific time frame and a scientific-sounding percentage, such as 85 percent survival in five years.

Learn to interpret information to your advantage. If the statistics and your doctors indicate that your risk of recurrence is small, believe them and assume that you will do as well as expected. Remind yourself repeatedly that you can expect to do well and that recurrence is not likely. If your risk of recurrence is great, remind yourself repeatedly that statistics do not say anything about how you in particular will do. Find something special about you or your cancer situation that sets you apart from the statistical mass. Remind yourself repeatedly that you can be the one who does well.

If this sounds contradictory and calculating, it is because healthy survivorship is a frame of mind. Being a healthy survivor means learning to process the information around you in a way that is adaptive for your unique situation. What is reassuring and strengthening for one survivor, such as survival statistics, can be detrimental to another. Use what works for you.

Just as facts should lead to action that diminishes fear, use them to create an attitude that diminishes your fear. Train yourself to reassure yourself in a genuine way. If you have ready responses for your fears, you will gain more and more control over your fears. Reminding yourself that you know what to do (second opinions, researching options, mobilizing support) if you should develop a recurrence will eliminate the component of fear that is due to the sense of being totally overwhelmed and out of control. Remind yourself of individuals who flourished after being treated for recurrent cancer or a type of cancer with a poor prognosis.

You cannot change the statistics regarding your cancer, but you can change how you interpret them and their impact on your life. Use statistics to help you.

Is There Any Way to Eliminate the Fear of Recurrence?

Most people can never completely eliminate the fear of recurrence. However, you can diminish your fear and make it very manageable. You can tame your fear in such a way that it has very little impact on your day-to-day life. Accepting that there will be times of fear and anxiety, and that these times will pass, helps disempower the fear and minimize its impact.

Recognize your fear for what it is—fear. Reassure yourself that it is natural and acceptable to have fear, and then reassure yourself that you can do things to lessen and control it.

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What Is Grief?

The human reaction to loss is grief—a heavy feeling in the chest, mental distress, and a sense of emptiness and sadness. We all grieve our losses in order to process them and move forward in a healthy way. Denying your losses, or not allowing yourself to grieve adequately, deprives you of the comfort and relief that come from healthy grieving.

If I Am Experiencing Loss(es), How Should I Grieve?

First, figure out what it is you are grieving. Acknowledge the losses, and express your feelings about the losses. It is best to share your feelings of loss with someone who can understand you, validate your feelings, and comfort you.

People unfamiliar with issues of recovery may not be supportive. They are liable to say things like “Don’t worry about your missing breast; at least you’re alive” or “Don’t worry about your girlfriend leaving you; if she left, she wasn’t much of a girlfriend anyway.” Your losses are real losses, and must be grieved. Lesser losses than death still need to be grieved. Having faced a life-threatening illness did not make you immune to the pain of losses.

It is common for people who have finished cancer treatment to be reluctant to take any more medications. You may find yourself declining your doctor’s offered prescriptions for the control of symptoms: you would rather deal with symptoms than take any more medications. Or you may forget to take your medicines even though you never forgot during your cancer treatment. After you did so much to get well, it seems inconsistent for you to turn down an opportunity for symptom control, enhanced recovery, or improved chance for durable remission. There are a number of possible explanations for this reluctance to take medicines.

Taking medicine is a crucial part of cancer therapy. It is perhaps the first time you took so many or such potent medications. If you want to create distance from your patienthood, you may avoid, consciously or subconsciously, anything that reminds you of being a cancer patient. This reluctance to take medication can work to your disadvantage, delaying your healing, prolonging side effects, allowing preventable problems to occur or progress. Instead of seeing your medicines as signs of being sick, see them as tools for speeding your recovery from patienthood.

Reluctance to take medication is often one aspect of the bigger issue of control. During cancer treatment you had little or no control over the type, timing, dosing, or administration of your medications, let alone whether you could skip a dose. After cancer treatment you can regain a sense of control by refusing medication or forgetting to take doses. You can afford to refuse or forget because it is not life threatening. This way of achieving a sense of control is often self-defeating. The little control you gain in determining what medications you take is offset by the loss of control of your symptoms or by a possible delay in your recuperation. It may help to see your choosing to take offered prescriptions as an act of control over your recovery.