- When Cancer Comes Back: Cancer Recurrence
- What is cancer recurrence?
- What are the types of recurrence?
- Could I have done something to prevent the recurrence?
- Common questions about cancer recurrence
- When cancer recurs
- Treating recurrence
- What happens if treatment is no longer working?
- How do people cope emotionally when cancer recurs?
- What about the “why” questions?
- Get support
- Treating cancer as a chronic illness
- To learn more
How do people cope emotionally when cancer recurs?
Not everyone has the same emotions and thoughts when cancer comes back. And not everyone has the responses shared here, but many have concerns and questions like these.
“I am so angry and upset! The cancer was gone! These are supposed to be my golden retirement years. Now I’m facing more treatment. It’s all my doctor’s fault.”
It’s understandable to be very upset when you expect one thing to happen and the opposite does. The last thing anyone expects is to have to go through more treatment for a cancer that they thought was gone. It’s normal to want to blame someone. A natural choice is your doctor. After all, this is the person who treated you the first time and said you appeared to be cancer-free. If you’re like most people, you really wanted to believe that you’d be cancer-free forever. Now you’re hearing the bad news about recurrence, finding out about a new treatment plan, and here you are going through a difficult time – again.
You may think your doctor didn’t do something right during your first treatment. Maybe you think your doctor did not follow up with you closely enough. Or maybe you feel you were not listened to as closely as you should have been. Whatever your feelings, they must be dealt with now. There are some things you can do to help resolve any issues you have at this time. You might try discussing your concerns with your doctor. See if you can clear up any bad feelings you have about how your treatment was handled.
It’s highly unlikely that any doctor would intentionally not treat you as well as possible the first time. When you think about it that just doesn’t make sense. Your doctors want you to do well; this is what makes the doctor successful, too. But if you feel it’s not possible to work with your current doctor, it may be wise to find a new one. You might find that a fresh start with a new health care team will help you improve your attitude and feel better about your current situation.
Feeling angry and upset about a cancer recurrence is completely normal, and you might need support and someone to talk to about these feelings. There are different sources for this type of support. For some, their support community is their place of worship. For others, a formal support group or online support group can be helpful. Other cancer survivors who have faced recurrence can understand and offer support like no one else. Still, some people prefer the privacy of one-on-one counseling. Ask your friends, family, or a trusted doctor for a referral. Just make sure that you are finding an outlet for your feelings. You deserve to be heard.
Some degree of depression and anxiety is common in people who are coping with cancer recurrence. But when a person is emotionally upset for a long time or is having trouble with their day-to-day activities, they may have a depression or severe anxiety that needs medical attention. These problems can cause great distress and make it harder for you to follow a treatment schedule.
Even if you are clinically depressed or anxious, you have some things going for you.
- Depression can be treated and treatment usually works well.
- Improving your physical symptoms and taking action may help make your mood better.
- You have already been in a battle with cancer once and you learned a lot along the way. Try the things you that helped you then. Those same relationships and coping skills may help you now.
Family and friends should watch for symptoms of distress. If they notice symptoms of depression or anxiety, they should encourage the person to seek the help of a health care professional. Anxiety and clinical depression can be treated many ways, including medicine, psychotherapy, or both. These treatments can help a person feel better and improve the quality of their life.
“I am only 35 years old. How am I supposed to deal with cancer recurrence? I’m too young to die.”
Cancer is hard at any age, but it’s especially hard to cope with when you are young and believe you have a full, long life ahead of you. Cancer recurrence may seem even more unfair then. Worse, it’s often more aggressive in the younger cancer survivor – it may grow and spread faster. This aggressiveness means that it could come back earlier and be harder to treat.
Having a recurrence does not mean you will die, but there’s no denying that it’s something you will and should think about. It’s a painful prospect, one that calls for thoughtful processing and even preparation. First of all, a talk with your doctor can give you some idea how realistic your fears and concerns are. Even when you’re healthy, it never hurts to be prepared for the chance you could die. You’ll want to make plans for your family if the worst happens.
You need to get support that works for you so you can talk about and express your feelings about recurrence. You can also learn more about yourself and explore the meaning of your life. Sometimes our lives have a purpose and meaning we cannot see clearly. It can be very helpful to discover that purpose and take pleasure from it when it seems there is no hope.
“How do I deal with the sense that recurrence means things are hopeless?”
There are different ways to look at and talk about cancer that has come back. Many things can affect your outcome. Is there a chance you might not survive your cancer recurrence? Yes. Does that mean there’s no hope? No. When cancer comes back, you may find that your hopes are very different from those you had when you were first diagnosed.
To be more precise, the type of cancer you have and your response to treatment will dictate your outcome. Today, a cancer recurrence may not mean you’ll have a very short life. Advances in cancer treatment and the management of treatment side effects continue to improve. There’s no denying the situation is more serious if the cancer has come back, but for many people this simply means that treatment will be different and perhaps more aggressive than it was at first.
At the same time, cancers that come back or get worse despite treatment tend to be harder to treat and control. It’s important for you to talk to your cancer care team. They can give you a good idea of what you can expect to happen. It may be that your cancer is not likely to be cured, but there are things that can be done to keep it from growing. You and your family should be clear about the goal of any treatment. With any new treatment, ask if the goal is cure, control of the cancer, or comfort.
It’s often very hard to think about starting more treatment for cancer. You might feel discouraged, but there often are more (or different) treatment options available. If you feel unsure about more treatment, it may help to get a second opinion from a doctor at a cancer center or university teaching hospital. Ask about your options, their pros and cons, and likely outcomes. Make sure you have covered all your bases and given yourself every chance to get the best treatment available to you. Even if the doctor tells you that your cancer can’t be cured, you might learn that there is a chance of another remission from the cancer. Or you might decide that the outcomes of certain types of treatment aren’t worthwhile to you. Your doctor can still help you if you choose treatment aimed to make you feel better without taking more chemo or radiation.
“The cancer has already spread to many parts of my body. Should I still think about more treatment?”
There is no one answer to this question. It depends on the type of cancer, how it’s affecting you, what your health care team is telling you, and what you and your family are thinking and feeling about the situation. During cancer treatment (even if the treatment isn’t working well), you’re under a doctor’s care, the cancer’s progress is being slowed, and side effects and symptoms are being watched and treated. For some, getting cancer treatment helps them feel better and stronger, because they’re doing something to fight the cancer. For others, being in treatment works the opposite way – it might make them feel more tired or less free. Only you can decide how you want to live your life. Of course, you will want to hear how your family feels about it, too. Their feelings are important since they are living through the cancer with you. But keep in mind, the final decision is up to you.
Whether or not you want aggressive cancer treatment, you should always get supportive or palliative care. It’s used along with more aggressive treatment, but is better known for its role in making you more comfortable when aggressive treatment is no longer working.
Palliative care is treatment of symptoms – it’s not expected to cure the cancer, although at least one study suggests it might prolong life. It’s care that focuses on making your life the best it can be, even if there’s not a good chance of curing the cancer. This means treating and controlling symptoms like nausea, pain, tiredness, or shortness of breath. Sometimes medicines are used, but other types of treatment may also be used. Most cancer care teams give palliative care, but it may also involve other specialists (surgeons, pain control specialists, and others as needed).
Along with people getting treatment that is expected to cure the cancer (curative treatment) and those getting only palliative or supportive care, there are people who are treated for cancer for long periods of time. Treatment is given even though a cure isn’t expected. For many patients, cancer can be controlled this way for years. Treatment can be used to shrink the cancer, help relieve symptoms, and help you live longer. Even though it can be hard to do, many families adjust to this kind of treatment schedule. See the section called “Treating cancer as a chronic illness.”
“Is having a positive attitude important in fighting the cancer? My friends say it is, but I feel sad and discouraged.”
When you have cancer, grief and sadness are normal.
In recent years, much attention has been paid to the importance of having a positive attitude. Some people go so far as to suggest that such an attitude will stop the cancer from growing or prevent death. Patients are even told that they will never beat the cancer if they don’t stop feeling sad, bad, depressed, or other so-called “negative” feelings. This kind of message is destructive to people who are dealing with cancer and recurrence. They are fighting for their lives and then are told they are responsible for causing their own illness. And to make matters worse, they may feel as if they aren’t supposed to grieve or feel sad over the new hardships and major changes in their lives. Please do not allow others’ misguided attempts to encourage positive thinking to place the burden of your cancer on you. That is not accurate, and it’s not fair to you.
Cancer is not caused by a person’s negative attitude nor is it made worse by a person’s thoughts. You might be better able to manage your life and cancer treatment when you are able to look at things in a positive light, but that’s not always possible either. It’s much healthier to admit that having cancer can make you and your loved ones feel sad. Once you can admit that reality, it is easier to get on with your life, whether that life is measured in days, months, or years. Some of those days will be good, some will be not so great. Most of us know that this is the natural course of life anyway – with or without cancer.
People may tell you about studies that show that patients with a positive attitude live longer. These studies often offer anecdotal evidence (people’s stories) based on too few patients and questionable research methods. No solid, well-accepted research has shown that a patient’s attitude has anything to do with whether the person will live or die. There are patients who live longer than they are expected to, but researchers do not know why. If they did, they could certainly use that information to try to help many people. So don’t let the positive attitude myths stop you from telling your loved ones or your cancer team how you feel. People with positive attitudes still die from cancer. People with negative attitudes often live a normal lifespan despite their cancer. Everyone gets through cancer in their own way.
What do I do when others say thoughtless things?
Many people feel nervous and awkward when they learn someone’s cancer has come back. They often don’t know what to say or do. You may hear things like, “I know how you feel,” or “You’ll be OK,” or “Stay strong.” They’re trying to say something hopeful and encouraging, but it doesn’t sound that way to you – in fact, it may seem hurtful and insensitive. You may be thinking, “You don’t know how I feel, I might not be OK, and I certainly don’t want to act strong all the time!”
Along those same lines, friends or relatives might try to reassure you with comments like “God doesn’t give us anything we can’t handle,” or “God must have a reason that this has happened.” Sometimes these words might make us feel better – we want to believe them! But sometimes they have the opposite effect. While people say these things with the very best of intentions, if you are struggling to find meaning in what’s happening, the thoughts and feelings invoked by such comments might only add to your stress.
People say things like this because they don’t know what else to say. You may feel very annoyed and even angry. Sometimes this can be a good topic to talk over with another cancer patient or your nurse or support group. They’ll understand where you are coming from. How do you respond to such comments? With close friends, you might want to share how you really feel when you hear things like this. But many times it’s a battle you just don’t want to fight. Since these people are trying to help, just a simple “thank you” and changing the subject may be the easiest response.
Last Medical Review: 07/28/2015
Last Revised: 07/28/2015