“Nurses are always good at getting patients to talk about their feelings, and getting patients to talk about feelings of hopelessness is incredibly empathetic and helpful for the patients,” said Recklitis. “Patients sometimes think those feelings are not allowed. Often times they feel hopeless. So whatever [health care] providers can do to spend time on feelings that might take place posttreatment is beneficial.”
Nancy McHugh, a strategic project manager for a New York-based technology company, survived ovarian cancer. What frightened McHugh the most about her ordeal with cancer was not the disease itself, but the impact the disease would have on her personal life after she survived it. “I found out I had cancer 6 weeks prior to my wedding date, so at that time my biggest fear was telling my husband-to-be that there was a high chance that we would never be able to have kids. I wasn’t afraid of dying or anything like that … I mostly felt that having cancer and the possibilities of what it might do to me would make me less desirable to the person I loved most in the world.”
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SURVIVING THE GOOD NEWS
Cancer survivors who will admit they thought about killing themselves after being told they were cancer free are not easily found. Survivors interviewed for this story talked candidly about the fear and anxiety being cured of cancer brought into their lives despite a belief in the preciousness of life.
Becky Olson, from Beaverton, Oregon, who survived breast cancer three times, said having the plug of cancer treatment suddenly pulled from her was a terrifying experience. “Cancer treatment is about having a major to-do list,” she said.
“Chemo, check. Radiation, check. Mastectomy, check,” Olson listed off. “We become so focused on the treatment and getting through each step that when your doctor finally tells you that you are done with treatment, you would expect to rejoice along with your friends and family. But for me … I felt a huge sense of impending doom. I wondered how they could know my cancer was gone. What if it comes back? Who is going to keep an eye on me to catch it if it does? And, though I am no longer actively fighting it, I’m exhausted from the battle. Family members expect things to return to normal. But normal isn’t the same anymore.”
Posttraumatic stress is a snake in the summer grass for cancer survivors, said Jason Kapnick, MD, assistant consulting professor at Duke University and a practicing oncologist in Florida. “Cancer survivors are scared, even if they don’t say it. I call it ‘no more cancer, for now.’ It affects everything in their lives. Relationships, sex. Suicide is not uncommon.”
Traumatic events from a cancer patient’s past can also play a part in creating painful and negative emotions that can work against the healing process. These emotions haunt a patient well after being told he or she is cancer-free.
Jamie Inman, a two-time survivor of breast cancer, was sexually abused as a child. Inman, now in her 60s, suffered from depression and nearly committed suicide when she was in her mid-30s. After her cancer diagnosis, the very process of cancer treatment brought on depression and mental anxiety that had been in hibernation following a long ordeal that included an abortion and a lengthy court case. Open and honest communication between Inman and her oncology care team helped keep her focused on healing, and worked to resolve more than just the frightening issue of Inman’s cancer.
“All your emotions collide when you enter cancer treatment. You are going to be fighting off feelings not just about cancer,” said Inman. “With me, past abuse complicated my feelings. When a part of our body is violated and then we go through radiation treatment, we are like bugs under a giant microscope, and suddenly you have nurses handling your breasts in a way that you have no control over, and this can trigger feelings that you have suppressed over the course of your life. With me it was a violation of my body.”
Clinicians need to pay attention to what else is going through the mind of a cancer patient, said Kapnick. “Sometimes the patient is not even talking about cancer when the doctor thinks they are. What’s happening is they are feeling some other form of pain. As a doctor you can’t let this [pain] leave the room.”
Inman’s recollection of going through cancer treatment is more a posttraumatic psychological portrait than a scientific case study of a patient battling cancer. She said “When a person of authority—your surgeon—tears your body apart, it recalled my childhood abuse and how my body was violated. You are totally dependent on them and you let them do what they want and then you don’t talk about it anymore.”
