Beating cancer can be physically and emotionally tough, and sometimes the journey doesn't end when you get the all-clear. For many people, adjusting to life beyond cancer can be difficult, with a new set of challenges to face.
I've been given the all-clear. Why do I feel so down?
There is no right or wrong way to feel. Everyone's experience of surviving cancer will feel slightly different – it depends on your personality, personal circumstances and what type of cancer and treatment you have had. But for most people it's an emotional experience.
Some people feel able to resume their life easily when their cancer treatment finishes and can put the experience behind them. Some are so pleased to have survived cancer that they relish their cancer-free life with renewed vigour. But for many others, the physical and emotional impact of their cancer experience hits home when it's all over. In fact, 40% of people who've experienced cancer report a significant level of anxiety or depression following the completion of treatment.
According to Dr Frances Goodhart, consultant clinical psychologist and author of 'The Cancer Survivor's Companion', this is a very natural response.
"When you find out you have cancer, it can all happen very quickly – the diagnosis followed by treatment decisions within days – and then you often go through a gruelling time getting through the treatments with loved ones and healthcare professionals all around you, helping you through it. It's only afterwards, when your support team has gone and you have the time to think about what you've been through, that you feel the effects."
Common feelings and experiences after cancer
You may find that you are trying to cope with anxiety, low mood, depression, anger or a mixture of negative emotions.
There are many reasons why this might be the case. Dr Goodhart explains that, "It's very common to feel frightened or vulnerable, sad or angry because of what's happened to you. I've known patients to feel lost when their treatment is over and they're no longer getting support from their cancer care team, or lonely because friends and family can be wonderful but they don't always understand the trauma you've been through.
"Others are scared to be happy in case the cancer comes back, and it's also common to feel confused about how to fit back into your life because your role and your relationships have had to change during your treatment.
"On top of that, people often feel guilty about those feelings because their family and their doctors have worked so hard to get them to that point, and they feel terrible for not feeling as happy as everyone else that they've got through it. And so it's common to put on a front to protect friends and family, and they [cancer survivors] can end up feeling quite isolated.
"Some of these emotions do resolve over time, but time alone is not always the answer. A lot of the distress does fade into the background over time, but you may need to find ways to manage it in whatever way suits you."
For tips to help with feeling more positive, see 'Advice on coping after cancer' below.
You may also be dealing with some physical changes that have resulted from cancer or cancer treatment. Changes to your body might include hair loss, weight loss or gain, scarring, loss of a limb or breast, loss of sexual function, or having a colostomy bag.
Whether your body has changed in a way that is visible to others or not, it can be a lot to come to terms with and adapt to. Your body and your appearance can have a big impact on how you feel about yourself and how you think others perceive you. Your self-esteem may have taken quite a knock and this can affect your confidence in a number of ways – for example at work, in social situations and in your relationships.
However, it is possible to come to terms with your body changes. Find more information below in 'Advice on coping after cancer'.
Cancer and cancer treatments can also leave you feeling fatigued (overwhelmingly tired). According to Dr Goodhart, "At least three-quarters of people going through cancer treatment say that they experience it, and the majority of those continue to feel fatigued after treatment ends."
Fatigue can be long-lasting and disrupt many areas of your life, so it's important not to ignore it. Instead, listen to your body and give yourself time to adjust. Dr Goodhart recommends trying the "3 Ps" – prioritise, plan and pace yourself – as a way of coping until the fatigue starts to lift. Try making a plan each day, prioritising the most important things you would like to achieve, and stick to it. If you find certain tasks take it out of you, pace yourself by reducing the amount you do.
At the same time, being physically active can help to reduce your fatigue, if you go about it in the right way. Start with a small amount of physical activity and gradually increase it over time. Don't do more than you feel able to. The type of exercise you choose can also be important. For more information, read Macmillan's advice about exercise after cancer treatment.
Read more self-help tips on fighting fatigue.
Advice on coping after cancer
Talking and support
Not everyone likes to talk about their feelings or how difficult they're finding a situation. If this is you, don't feel obliged to open up. You may find that working through the hard times by yourself or expressing yourself more privately through art or music works best for you.
But for many of us, talking to someone about a distressing experience provides an opportunity to let off steam, let out difficult feelings, receive support and get a different perspective on things.
Who you talk to depends on your circumstances and how you're feeling. Some people are most comfortable with their partner or a close family member, while others find it hard to admit their true feelings and worries to their loved ones.
Dr Goodhart explains: "For some people, talking to someone they're not close to allows them to let their guard down and admit just how tricky it [coping after cancer] is sometimes."
You might feel that you would like to talk to a healthcare professional or to people who have been through similar experiences to you, and there are a number of ways you can find them. You can discuss your feelings and get advice and support from:
- Your cancer care team – when you finish your treatment they can give you advice on where to go for further support. Depending on your area, they may be able to refer you to a psychologist who specialises in cancer care.
- Support groups – post-cancer support groups are increasingly available and can be a very positive experience for people who attend. These support groups tend to be very informal and provide a place for people to chat, swap experiences and offer advice and support to each other, if they feel like it. It is generally acceptable to just sit and listen if you prefer. Find a group near you.
- Cancer support centres such as Maggie's Centres provide relaxed and informal environments to meet other people who have or have had cancer.
- You can also blog about your experiences and chat to people online via Maggie's online centre.
Further advice on coping after cancer
You may also find the following advice helpful for coping with the physical and emotional after-effects of cancer:
- Recognise what you've been through and how well you have done.
- Don't be hard on yourself.
- Give yourself permission to grieve for what you've lost and, if it feels right for you, find someone you feel you can talk to about it.
- Don't avoid the issue – we all avoid doing things we find hard, but by doing this difficult feelings can build up and fester.
- Try to give yourself a goal – something you know you need to do, such as accepting a part of your body that has changed – and gradually build up to it. For example, Dr Goodhart suggests, "If you don't want to go out because you're worried about being stared at, start by making a list of things you could say to any comments people might make, and go out with a friend or partner to a local café for 10 minutes. Then increase the length and frequency of your outings."
- Re-build your self-esteem – focus on your achievements and take time to assess all the good things that you have done and still have to offer.
- Learn to trust your body again – Dr Goodhart explains: "Confidence in your own body can be very damaged by cancer. Your body can feel as though it's failed you and can't be trusted. Every twinge may feel like a sign that the cancer has returned. But you can re-learn your body's signals and, in time, start to have confidence in yourself as a 'healthy person' like you did before the cancer."
- Try some exercise – when you feel up to it, regular exercise can help you to combat low mood and help you feel physically stronger. Read more about the benefits of exercise on the Macmillan webpage 'Exercise during and after cancer'.
- Get further advice on tackling depression, anxiety or anger – if you're struggling or worried, talk to your GP or cancer care team. They can discuss diagnosis and treatment options with you, such as talking therapies and medication.