National Cancer Institute

Facing Forward
Life After Cancer Treatment

U.S. DEPARTMENT
OF HEALTH AND
HUMAN SERVICES
National Institutes
of Health
A Note About Cancer Survivors
There are almost 14 million people in the U.S. today who are
cancer survivors. Three out of every four American families
will have at least one family member diagnosed with cancer.
To help support survivors unique needs, the National Cancer
Institute (NCI) formed the Office of Cancer Survivorship (OCS)
in 1996. The office is dedicated to enhancing the length and
quality of life of people with cancer. OCS also promotes research
that looks at the long- and short-term effects of cancer and its
treatment. For more information about survivorship issues and
OCS, visit online at http://cancercontrol.cancer.gov/ocs/.

Acknowledgments
We would like to offer a sincere thank you to the extraordinary
survivors who contributed to the development and review of
this booklet.

NCI extends a special thanks to the following researchers for

their pivotal work in the area of cancer survivorship under NCI
Grant No. CA63018. Facing Forward was adapted from materials
used in the study, Moving Beyond Cancer.

Patricia A. Ganz, M.D., Professor, UCLA Schools of Medicine

and Public Health and Division of Cancer Prevention &
Control Research, Jonsson Comprehensive Cancer Center,
Los Angeles, CA

Beth Leedham, Ph.D., Clinical Psychologist, private

practice, Encino, CA

Beth E. Meyerowitz, Ph.D., Professor, Department

of Psychology, University of Southern California,
Los Angeles, CA

This booklet is also available in Spanish

(visit http://www.cancer.gov or call 1-800-4-CANCER).
Este folleto tambin se puede obtener en espaol.
Facing Forward
Life After Cancer Treatment

While I was having chemo, I quit doing

almost everything. So when treatment
ended, the challenge for me was, what
am I going to do now with my life?
What should I go back to doing? LEN
Now that treatment is over
Many cancer survivors have told us
that while they felt they had lots
of information and support during Who is a survivor?
their illness, once treatment stopped,
they entered a whole new world This booklet uses the term cancer
one filled with new questions. survivor to include anyone who
This booklet was written to share has been diagnosed with cancer,
common feelings and reactions that from the time of diagnosis through
many people just like you have had the rest of his or her life. Family
after treatment ended. members, friends, and caregivers
are also part of the survivorship
It also offers some practical tips to experience.
help you through this time. Use
this booklet in whatever way works You may not like the word, or you
best for you. You can read it from may feel that it does not apply to
beginning to end. Or you can just you, but the word survivor helps
refer to the section you need. many people think about embracing
their lives beyond their illness.
This booklet shares what we have
learned from other survivors about
life after cancer: practical ways of
dealing with common problems and guidelines for managing your physical,
social, and emotional health. When possible, we include specific information
from research with cancer survivors.

While cancer is a major event for all who are diagnosed, it brings with it the
chance for growth. As hard as treatment can be, many cancer survivors have
told us that the experience led them to make important changes in their lives.
Many say they now take time to appreciate each new day. They also have
learned how to take better care of themselves and value how others care for
them. Others draw from their experience to become advocates to improve
cancer research, treatment, and care.

We hope that this booklet will serve as a resource and inspiration to you as
you face forward to your life after cancer.

For ease of reading, rather than listing the many professionals that you
may see as part of your medical care, youll find the term doctor used in
the booklet to describe all medical interactions.
Table of Contents

Congratulations on Finishing Your Cancer Treatment...... 1

What Is Normal After Treatment?............................................................ 1

Getting Follow-up Medical Care........................................ 2

What Is Follow-up Care?.............................................................................. 3
Which Doctor Should I See Now? How Often?........................................... 5
A Survivors Wellness Plan........................................................................... 5
Talking With Your Doctor............................................................................ 7
Questions About Your Follow-up Plan....................................................... 10
Guidelines for Follow-up Care................................................................... 11

Ways To Manage Physical Changes.................................. 15

Fatigue........................................................................................................ 16
Memory and Concentration Changes....................................................... 18
Pain............................................................................................................. 20
Nervous System Changes (Neuropathy).................................................... 23
Lymphedema or Swelling........................................................................... 24
Mouth or Teeth Problems.......................................................................... 26
Changes in Weight and Eating Habits....................................................... 28
Trouble Swallowing.................................................................................... 29
Bladder or Bowel Control Problems........................................................... 29
Menopause Symptoms............................................................................... 30

Body Changes and Intimacy............................................. 32

Your Feelings................................................................... 37

Social and Work Relationships........................................ 49

Reflectio . ....................................................................... 55

Appendix.......................................................................... 56
Financial and Legal Matters....................................................................... 56
Resources.................................................................................................... 57
Learning To Relax....................................................................................... 60
I thought when Id finished
treatmentwhen they looked at
my tests and they said it looked
goodI thought, OK, Im done.
But now Im starting to realize
that its not over. JANE
Congratulations on Finishing
Your Cancer Treatment

The end of cancer treatment is often a time to rejoice. You are probably
relieved to be finished with the demands of treatment and are ready to put the
experience behind you. Yet at the same time, you may feel sad and worried.
Its common to be concerned about whether the cancer will come back and
what you should do after treatment.

When treatment ends, you may expect life to return to the way it was before
you were diagnosed with cancer. But it can take time to recover. You may have
permanent scars on your body, or you may not be able to do some things you
once did easily. Or you may even have emotional scars from going through
so much. You may find that others think of you differently nowor you may
view yourself in a different way.

One of the hardest things after treatment is not knowing what happens next.

Because the doctors and nurses never told

me what to expect, I had very unrealistic
expectations of wellness, and so did my
family and friends. This led to a great deal
of worry. BOB

What Is Normal After Cancer Treatment?

Those who have gone through cancer treatment describe the first few months
as a time of change. Its not so much getting back to normal as it is finding
out whats normal for you now. People often say that life has new meaning or
that they look at things differently now. You can also expect things to keep
changing as you begin your recovery.

Your new normal may include making changes in the way you eat, the
things you do, and your sources of support, all of which are discussed in
this booklet.

1
 Getting Follow-up Medical Care

All cancer survivors should have follow-up care. Knowing what to expect after
cancer treatment can help you and your family make plans, lifestyle changes,
and important decisions.

Some common questions you may have are:

Should I tell the doctor about symptoms that worry me?

Which doctors should I see after treatment?
How often should I see my doctor?
What tests do I need?
What can be done to relieve pain, fatigue, or other problems after
treatment?
How long will it take for me to recover and feel more like myself?
Is there anything I can or should be doing to keep cancer from
coming back?
Will I have trouble with health insurance?
Are there any support groups I can go to?

Coping with these issues can be a challenge. Yet many say that getting
involved in decisions about their medical care and lifestyle was a good way for
them to regain some of the control they felt they lost during cancer treatment.
Research has shown that people who feel more in control feel and function
better than those who do not. Being an active partner with your doctor and
getting help from other members of your health care team is the first step.

If you dont have health insurance, Medicare, or Medicaid, you may feel
that some of the information in this booklet wont be helpful to you. You
may have already struggled just to get treated and now see follow-up
care as another battle. It can be hard to get care if you dont have good
medical coverage, but you must make sure you continue to get the care
you needespecially now that treatment is over.

There may be resources in your community to help you get these services.
Talk with your doctor, social worker, or the business office at your local
hospital or clinic. There are also organizations listed in the Resources
section on page 57 that may be able to help you with health care costs.
2
 Follow-up Medical Care
What Is Follow-up Care?
Once you have finished your cancer treatment, you should receive a follow-
up cancer care plan. Follow-up care means seeing a doctor for regular medical
checkups. Your follow-up care plan depends on the type of cancer and type of
treatment you had, along with your overall health. It is usually different for
each person who has been treated for cancer.

In general, survivors usually return to the doctor every 3 to 4 months during

the first 2 to 3 years after treatment, and once or twice a year after that. At
these visits, your doctor will look for side effects from treatment and check if
your cancer has returned (recurred) or spread (metastasized) to another part
of your body.

At these visits, your doctor will:

Review your medical history

Give you a physical exam

Your doctor may run follow-up tests such as:

Blood tests

MRI or CT scans. These scans take detailed pictures of areas inside the
body at different angles.

Endoscopy (en-DOSS-koh-pee). This test uses a thin, lighted tube to

examine the inside of the body.

At your first follow-up visit, talk with your doctor about your follow-up
care plan.

See page 11 for a list of organizations and programs that give follow-up care
guidelines for survivors or Resources on page 57 for a detailed list of cancer-
related organizations.

Follow-up care can also include home care, occupational or vocational

therapy, pain management, physical therapy, and support groups. (See pages
1213 for a description of these services.)

3
 Medical Records and Follow-up Care
Be sure to ask your oncologist for a written summary of your
treatment. In the summary, he or she can suggest what aspects of
your health need to be followed. Then, share this summary with
any new doctors you see, especially your primary care doctor, as you
discuss your follow-up care plan.

Many people keep their medical records in a binder or folder and

refer to them as they see new doctors. This keeps key facts about
your cancer treatment in the same place. Other kinds of health
information you should keep include:

The date you were diagnosed

The type of cancer you were treated for

Pathology report(s) that describe the type and stage of cancer

Places and dates of specific treatment, such as:

Details of all surgeries

Sites and total amounts of radiation therapy

Names and doses of chemotherapy and all other drugs

Key lab reports, x-ray reports, CT scans, and MRI reports

List of signs to watch for and possible long-term effects

of treatment

Contact information for all health professionals involved in

your treatment and follow-up care

Any problems that occurred during or after treatment

Information about supportive care you received (such as special

medicines, emotional support, and nutritional supplements)

Be sure to give any new doctors

that you see a copy of
your treatment summary or
medical records.
4
 Which Doctor Should I See Now? How Often?
You will need to decide which doctor will provide your follow-up cancer care
and which one(s) you will see for other medical care. For follow-up cancer
care, this may be the same doctor who provided your cancer treatment. For
regular medical care, you may decide to see your main provider, such as a
family doctor. For specific concerns, you may want to see a specialist. This is
a topic you can discuss with your doctors. They can help you decide how to
make transitions in care.

Depending on where you live, it may make more sense to get follow-up cancer
care from your family doctor, rather than your oncologist. Its important
to note that some insurance plans pay for follow-up care only with certain
doctors and for a set number of visits.

In coming up with your schedule, you may want to check your health
insurance plan to see what follow-up care it allows. No matter what your
health coverage situation is, try to find doctors you feel comfortable with.

Always tell any new doctors you see about your history of cancer. The type
of cancer you had and your treatment can affect decisions about your care
in the future. They may not know about your cancer unless you tell them.

A Survivors Wellness Plan

After cancer treatment, many survivors want to find ways to reduce the
chances of their cancer coming back. Some worry that the way they eat, the
stress in their lives, or their exposure to chemicals may put them at risk.
Cancer survivors find that this is a time when they take a good look at how
they take care of themselves. This is an important start to living a healthy life.

When you meet with your doctor about follow-up care, you should also ask
about developing a wellness plan that includes ways you can take care of your
physical, emotional, social, and spiritual needs. If you find that its hard to talk
with your doctor about these issues, it may be helpful to know that the more
you do it, the easier it becomes. And your doctor may suggest other members
of the health care team for you to talk with, such as a social worker, clergy
member, or nurse. For tips on talking with your doctor, see pages 79.

5
 Changes You May Want To Think About Making
Quit smoking. Research shows that smoking can increase the chances
of getting cancer at the same site or another site.

Cut down on how much alcohol you drink. Research shows

that drinking alcohol increases your chances of getting certain types of
cancers.

Eat well. Healthy food choices and physical activity may help reduce
the risk of cancer or recurrence. Talk with your doctor or a nutritionist
to find out about any special dietary needs that you may have. The
American Cancer Society and the American Institute for Cancer Research
have developed similar diet and fitness guidelines that may help reduce
the risk of cancer:
Eat a plant-based diet and have at least 59 servings of fruit
and vegetables daily. Try to include beans in your diet, and
eat whole grains (such as cereals, breads, and pasta) several times
daily.
Choose foods low in fat and low in salt.
Get to and stay at a healthy weight.

For more tips on nutrition and healthy eating, go to http://www.aicr.org,

or http://www.cancer.org and search Survivors.

Exercise and stay active. Several recent reports suggest that staying
active after cancer can help lower the risk of recurrence and can lead
to longer survival. Moderate exercise (walking, biking, swimming) for
about 30 minutes everyor almost everyday can:

Reduce anxiety and depression

Improve mood and boost self-esteem
Reduce fatigue, nausea, pain, and diarrhea

It is important to start an exercise program slowly and increase

activity over time, working with your doctor or a specialist (such as a
physical therapist) if needed. If you need to stay in bed during your
recovery, even small activities like stretching or moving your arms or
legs can help you stay flexible, relieve muscle tension, and help you
feel better. Some people may need to take special care in exercising.
Talk with your doctor before you begin any exercise program.

6
 Talking With Your Doctor
During cancer treatment, you had a lot of practice in getting the most out of
every doctors visit. These same skills now apply to you as a survivor and are
especially helpful if you are changing doctors or going back to a family or
primary care doctor you may not have seen for a while.

It is important to be able to talk openly with your doctor. Both of you need
information to manage your care. Be sure to tell your doctor if you are having
trouble doing everyday activities, and talk about new symptoms to watch for
and what to do about them. If you are concerned that the treatment you had
puts you at a higher risk for having health problems, be sure to discuss this
with your doctor as you develop your follow-up plan.

At each visit, mention any health issues you are having, such as:

New symptoms

Pain that troubles you

Physical problems that get in the way of your daily life or that bother
you, such as fatigue, trouble sleeping, sexual problems, or weight gain
or loss

Other health problems you have, such as heart disease, diabetes,

or arthritis

Medicines, vitamins, or herbs you are taking and other treatments you
are using

Emotional problems, such as anxiety or depression, that you may have

now or that youve had in the past

Changes in your familys medical history, such as relatives with cancer

Things you want to know more about, such as new research or

side effects

Just because you have certain symptoms, it doesnt always mean the
cancer has come back. Symptoms can be due to other problems that
need to be addressed.

7
 Considering Complementary and Alternative Medicine
Complementary and alternative medicine includes many different healing
approaches that people use to prevent illness, reduce stress, prevent or reduce
side effects and symptoms, or control or cure disease. An approach is generally
called complementary when it is used in addition to treatments prescribed
by a doctor. When it is used instead of treatments prescribed by a doctor, it
is often called alternative. Research has shown that more than half of all
people with a history of cancer use one or more of these approaches.

Some common methods include imagery or relaxation (see page 60),

acupressure and massage, homeopathy, vitamins or herbal products, special
diets, psychotherapy, prayer, yoga, and acupuncture.

Even though you have finished your cancer treatment, if you are thinking
about using any of these methods, discuss it with your doctor or nurse first.
Some complementary and alternative therapies may interfere or be harmful
when used with medicines normally prescribed by a doctor. For more
information, see the Resources section on page 57 to order the NCI brochure
Thinking About Complementary & Alternative Medicine: A Guide for People
With Cancer. You can also go to NCIs Office of Cancer Complementary and
Alternative Medicine at http://www.cancer.gov/cam.

Asking About Your Familys Cancer Risk

You may worry that having cancer might increase your childrens risk. Its
important to know that most cancer is not passed down through families.
Only about 510 percent of the most common cancers (such as breast, colon,
and prostate) are inherited. In most of the families that have inherited cancers,
researchers have found relatives who may have had:

Cancer before they were 50 years old

Cancer in two of the same body parts (like both kidneys or both breasts)

Other risk factors for cancer (such as colon polyps or skin moles)

If you think that your cancer may be inherited, talking with a cancer genetic
counselor can help answer your questions and those of your family. He or
she can also help you and your doctor decide on the medical care that you
and your family might need if a genetic link is found. Genetic testing can
determine whether the cancers that occur in your family are due to genes or to
other factors.

8
Getting the Most From Your Follow-up Visits
Here are some ideas that helped others with their follow-up care.

Before You Go:

Bring paper, so you can take notes, or ask if you can tape-record
the answers.
Ask someone to come with you to your doctor visits. A friend or family
member can help you think about and understand what was said. He or
she also may think of new questions to ask.
Make a list of questions ahead of time and bring it with you.

At Your Visit:
Ask to talk with the doctor or nurse in a private room with the
door closed.
Ask your most important questions first, in case the doctor runs out
of time.
Express yourself clearly.
Describe your problem or concern briefly.
Tell the doctor how your problem or concern makes you feel.
Ask for what you want or need, for example, I am tired most of
the time each day. Ive tried napping, but it doesnt help. My fatigue
gets in the way of my daily life. What can be done to help me with
this problem?
Ask the doctor to explain what he or she said in terms you understand.
Repeat back in your own words what you think the doctor meant.
Tell your doctor if you need more information.

Before You Leave:

Ask your doctor or pharmacist about the best way to take your
medicine and about possible side effects.
Dont be afraid to ask for more time when you make your next
appointment. Or ask the doctor to suggest a time when you could call
and get answers to your questions.
Ask if there are any survivor support groups in the area.
Ask for booklets or other materials to read at home.
Keep your own set of records about any follow-up care you have.

9
 Questions About Your Follow-up Plan

1. How often should I Doctors Name How Often

see my doctors?
_____________________________ ____________

_____________________________ ____________

_____________________________ ____________

_____________________________ ____________

2. What follow-up tests, Test How Often

should be done
(for example, CT scan,
_____________________________ ____________
MRI, bone scan)?
How often? _____________________________ ____________

_____________________________ ____________

_____________________________ ____________

3. Are there symptoms ____________________________________________

that I should ____________________________________________
watch for?
____________________________________________

____________________________________________

4. If I develop any of ____________________________________________

these symptoms,
____________________________________________
whom should I call?
____________________________________________

____________________________________________

10
 Guidelines for Follow-up Care
The following programs or organizations provide helpful follow-up care
guidelines for some cancers. You can use them as you talk with your doctor
they arent meant to contradict or take the place of your doctors knowledge
or judgment. Ask your oncologist for a treatment summary and a survivorship
care plan. Both documents are recommended by the National Cancer Institute
and other cancer organizations.

Cancer.Net. The American Society of Clinical Oncology has a series of

follow-up care guides focused on breast and colorectal cancer. They can be
viewed at http://www.cancer.net/patient/survivorship.

Childrens Oncology Group Long-Term Follow-up Guidelines.

The Childrens Oncology Group offers long-term follow-up guidelines for
survivors of childhood, adolescent, and young adult cancers at
http://www.survivorshipguidelines.org.

Journey Forward. The Journey Forward is a program centered on its

Survivorship Care Plan. By using an online Care Plan Builder, the oncologist
creates a full medical summary and recommendations for follow-up care to
be shared with patients and their primary care providers. It was created by
the National Coalition for Cancer Survivorship, UCLA Cancer Survivorship
Center, Genentech, and WellPoint, Inc. Go to http://www.journeyforward.org.

Life After Cancer Care. M.D. Andersons Cancer Center website

lists follow-up guidelines for 15 different disease sites at http://www.
mdanderson.org/survivorship, and click on Follow-up Medical Care.

Livestrong Care Plan. Developed by Livestrong and the University

NCCN. The National Comprehensive Cancer Network Web site includes

information about follow-up care for cancer, along with guidance on
making formal survivorship plans. See their website at
http://www.nccn.org.

For more information about follow-up care, see the NCI Factsheet, Follow-
Up Care After Cancer Treatment at http://www.cancer.gov/cancertopics/
factsheet/Therapy/followup. If you dont have a computer, or have trouble
accessing this sheet or the sites above, call the National Cancer Institute
at 1-800-4-CANCER (1-800-4226-237) and ask for help.
11
 Services To Think About
Talk with your doctor to help you locate services such as these:

Couples Counseling
You and your partner work with trained specialists who can help you talk
about problems, learn about each others needs, and find ways to cope.
Counseling may include issues related to sex and intimacy.

Faith or Spiritual Counseling

Some members of the clergy are trained to help you cope with cancer
concerns, such as feeling alone, fear of death, searching for meaning, and
doubts about faith.

Family Support Programs

Your whole family may be involved in the healing process. In these
programs, you and your family members take part in therapy sessions with
trained specialists who can help you talk about problems, learn about each
others needs, and find answers.

Genetic Counseling
Trained specialists can advise you on whether to have genetic testing for
cancer and how to deal with the results. It can be helpful for you and for
family members who have concerns about their own health.

Home Care Services

State and local governments offer many services that you may find useful
after cancer treatment. For example, a nurse or physical therapist may
be able to come to your home. You may also be able to get help with
housework or cooking. Check the phone book under the categories Social
Services, Health Services, or Aging Services.

Individual Counseling
Trained mental health specialists can help you deal with your feelings,
such as anger, sadness, and concern for your future.

Long-Term Follow-up Clinics

All doctors can offer follow-up care, but there are also clinics that specialize
in long-term follow-up after cancer. These clinics most often see people
who are no longer being treated by an oncologist and who are considered
disease-free. Ask your doctor if there are any follow-up cancer clinics in
your area.

Nutritionists/Dietitians
They can help you with gaining or losing weight and with healthy eating.

Occupational Therapists
They can help you regain, develop, and build skills that are important for
day-to-day living. They can help you relearn how to do daily activities,
12 such as bathing, dressing, or feeding yourself, after cancer treatment.
 Oncology Social Workers
These professionals are trained to counsel you about ways to cope with
treatment issues and family problems related to your cancer. They can tell
you about resources and connect you with services in your area.

Ostomy Information and Support

The United Ostomy Association provides education, information, and
support for people with intestinal/urinary diversions. Call 1-800-826-0826,
or visit online at http://www.uoa.org.

Pain Clinics (also called Pain and Palliative Care Services)

These are centers with professionals from many different fields who are
specially trained in helping people get relief from pain.

Physical Therapists
Physical therapists are trained to understand how different parts of your
body work together. They can teach you about proper exercises and body
motions that can help you gain strength and move better after treatment.
They can also advise you about proper postures that help prevent injuries.

Quitting Smoking (Smoking Cessation Services)

Research shows that the more support you have in quitting smoking, the
greater your chance for success. Ask your doctor, nurse, social worker,
or hospital about available programs, or call NCIs Smoking Quitline at
1-877-44-U-QUIT (1-877-448-7848).

Speech Therapists
Speech therapists can evaluate and treat any speech, language, or
swallowing problems you may have after treatment.

Stress Management Programs

These programs teach ways to help you relax and take more control over
stress. Hospitals, clinics, or local cancer organizations may offer these
programs and classes.

Support Groups for Survivors

In-person and online groups enable survivors to interact with others in
similar situations. (See pages 4445.)

Survivor Wellness Programs

These types of programs are growing in number, and they are meant for
people who have finished their cancer treatment and are interested in
redefining their life beyond cancer.

Vocational Rehabilitation Specialists

If you have disabilities or other special needs, these specialists can help
you find suitable jobs. They offer services such as counseling, education
and skills training, and help in obtaining and using assistive technology
and tools.
13
 I thought I could get right back
into my normal work routine, but
Im finding that I just do t have
the same energy that I used to. BILL

14
 Ways to Manage Physical Changes
Ways To Manage Physical Changes

If I could stop feeling so tired all the time,

I think Id be fine. Ive started getting
used to everything else. ROSA

Some have described survivorship as being disease-free, but not free of your
disease. What you experience with your body may be related to the type of
cancer you had and the treatment you received. Its important to remember
that no two people are alike, so you may experience changes that are very
different from someone elses, even if that person had the same type of cancer
and treatment.

You may find that you are still coping with the effects of treatment on your
body. It can take time to get over these effects. You may wonder how your
body should feel during this time and what are signs that cancer is coming
back. This section describes some of the problems that can occur when
treatment is over. Some of the most common problems that people report are:

Fatigue

Memory and concentration changes

Pain

Nervous system changes (neuropathy)

Lymphedema, or swelling

Mouth or teeth problems

Changes in weight and eating habits

Trouble swallowing

Bladder or bowel control problems

Menopause symptoms

15
 Fatigue
Some cancer survivors report that they still feel tired or worn out. In fact, fatigue
is one of the most common complaints during the first year of recovery.

Rest or sleep does not cure the type of fatigue that you may have. Doctors do
not know its exact causes. The causes of fatigue are different for people who
are receiving treatment than they are for those who have finished.

Fatigue during treatment can be caused by cancer therapy. Other

problems can also play a part in fatigue, like anemia (having too
few red blood cells) or having a weak immune system. Poor nutrition,
not drinking enough liquids, and depression can also be causes.
Pain can make fatigue worse.

Researchers are still learning about what may cause fatigue

after treatment.

How long will fatigue last? There is no normal pattern. For some, fatigue gets
better over time. Some people, especially those who have had bone marrow
transplants, may still feel energy loss years later.

Some people feel very frustrated when fatigue lasts longer than they think it
should and when it gets in the way of their normal routine. They may also
worry that their friends, family, and coworkers will get upset with them if they
continue to show signs of fatigue.

Getting Help
Talk with your doctor or nurse about what may be causing your fatigue and
what can be done about it. Ask about:

How any medicines you are taking or other medical problems you have
might affect your energy level

How you can control your pain, if pain is a problem for you

Exercise programs that might help, such as walking

Relaxation exercises

Changing your diet or drinking more fluids

Medicines or nutritional supplements that can help

Specialists who might help you, such as physical therapists,

16 occupational therapists, nutritionists, or mental health care providers
Coping With Fatigue
Here are some ideas:

Plan your day. Be active at the time of day when you feel most
alert and energetic.

Save your energy by changing how you do things.

For example, sit on a stool while you cook or wash dishes.

Take short naps or rest breaks between activities.

Try to go to sleep and wake up at the same time
every day.
Do what you enjoy, but do less of it. Focus on old or new
interests that dont tire you out. For example, try to read something
brief or listen to music.

Let others help you. They might cook a meal, run errands, or
do the laundry. If no one offers, ask for what you need. Friends and
family might be willing to help but may not know what to do.

Choose how to spend your energy. Try to let go of things that

dont matter as much now.

Think about joining a support group. Talking about your

fatigue with others who have had the same problem may help you
find new ways to cope.

17
 Memory and Concentration Changes

Not being able to concentrate the way I used

to has been the hardest for me. Im hoping it
doesnt affect my work. JOSH

Research shows that one in four people with cancer reports memory and
attention problems after chemotherapy. This is sometimes called chemobrain.
Many survivors describe this as brain fog, which can lead to problems paying
attention, finding the right word, or remembering new things.

These effects can begin soon after treatment ends, or they may not appear
until much later. They dont always go away. If a person is older, it can be
hard to tell whether these changes in memory and concentration are a result
of treatment or of the aging process. Either way, some feel they just cant
focus as they once did.

Research is starting to explore why some people develop problems with

memory and concentration while others dont. It seems that people who have
had chemotherapy or have had radiation to the head area are at higher risk
for these problems. People who had high doses of chemotherapy may have
memory problems, but even those who had standard doses have reported
memory changes.

Getting Help
Your doctor can help you with memory and concentration problems. Talk
with him or her if:

You are still having memory and thinking problems. You may
want to ask about seeing a specialist (called a neuropsychologist) to
help you with these problems.

You think a medicine you are taking could be causing or

adding to your problem.

You think you suffer from depression or anxiety. These

problems can affect attention, concentration, and memory.

You are going through menopause. Some memory and

18 concentration problems can be related to menopause.
 Improving Memory and Concentration
Cancer survivors have found many ways to help improve their memory
after cancer treatment. See if any of these ideas work for you:

Jot it down. You can write down each task, how long it will take,
and where you need to go in a notebook or pocket calendar. Plan
your whole day. Keep it simple, and be realistic about how much
you can do in a day.

Set up reminders. Put small signs around the house to remind

you of things to do, such as taking out the trash or locking the door.

Group long numbers into chunks. For example, the phone

number 812-5846 can be repeated as eight-twelve, fifty-eight,
forty-six.

Talk yourself through tasks. When doing a task with a number

of steps, such as cooking or working on a computer, whisper each
step to yourself.

Manage stress. Managing stress better may improve your

memory and attention. And learning how to relax can help you
remain calm even in stressful moments.

Go over what you plan to say. Before you go to family events

or work functions, go over names, dates, and key points you want
to make.

Repeat what you want to remember. Saying it a couple of

times can help your mind hold on to the information.

For more information about chemobrain, see CancerCares listing in

the Resources section on page 57 or view the fact sheet Cognitive
Problems After Chemotherapy online at http://www.cancercare.org/
pdf/fact_sheets/fs_chemobrain_cognitive.pdf.

19
 Pain
Some people have a lot of pain after treatment, while others have less. Everyone
is different. Types of pain you may feel after cancer treatment include:

Pain or numbness in the hands and feet due to injured

nerves. Chemotherapy or surgery can damage nerves, which can
cause severe pain. For more information on nervous system changes,
see page 23.
Painful scars from surgery.
Pain in a missing limb or breast. While doctors dont know
why this pain occurs, it is real. Its not just in your mind. This is
sometimes called phantom pain.

Getting Help
If you find that you still have pain after treatment ends, your doctor can help
find the source of your pain and get relief. You do not have to be in pain. And
wanting to control pain is not a sign of weakness. Its a way to help you feel
better and stay active. Pain may be caused by treatment or other health issues,
such as arthritis.

With your help, your doctor can assess how severe your pain is and may
recommend one or more of the following approaches:

Pain-relief medicines. In most cases, doctors will try the mildest

medicines first. Then they will work up to stronger ones if you need
them. The key to getting relief is to take all medicines just as your
doctor prescribes. To keep pain under control, do not skip doses or wait
until you hurt to take these medicines.

You may be afraid that if you use these medicines youll become
addicted, but this rarely happens if you take the correct dose and
see your doctor regularly.

Antidepressant medicines. Some of these are prescribed to reduce

pain or numbness from injured nerves.
Physical therapy. Going to a physical therapist may help relieve
your pain. The therapist may use heat, cold, massage, pressure, and/or
exercise to help you feel better.
Braces. These limit movement of a painful limb or joint.
Acupuncture. This is a proven method that uses needles at pressure
20 points to reduce pain.
 Hypnosis, meditation, or yoga. Any of these may help your pain. A
trained specialist can teach you these approaches.
Relaxation skills. Many people with cancer have found that
practicing deep relaxation helps relieve their pain or reduce their stress.
Nerve blocks or surgery. If you dont get relief from the other
approaches in this section, you may want to ask your doctor about
these. Nerve blocks or surgery often help if you have persistent,
limiting pain, but they may put you at risk for other problems. They
may also require you to stay in the hospital.

Talking With Your Doctor About Pain

There are different ways you can describe your pain to your doctor:
Use numbers. Talk about how strong the pain feels on a scale of 0 to
10, with 0 being no pain and 10 being the worst pain you could have.
Describe what the pain feels like. Is it sharp, dull, throbbing,
steady?
Point out the exact places it hurts, either on your body or on a
drawing. Note whether the pain stays in one place or whether it moves
outward from the spot.
Explain when you feel pain. Note when it starts, how long it lasts,
if it gets better or worse at certain times of the day or night, and if
anything you do makes it better or worse.
Describe how your pain affects your daily life. Does it stop you
from working? Doing household chores? Seeing friends and family?
Going out and having fun?
Make a list of all the medicines you are taking (for any
reason). If you are taking any for pain relief, how much do they help?
Talk about any side effects you have from your pain control
medicine, such as constipation or other changes in bowel habits, or
feeling groggy or out of it. Many of these problems can be helped.
Keep a record of your pain. Jotting down notes about your pain
can help you track changes over time. It can also show how you
respond to any pain control medicine or other treatment you receive.

Make sure your insurance covers the pain relief approaches your
doctor recommends.

21
 Pain Diary
Use this pain diary and pain rating scale to record your pain.
(You may want to photocopy this sheet before writing on it.)

0 1 2 3 4 5 6 7 8 9 10

No Worst pain
pain imaginable

Date Time Pain Pain mediation Other pain-releif Side effects

rating (name, dose methods tried from pain
(010) how often taken) mediation

6/8 8a.m. 8 Morphine 30mg massage constipation

(example) every 4 hrs

22
 Nervous System Changes (Neuropathy)
Sometimes cancer treatment can cause damage to your nervous system. This
is called neuropathy (new-RAH-path-ee), or problems with nerve function.
Sometimes these symptoms can be made worse by other conditions, such as
diabetes, kidney failure, alcoholism, and malnutrition. Most people first notice
symptoms in their hands or feet, usually starting with their fingertips and toes.
Sometimes, the tingling and pain move up the fingers to the hands or from
the toes to the feet.

Common symptoms include tingling, burning, weakness, or numbness in your

hands or feet; sudden, sharp, stabbing, or electric shock pain sensations; loss
of sensation of touch; loss of balance or difficulty walking; clumsiness; trouble
picking up objects or buttoning clothes; hearing loss; jaw pain; constipation;
and being moreor lesssensitive to heat and cold.

Symptoms can start when you begin chemotherapy or after treatment. If they
do, tell your health care team right away. Symptoms can improve over time,
but it may take up to a year or more.

Getting Help
Treatments include medications, topical creams, and pain patches.

Other approaches include acupuncture, physical therapy, and exercise.

Managing Nervous System Changes

Be careful when handling knives, scissors, and other sharp objects.
Avoid falling. Walk slowly, hold onto handrails, and put no-slip bath
mats in your tub or shower. Remove area rugs or cords you could trip
over. Steady yourself when you walk by using a cane or other device.

Wear tennis shoes or other footwear with rubber soles.

Use a thermometer and gloves instead of your bare hand.
These can help you avoid being burned when checking water
temperature. If possible, lower the temperature setting on your hot
water heater.

Allow yourself time to rest.

23
 Lymphedema or Swelling
Lymphedema (LIMF-eh-DEE-ma) is a swelling of a part of the body caused by
the buildup of lymph fluids. It often happens in the arm, leg, face, or neck.
It can be caused by cancer or its treatment. There are many different types of
lymphedema. Some types happen right after surgery, are mild, and dont last
long. Other types can occur months or years after cancer treatment and can be
quite painful. These types can also develop after an insect bite, minor injury,
or burn.

People who are at risk for lymphedema are those who have had:

Breast cancer. If you had radiation therapy, or had your underarm

lymph nodes removed, or had radiation in the underarm area after
your lymph nodes were removed

Melanoma of the arms or legs. If you had lymph nodes removed

and/or had radiation therapy

Prostate cancer. If you had surgery or radiation therapy to the

whole pelvis

Cancer of the female or male reproductive organs. If you had

surgery to remove lymph nodes or had radiation therapy

Other cancers that have spread to the lower abdominal area.

The pressure from the growing tumor can make it hard for your body
to drain fluid.

Getting Help
Your doctor or nurse may be able to help you find ways to prevent and relieve
lymphedema. Ask about:

Skin care. Its important to keep your skin clean. You should also use
lotion to keep it moist.

Exercise. Find out about exercises to help the body drain lymph fluid
and what types of exercise you should not do.

24
 Ways to treat lymphedema. Your doctor may suggest:
Keeping the arm or leg raised above your chest for periods of time
Having special types of massage that can help by moving the lymph
fluid from where it has settled
Wearing special elastic sleeves and clothing that can help lymph
fluid drain
Losing weight
Finding sources of emotional support to help you cope
Avoiding procedures done in the area with lymphedema, such as
shots or blood tests

Preventing or Relieving Lymphedema

Other cancer survivors have found these tips helpful:

Watch for signs of swelling or infection (redness, pain, heat, fever).

Tell your doctor or nurse if your arm or leg is painful or swollen.

Keep your arm or leg free of cuts, insect bites, and sunburn. Try not to
have shots or blood tests done in that area.

Eat a well-balanced, protein-rich, low-salt diet.

Keep regular follow-up appointments with your doctor.

Wear loose-fitting clothing on your arm or leg.

Protect the area. Try not to use that arm or leg to figure out how hot
or cold something is, such as bath water or cooked food. You may be
less able to feel hot and cold now.

25
 Mouth or Teeth Problems
Many people who have been treated for cancer develop problems with their
mouth or teeth. Some problems go away after treatment. Others last a long
time, while some may never go away. Some problems may develop months or
years after your treatment has ended.

Radiation or surgery to the head and neck can cause problems with your teeth
and gums; the soft, moist lining of your mouth; glands that make saliva (spit);
and jawbones. If you were treated with certain types of chemotherapy, you
may also have these problems. This can cause:

Dry mouth

Cavities and other kinds of tooth problems

Loss of or change in sense of taste

Painful mouth and gums

Infections in your mouth

Jaw stiffness or jawbone changes

Who Has These Problems?

Almost all people who have had radiation therapy to the head and neck

Most people who have had bone marrow transplants

About two out of every five people treated with chemotherapy

Getting Help
If you find that problems persist after cancer treatment ends, talk with your
doctor about possible causes and ways to control mouth pain.

Try to see your dentist soon after you are done with treatment. Ask how often
you should have checkups and ways to take care of your mouth and teeth.

26
Preventing or Relieving Mouth or Teeth Problems
Keep your mouth moist.
Drink a lot of water.
Suck on ice chips.
Chew sugarless gum or suck on sugar-free hard candy.
Use a saliva substitute to help moisten your mouth.

4 Keep your mouth clean.

Brush your teeth, gums, and tongue with an extra-soft toothbrush
after every meal and at bedtime. If it hurts, soften the bristles in
warm water.
Ask your dentist for tooth sponges, such as Toothettes or Dentips,
that you can use in place of a toothbrush.
Use a mild fluoride toothpaste (like childrens toothpaste) and a
mouthwash without alcohol.
Floss your teeth gently every day. If your gums bleed or hurt, stay
away from the areas that are bleeding or sore, but keep flossing your
other teeth.
Rinse your mouth several times a day with a solution of 1/4 teaspoon
baking soda and 1/8 teaspoon salt in 1 cup of warm water. Follow
with a plain water rinse.
If you have dentures, clean, brush, and rinse them after meals. Have
your dentist check them to make sure they still fit you well.

4 If your mouth is sore, remember to stay away from:

Sharp, crunchy foods, like chips, that can scrape or cut your mouth
Foods that are hot, spicy, or high in acid, like citrus fruits and juices,
which can irritate your mouth
Sugary foods, like candy or soda, that can cause cavities
Toothpicks (they can cut your mouth)
All tobacco products
Alcoholic drinks

27
 Changes in Weight and Eating Habits
Some survivors who have had certain kinds of chemotherapy or medicines
have problems with weight gain. Sometimes the added pounds stay on even
when treatment ends. Breast cancer survivors who have had certain types of
chemotherapy gain weight in a different waythey may lose muscle and
gain fat tissue.

Unfortunately, the usual ways people try to lose weight may not work for
them. Try to be patient with yourself. Look for the positive things that you
can control, such as eating a healthy diet. Try to focus on the fact that
treatment is over, and you are trying to get stronger with time.

Some cancer survivors have the opposite problem: they have no desire to eat,
and they lose weight. Some men say that weight loss or loss of muscle tone is
a bigger concern for them than weight gain. It makes them feel less strong and
like less of a man.

Managing a Healthy Weight

For weight issues, ask your doctor or nurse about:

Doing strength-building exercises, if you have lost muscle or gained

fat tissue

Talking to a dietitian or nutritionist who can help you plan a healthy

diet that wont add extra pounds

Regaining a Lost Appetite

Here are some tips that have helped others improve their appetites:

Start with small meals. Five small meals a day may be easier to
manage than three larger ones.

Focus on your favorite foods. If the thought of eating still lacks

appeal, try the foods you really liked before treatment to jump-start
your appetite. Try adding some fresh fruit, juice, or other flavoring to
improve the taste.

Stay active. A short walk before a meal can help you feel hungry.

28
 Trouble Swallowing
Some people who have had radiation therapy or chemotherapy may find
it hard to eat because they have trouble swallowing. People who have had
radiation therapy to the head, neck, breast, or chest or those who have had
surgery involving the larynx may also have this problem.

Getting Help
Eat soft, bland foods moistened with sauces or gravies. Puddings,
ice cream, soups, applesauce, and bananas and other soft fruits are
nourishing and usually easy to swallow.
Use a blender to process solid foods.
Ask for advice from your health care team, including your doctor,
nurse, nutritionist, and/or speech pathologist.
Tilt your head back or move it forward while you are eating.
Have a sip of water every few minutes to help you swallow and talk more
easily. Carry a water bottle with you so you always have some handy.

Bladder or Bowel Control Problems

Bladder and bowel problems are among the most upsetting issues people
face after cancer treatment. People often feel ashamed or fearful to go out
in public. Going back to work was the hardest thing, one prostate cancer
survivor noted.

This loss of control can happen after treatment for bladder, prostate, colon,
rectal, ovarian, or other cancers. Your surgery may have left you with no
bladder or bowel control at all. Or perhaps you still have some control, but
you make lots of sudden trips to the bathroom. The opposite problem can
happen when a medicine you are taking for pain causes constipation.

Getting Help
It is very important to tell your doctor about any changes in your bladder or
bowel habits. Ask your doctor or nurse about:
Problems with constipation
Kegel exercises (see page 34 on muscle weakness)
Medicines that may help
Help in coping with ostomies. If you have an ostomy, an opening from
inside the body to the outside to pass urine or waste material, there are
services and support groups to help you cope with changes (see page 13).
29
 Menopause Symptoms
After chemotherapy, some women stop getting their periods every month
or stop getting them altogether. Some cancer treatments (and the medicines
tamoxifen and raloxifene) can cause changes in womens bodies and reduce the
amount of hormones they make. These changes can cause your periods to stop,
as well as cause other symptoms of menopause (also called the change
or change of life).

Over time, some women will start getting their periods again (this is more
likely for younger women), but others will not. Even though your doctor may
have discussed early menopause with you, give yourself permission to mourn
the loss of your fertility.

Some common signs of menopause are:

Irregular periods. One of the first signs is a change in your periods.
They may become less regular. They could be lighter. Some women
have short times of heavy bleeding. Sometimes, they stop all of
a sudden.
Hot flashes. Hot flashes are often worse at night and can affect sleep
or cause mood changes.
Problems with your vagina or bladder. Tissues in these areas
become drier and thinner. You may be more likely to get vaginal
infections. As you get older, you may also have problems holding your
urine or urinary tract problems.
Lack of interest in having sex. These changes may make it hard for
you to become sexually aroused.
Fatigue and sleep problems. You may feel tired or have trouble
getting to sleep, getting up early, or getting back to sleep after waking
up in the middle of the night.
Memory and other problems, such as depression, mood
swings, and irritability. Some of these, especially memory
problems, may be related to growing older. There may be a connection
between changes in your hormone levels and your emotions.
Other changes in your body. You may notice your waist getting
bigger, less muscle and more fat around your body, or thinning and loss
of elasticity of your skin.

Ask your doctor if you still need to use birth control

even if you are not getting your period.
30
Getting Help
See a gynecologist every year. Ask about:
Medicines, supplements, or other approaches that can help you manage
menopause symptoms
Tests you should have (such as a bone density test to see if you are at
risk for osteoporosis)
Ways you can reduce your chance of getting:
Osteoporosis. Menopause can put you at risk for losing bone
tissue, which can weaken your bones and make them easier
to break.
Heart disease. Menopause can also lead to higher cholesterol,
which can increase your risk of diseases that affect your heart and
blood vessels.

Relieving Hot Flashes

Here are some tips that have helped others deal with hot flashes:

Quit smoking.
Drink plenty of water.
Through exercise and diet, try to maintain a healthy
weight. Exercise most days of the week, doing both weight-bearing
and muscle-strengthening activities. Eat wisely. A balanced diet
will provide most of the nutrients and calories your body needs
to stay healthy.

If you are having hot flashes, try to write down when they
happen and what may cause them. This may help you find out what to
avoid. You may also want to:
Sleep in a cool room to avoid being awakened by hot flashes.
Dress in layers that you can take off if you get warm.
Use cotton sheets, and wear clothing that lets your skin breathe.
Try having a cold drink or turning on a fan at the beginning of a
hot flash.
Try not to eat a lot of spicy foods.
Limit the alcohol and caffeine you drink.

31
 Body Changes and Intimacy

Some body changes are short-term, and others will last forever. Either way,
your looks may be a big concern after treatment. For example, people with
ostomies after colon or rectal surgery are sometimes afraid to go out. They may
feel ashamed or afraid that others will reject them. They may worry about the
idea of having an accident in social situations.

Others dont like people being able to see treatment effects such as scars, skin
changes, loss of limbs, and changes in weight. Even if your treatment doesnt
show, your body changes may trouble you. Feelings of anger and grief are
natural. Feeling bad about your body can also lower your sex drive. This loss of
or reduction in your sex life may make you feel even worse about yourself.

Changes in the way you look can also be hard for your loved ones, which can
be hard on you. Parents and grandparents often worry about how they look
to a child or grandchild. They fear that changes in their appearance may scare
the child or get in the way of their staying close.

Getting Help
How do you cope with body changes?

Mourn your losses. They are real, and you have a right to grieve.

Try to focus on the ways that coping with cancer has made you
stronger, wiser, and more realistic.

If you find that your skin has changed from radiation, ask your doctor
about ways you can care for it.

Look for new ways to enhance your appearance. A new haircut, hair
color, makeup, or clothing may give you a lift.

If you choose to wear a breast form (prosthesis), make sure it fits you
well. Your health insurance plan may pay for it.

Try to recognize that you are more than your cancer. Know that you
have worthno matter how you look or what happens to you in life.

32
 Body Changes and Intimacy
Changes in Sex Life
You may have changes in your sex life after cancer treatmentmany people
do. Depending on the cancer you had, these problems may be short-term
or long-term. For example, about half of women who have had long-term
treatment for breast and reproductive organ cancers and more than half of
men treated for prostate cancer report long-term sexual problems. Many
cancer survivors say they were not prepared for the changes in their sex lives.

Sexual problems after cancer treatment are often caused by changes to your
bodyfrom surgery, chemotherapy, or radiation, or by the effects of certain
medicines. Sometimes emotional issues can be the cause of sexual problems.
Some examples include anxiety, depression, feelings of guilt about how you
got cancer, changes in body image after surgery, and stress between you and
your partner. Your past sex life is not related to your current sexual problems.

What types of problems occur? People report these main concerns:

Worrying about intimacy after treatment. Some may struggle

with their body image after treatment. Even thinking about being seen
without clothes may be stressful. People may worry that having sex will
hurt or that they wont be able to perform or will feel less attractive.
Pain, loss of interest, depression, or cancer medicines can also affect
sex drive.

Not being able to have sex as you did before. Some cancer
treatments cause changes in sex organs that also change your sex life.
Some men can no longer get or keep an erection after treatment for
prostate cancer, cancer of the penis, or cancer of the testes. Some
treatments can also weaken a mans orgasm or make it dry.
Some women find it harder, or even painful, to have sex after
cancer treatment. Some cancer treatments can cause these problems;
sometimes, there is no clear cause. Some women also have a loss
of sensation in their genital area.

Having menopause symptoms. When women stop getting their

periods, they can get hot flashes, dryness or tightness in the vagina,
and/or other problems that can affect their desire to have sex.

Losing the ability to have children. Some cancer treatments can

cause infertility, making it impossible for cancer survivors to have
children. Depending on type of treatment, age, and length of time
since treatment, you may still be able to have children. For more
information about fertility, refer to the organization Fertile Hope at
http://fertilehope.org. 33
 Getting Help

I knew about the chance of impotence. What

I didnt expect was my total loss of interest in
sex, which really caused some problems
between my wife and me. MITCH

Your doctor may be able to help you deal with these problems, but he or she
may not bring up the subject. You may have to mention it yourself. If you
think you might have trouble getting started, bring this booklet with you.

Often, sexual problems will not get better on their own. To get help with
many of these problems, its important to tell your doctor about any changes
in your sex life. Sometimes there can be an underlying medical problem that
causes changes, such as:
Erection problems. Medicine, assistive devices, counseling, surgery,
or other approaches may help.
Vaginal dryness. Dryness or tightness in the vagina can be caused
by menopause. Ask whether using a water-based lubricant during sex,
using vaginal dilators before sex, and/or taking hormones or using a
hormone cream are options for you.
Muscle weakness. You can help strengthen muscles in your genital
area by doing Kegel exercises. Practice by controlling your muscles to
stop the flow of urine. You can do these exercises even when you are
not urinating. Just tighten and relax the muscles as you sit, stand, or
go about your day.

Other issues you may want to discuss include:

Concerns about having children. Discuss family planning
concerns with your doctor. If youre a woman, ask if you still need to
use birth control, even if you are not getting your period.
Talking with a counselor or a psychologist. You may feel that
some of your sexual problems are due to your emotions, like stress or
body image. Some people find that sexual problems related to cancer
start to strain their relationship with their partner. If this is the case,
ask a nurse or social worker if you can talk to a counselor. Talking to
someone alone, or with your partner, may help.
Seeing a sex therapist. He or she may be able to help you talk
openly about your problems, work through your concerns, and come
up with new ways to help you and your partner.
34
 Talking With Your Partner
Even for a couple that has been together a long time, staying connected
can be a major challenge at first. It may be comforting to learn that very
few committed relationships end because of ostomies, scars, or other body
changes. Divorce rates are about the same for people with and without a
cancer history.

Tell your partner how you feel about your sex life and what you would like to
change. You might want to talk about your concerns, your beliefs about why
your sex life is the way it is, your feelings, and what would make you feel better.

Approaching it openly avoids blame, stays positive, and gives your partner a
better sense of how you are feeling. Here is an example of how you might start
your discussion:
I know its tough to talk about, but I think we should discuss our sex life.
Weve only made love a few times lately. I miss being close to you. I worry
that my scars might be a problem. Can you tell me how you feel?

Try to be open minded as you listen to your partners point of view:

Focus on your partners comments, not on what you plan to say

in response.

Repeat what he or she says in your own words.

Ask questions to better understand your partners concerns.

Acknowledge that your partners views matter to you. Say things like I
see why you might think that or I never thought of it that way before.

Feeling Intimate After Treatment

Be proud of your body. It got you through treatment!
Think of things that help you feel more attractive and
confident.
Focus on the positive. Try to be aware of your thoughts, since they
can affect your sex life.

Touch each other. Kiss, hug, and cuddle, even if you cannot have
the kind of sex that you used to have.

Be open to change. You may find new ways to enjoy intimacy.

35
 Dating
If youre single, body changes and concerns about sex can affect how you feel
about dating. As you struggle to accept the changes yourself, you may also
worry about how someone else will react to physical things, such as scars or
ostomies. Or you may find it awkward to bring up sexual problems or loss of
fertility, which can make feeling close even harder.

You may wonder how and when to tell a new person in your life about your
cancer and body changes. For some, the fear of being rejected keeps them from
seeking the social life they would like to have. Others who choose not to date
may face pressure from friends or family to be more sociable. Here are some
ideas that can make it easier to get back into social situations:

Focus on activities that you have time to enjoy, such as taking a class or
joining a club.

Try not to let cancer be an excuse for not dating or trying to meet people.

Wait until you feel a sense of trust and friendship before telling a new
date about your cancer. Practice what you will say to someone if you
are worried about how you will handle it. Think about how he or she
might react, and be ready with a response.

Think about dating as a learning process with the goal of having a

social life you enjoy. Not every date has to be perfect. If some people
reject you (which can happen with or without cancer), you have not
failed. Try to remember that not all dates worked out before you
had cancer.

36
 Your Feelings
Your Feelings

I dont think you ever forget the fact that

it could come back. EMILY

Just as cancer treatment affects your physical health, it can affect the way
you feel, think, and do the things you like to do. Its normal to have many
different feelings after treatment ends. Just as you need to take care of your
body after treatment, you need to take care of your emotions.

Each persons experience with cancer is different, and the feelings, emotions,
and fears that you have are unique. The values you grew up with may affect
how you think about and deal with cancer. Some people may feel they have
to be strong and protect their friends and families. Others seek support from
loved ones or other cancer survivors or turn to their faith to help them cope.
Some seek help from counselors and others outside the family, while others
dont feel comfortable with this approach.

Whatever you decide, its important to do whats right for you and try not to
compare yourself with others.

Worrying About Your Health

Worrying about the cancer coming back is normal, especially during the first
year after treatment. This is one of the most common fears people have after
cancer treatment. For some, the fear is so strong that they no longer enjoy
life, sleep well, eat well, or even go to follow-up visits. If I get it again, what
am I going to do? one woman said. I never thought Id make it through the
first time. Others may react in a more positive way. As one survivor put it,
Cancer is just part of life, and we always have hope.

As time goes by, many survivors report that they think about their cancer
less often. However, even years after treatment, some events may cause you
to become worried. Follow-up visits, symptoms similar to the ones you had
before, the illness of a family member, or the anniversary of the date you were
diagnosed can trigger concern.

37
 Coping With Fear of Cancer Returning
Be informed. Learning about your cancer, understanding what
you can do for your health now, and finding out about the services
available to you can give you a greater sense of control. Some studies
even suggest that people who are well-informed about their illness
and treatment are more likely to follow their treatment plans and
recover from cancer more quickly than those who are not.

Express your feelings of fear, anger, or sadness. People have

found that when they express strong feelings like anger or sadness,
theyre more able to let go of them. Some sort out their feelings by
talking to friends or family, other cancer survivors, or a counselor. But
even if you prefer not to discuss your cancer with others, you can still
sort out your feelings by thinking about them or writing them down.

Look for the positive. Sometimes this means looking for the good
even in a bad time or trying to be hopeful instead of thinking the
worst. Try to use your energy to focus on wellness and what you can
do now to stay as healthy as possible.

Dont blame yourself for your cancer. Some people believe

that they got cancer because of something they did or did not do.
Remember, cancer can happen to anyone.

You dont have to be upbeat all the time. Many people say
they want to have the freedom to give in to their feelings sometimes.
As one woman said, When it gets really bad, I just tell my family Im
having a bad cancer day and go upstairs and crawl into bed.

Find ways to help yourself relax. The exercises on pages 6061

have been proven to help others and may help you relax when you
feel worried.

Be as active as you can. Getting out of the house and doing

something can help you focus on other things besides cancer and the
worries it brings.

Look at what you can control. Some people say that putting
their lives in order helps. Being involved in your health care, keeping
your appointments, and making changes in your lifestyle are among
the things you can control. Even setting a daily schedule can give
you a sense of control. And while no one can control every thought,
some say that they try not to dwell on the fearful ones.
38
 Feeling Stress
When you were diagnosed, you may have put concerns such as family, work, or
finances aside. Now that treatment is over, these issues may begin to resurface.

Many cancer survivors also worry that stress may have played a role in their
illness. Its important to remember that the exact cause of many cancers is still
unknown. No research shows that stress causes cancer, but we do know that
stress can cause other health problems. Finding ways to reduce or control the
stress in your life may help you feel better. Devoting time to any activities that
make you feel calm or relaxed may help.

Reducing Stress
Many survivors have found activities like the ones below useful in dealing
with their worries after treatment ends. Ask your doctor, nurse, social worker,
or local cancer organization about taking part in activities like these.

Exercise. Exercise is a known way to reduce stress and feel less

tensewhether youve had cancer or not. As one man put it, I can
feel down a little bit, and it is a fine line with depression, but when
I walk 30 or 45 minutes in the fresh air, I feel like I can take on the
world sometimes. See your doctor before making an exercise plan, and
be careful not to overdo it. If you cant walk, ask about other types of
movement that may be helpful, such as chair exercises or stretching.

Mind-body methods. Things like meditation or relaxation may help

you lower stress by quieting your mind. Try focusing on your breathing
or repeating words or phrases to yourself. Other methods include
hypnosis, yoga, or imagery.

Creative outlets. Art, music, or dance gives people the chance to

express themselves in different ways. Even people who have never
danced, painted, or drawn before have found these activities helpful
and fun.

Sharing personal stories. Telling and hearing stories about living

with cancer can help people air their concerns, solve problems, and
find meaning in what theyve been through. See pages 4445 for
support group information.

39
 Finding Humor and Laughing

Is cancer life-threatening? Yes, but why die

mad? So I joked about it all the way through,
and I think it helped me. ARI

Laughter can help you relax. When you laugh, your brain releases chemicals
that produce pleasure and relax your muscles. Even a smile can fight off
stressful thoughts. Of course, you may not always feel like laughing, but other
people have found that these ideas can help:

Ask people to send you funny cards.

Enjoy the funny things children and pets do.

Watch funny movies or TV shows.

Listen to comedy recordings.

Buy a funny desk calendar.

Read joke books or check out jokes on the Internet.

If you dont own a computer, use one at your local library.

You may even find that you can laugh at yourself. I went by to help a friend
this summer, and it was really hot, so I took my wig off, one woman said.
I got ready to go and I couldnt find it. After searching high and low, I found
it hanging from her dogs mouth. But I just stuck it on my head and went
home. My husband said, What happened? Needless to say that wig has
never been the same.

40
 Coping With Depression and Anxiety
After treatment, you may still feel angry, tense, or sad. For most people, these
feelings go away or lessen over time. For some people though, these emotions
can become more severe. The painful feelings do not get any better, and they
get in the way of daily life. These people may have a medical condition called
depression. For some, cancer treatment may have added to this problem by
changing the way the brain works.

Getting Help
Talk with your doctor. If your doctor thinks that you suffer from depression,
he or she may treat it or refer you to other experts. Many survivors get help
from therapists who are experts in both depression and helping people
recovering from cancer. Your doctor may also give you medicine to help you
feel less tense.

If you find it hard to talk about your feelings, you may want to show your
doctor this booklet. It can help you explain what youre going through. Dont
feel that you should have to control these feelings on your own. Getting the
help you need is important for your life and your health.

Do I Need Help?
If you have any of the following signs for more than 2 weeks, talk to your
doctor about treatment. Some symptoms could be due to physical problems,
so its important to be willing to talk about them with your doctor.

Emotional signs:
Feelings of worry, anxiety, or sadness that dont go away
Feeling emotionally numb
Feeling overwhelmed, out of control, or shaky
Having a sense of guilt or feeling unworthy
Feeling helpless or hopeless
Feeling short-tempered or moody
Having a hard time concentrating, or feeling scatterbrained
Crying for long periods of time or many times each day
Focusing on worries or problems

41
 Having a hard time getting certain thoughts out of your mind
Finding it hard to enjoy everyday things, such as food or being
with friends
Finding yourself avoiding situations or things that you know are
really harmless
Thinking about hurting or killing yourself

Body changes:
Unintended weight gain or loss not due to illness or treatment
Sleep problems, such as not being able to sleep, having nightmares,
or sleeping too much
Racing heart, dry mouth, increased perspiration, upset stomach,
diarrhea
Physically slowing down
Fatigue that doesnt go away, headaches, or other aches and pains

Feeling Angry
Many people find themselves feeling angry about having cancer or about
things that happened to them during their diagnosis or treatment. They may
have had a bad experience with a health care provider or with an unsupportive
friend or relative.

Feeling angry is normal. And sometimes it can motivate you to take action.
But hanging on to it can get in the way of taking care of yourself or moving
on. If you can, look at whats causing your anger and what you can do to
lessen it.

42
 Feeling Alone

I went to radiation treatment every day, and

the staff became like part of my family. And
then when I finished, there was this instant
separation, and I really felt a loss. TOM

After treatment, you may miss the support you got from your health care
team. You may feel as if your safety net has been pulled away and that you get
less attention and support from health care providers now that treatment is
over. Feelings like these are normal any time your regular contact with people
who mean a lot to you comes to an end.

Its also normal to feel somewhat cut off from other peopleeven family and
friendsafter cancer treatment. Often, friends and family want to help, but
they dont know how. Others may be scared of the disease. You may also feel
that only others who have had cancer can understand your feelings.

Getting Help
What can you do to make yourself feel better? Try to think about how you
could replace the emotional support you used to receive from your health care
team, such as:

Asking one of your nurses or doctors if you could call

sometimes. This could help you stay connected and help you feel
less alone. Even just knowing you can call them may help.

Finding support services offered over the phone or Internet.

Finding new sources of support for your recovery. Friends,

family, other cancer survivors, and clergy members are a few ideas.

Joining a cancer support group. People who have had cancer meet
in groups to talk about their feelings and concerns. Besides sharing their
own stories, they hear what others have gone through and how other
people have dealt with the same problems they are facing. A support
group may also help members of your family cope with their concerns.

43
 Joining a Support Group

I could feel myself getting down, and I

joined this group and we have a great time.
We cry, we laugh, we carry on. ELIA

Support groups can have many benefits. Even though a lot of people receive
support from friends and family, the number one reason they join a support
group is to be with others who have had similar cancer experiences. Some
research shows that joining a support group improves quality of life and
enhances survival.

Support groups can:

Give you a chance to talk about your feelings and work through them
Help you deal with practical problems, such as problems at work
or school
Help you cope with side effects of treatment

Types of Support Groups and Where To Find Them

There are many different types of support groups. Some may be for one type of
cancer only, while others may be open to those with any cancer. Some may be
for women or for men only. Support groups may be led by health professionals
or fellow cancer survivors.

Support groups arent just for people who have had cancer. Support groups can
be helpful for children or family members of survivors. These groups focus on
family concerns such as role changes, relationship changes, financial worries,
and how to support the person who had cancer. Some groups include both
cancer survivors and family members.

Not only do support groups meet in person, they also meet online. Internet
support groups can be a big help to people with computers who live in rural
areas or who have trouble getting to meetings. Some Internet groups are
sponsored by cancer organizations, while others are not monitored. With
informal chat groups, you can seek support at any time of the day or night.
While these online groups can provide valuable emotional support, they may
not always offer correct medical information. Be careful about any cancer
information you get from the Internet, and check with your doctor before
making any changes that are based on what you read.
44
Is a Support Group Right for Me?
A support group may not be right for everyone. For some people, hearing
about others problems can make them feel worse. Or you may find that your
need for a support group changes over time.

If you are thinking about joining a support group, here are some questions
you may want to ask the groups contact person:

How large is the group?

Who attends (survivors, family members, types of cancer, age range)?
How long are the meetings?
How often does the group meet?
How long has the group been together?
Who leads the meetingsa professional or a survivor?
What is the format of the meetings?
Is the main purpose to share feelings, or do people also offer tips to
solve common problems?
If I go, can I just sit and listen?

Before joining a group, here are questions you may want to ask yourself:

Am I comfortable talking about personal issues?

Do I have something to offer to the group?
What do I hope to gain by joining a group?

Support groups vary greatly, and if you have one bad experience, it doesnt
mean support groups are not a good option for you. You may also want to find
another cancer survivor with whom you can discuss your cancer experience.
Many organizations can pair you with someone who had your type of cancer
and is close to your age and background.

The Association of Cancer Online Resources (ACOR) offers access to

mailing lists that provide support and information to those affected by
cancer and related disorders. The ACOR mailing lists are a group of free,
unmoderated discussion lists for patients, family, friends, researchers, and
physicians to discuss clinical and other issues and advances pertaining to
all forms of cancer. Learn more online at http://www.acor.org.

45
 Finding Meaning After Cancer Treatment

After treatment for breast cancer, I knew

my life had changed forever. Nothing could
ever be the same. I was very sad about all the
things that had changed, but I felt I had
been given the gift of a new life. LINDA

Survivors often express the need to understand what having had cancer means
to their lives now. In fact, many find that cancer causes them to look at life in
new ways. They may reflect on spirituality, the purpose of life, and what they
value most.

These changes can be very positive. Many report feeling lucky or blessed to
have survived treatment and take new joy in each day. For some, the meaning
of their illness becomes clear only after they have been living with cancer for
a long time; for others, the meaning changes over time. Its also common to
view the cancer experience both negatively and positively at the same time.

Often, people make changes in their lives to reflect what matters most to
them now. You might spend more time with your loved ones, place less focus
on your job, or enjoy the pleasures of nature. You might also find that going
through a crisis like cancer gives you renewed strength.

I feel good that Ive found ways to cope, one colon cancer survivor said.
I also feel better able to handle any future problems that might come up.
I have strength that I didnt know I had.

Faith, Religion, or Spirituality

Having a serious illness can affect your spiritual outlook, regardless of whether
you feel connected to traditional religious beliefs. After treatment, you and
your loved ones may struggle to understand why cancer has entered your lives.
You may wonder why you had to endure such a trial in your life.

Cancer survivors often report that they look at their faith or spirituality in a
new way. For some, their faith may get stronger or seem more vital. Others
may question their faith and wonder about the meaning of life or their
purpose in it. Many say they have a new focus on the present and try to live
each day to the fullest.
46
Many survivors have found that their faith, religion, or sense of spirituality
is a source of strength. They say that through their faith, they have been able
to find meaning in their lives and make sense of their cancer experience.
Faith or religion can also be a way for survivors to connect with others in
their community who may share similar experiences or outlooks or who can
provide support. Studies have also shown that for some, religion can be an
important part of both coping with and recovering from cancer.

The way cancer affects faith or spirituality is different for everyone. Its
common to question your beliefs after cancer. These questions can be
difficult, but for some, seeking answers and searching for personal meaning in
spirituality helps them cope.

Finding Comfort and Meaning

Read uplifting stories about the human spirit.
Pray or meditate to help you gain perspective.
Take part in community or social gatherings for your own
support and to support others.

Talk with others who have had similar experiences.

Find resources at a place of worship for people dealing with chronic
illnesses like cancer.

Grieve for your losses. Recognize that you have been through a lot,
and its normal to be sad over the way life was before cancer.

Finding Support
How can you find faith-based support in your community? Here are some
ideas that have helped other cancer survivors:
Contact a religious or spiritual leader in your community.
Most have been trained in counseling people with major illnesses.
Contact the chaplain at your local hospital or treatment
facility. Most hospitals have a staff chaplain who can provide support
to people of different faiths and religions, as well as people who do not
consider themselves religious at all. These chaplains have also been
trained to provide spiritual support to patients and families in crisis.
Talk with your hospital, health care team, or social worker.
They may know about faith-based organizations in your community
that provide specialized services for cancer survivors. 47
 How Can You Find New Meaning in Your Life After Cancer?
Assess your life. Some survivors say their cancer gave them a wake-
up call and a second chance to make life what they want it to be. Ask
yourself: do your roles in your family fulfill you, or are you doing what
people expect of you? What are things youve always wanted to try?
Are you happy in your job, or are you just used to it?

Seek spiritual support. A trusted clergy member or professional

counselor may be able to help you with life questions.

Keep a journal. Write down your thoughts about what gives meaning
to your life now.

Think about helping others who have had cancer. For some,
reaching out and helping others helps them find meaning. Others want
to get cancer out of their minds and prefer to focus their energy in
other ways. If you want to help, many local and national cancer groups
need volunteers. Or you may prefer to reach out to people you know
and spread the word through family and friends. (The NCI booklet
Facing Forward: Making a Difference in Cancer gives more information.
See the Resources section on page 57 for how to order it.)

Think about taking part in a research study. Research studies

are trying to identify the effects of cancer and its treatment on
survivors. Joining a research study is always voluntary, and it could
benefit both you and others. If you want to learn more about studies
that involve cancer survivors, talk with your doctor or see the
Resources section.

48
 Social and Work Relationships
Social and Work Relationships

I think some families become stronger because

of it. Weve had our rough spots, but we have
never again taken each other for granted.
DARRYL

Having cancer can change relationships with the people in your life. Its
normal to notice changes in the way you relate to family, friends, and other
people that you are around every dayand the way they relate to you.

Your Family
When treatment ends, families are often not prepared for the fact that
recovery takes time. In general, your recovery will take much longer than your
treatment did. Survivors often say that they didnt realize how much time they
needed to recover. This can lead to disappointment, worry, and frustration for
everyone. Families also may not realize that the way their family works may
have changed permanently as a result of cancer. They may need help to deal
with the changes and keep the new family strong.

Some survivors say they would not have been able to cope without their
family members and the help they offered. And even though treatment
has ended, they still receive a lot of support. For others, problems that were
present before the cancer may still exist, or new ones may develop. You may
receive less support from others than you had hoped.

Even though treatment has ended, you may face problems with your family.
For instance, if you used to take care of the house or yard before your
treatment, you may find that these jobs are still too much for you to handle.
Yet family members who took over for you may want life to go back to normal
and expect you to do what you used to do around the house. You may feel
that you arent getting the support you need.

At other times, you may expect more from your family than you receive.
They may disappoint you, which might make you angry or frustrated. For one
woman, it was a family members lack of support during her treatment that
upset her. Never once, not a card, not a phone call, and I have a hard time
looking at her today.
49
 You may still need to depend on others during this time, even though you
want to get back to the role you had in your family before. At the same time,
your family is still adjusting. It may be hard for you and your family to express
feelings or know how to talk about your cancer.

To help your family members, you may want to share NCIs booklet for
caregivers, Facing Forward: When Someone You Love Has Completed Cancer
Treatment. Go to http://www.cancer.gov and search "caregivers."

Getting Help With Family Issues

Some family members may have trouble adjusting to changes or feel that their
needs arent being met. Your family may want to deal with issues such as these
on its own, or you may want to consider getting help. Ask your doctor or
social worker to refer you to a counselor or therapist. An expert on family roles
and concerns after cancer treatment may be able to help your family solve
its problems.

How do you cope with family issues? Here are some ideas that have helped
others deal with family concerns:

Let others know what you are able to do as you healand what not
to expect. For example, dont feel you must keep the house or yard in
perfect order because you always did in the past.

Give yourself time. You and your family may be able to adjust over
time to the changes cancer brings. Just being open with each other can
help ensure that each persons needs are met.

Help the children in your family understand that you were treated for
cancer and that it may take a while for you to have the energy you used
to have.

Children of cancer survivors have said that these things are important:

Being honest with them

Speaking as directly and openly as possible

Allowing them to become informed about your cancer and involved in

your recovery

Spending extra time with them

With your permission, other family members should also be open with your
children about your cancer and its treatment.

50
 Your Workplace
Research shows that cancer survivors who continue to work are as productive
on the job as other workers. Most cancer survivors who are physically able to
work do go back to their jobs. Returning to work can help them feel they are
getting back to the life they had before being diagnosed with cancer.

Some cancer survivors change jobs after cancer treatment. If you decide to look
for a new job after cancer treatment, remember that you do not need to try to
do moreor settle for lessthan you are able to handle. If you have a rsum,
list your jobs by the skills you have or what youve done, rather than by jobs
and dates worked. This way, you dont highlight the time you didnt work due to
your cancer treatment.

Whether returning to their old jobs or beginning new ones, some survivors are
treated unfairly when they return to the workplace. Employers and employees
may have doubts about cancer survivors ability to work.

Handling Problems at Work

Decide how to handle the problem.
What are your rights as an employee?
Are you willing to take action to correct a problem?
Do you still want to work there? Or would you rather look for a
new job?
If necessary, ask your employer to adjust to your needs.
Start by talking informally to your supervisor, personnel office,
employee assistance counselor, shop steward, or union representative.
Ask for a change that would make it easier for you to keep your job
(for example, flextime, working at home, special equipment at work).
Document each request and its outcome for your records.
Get help working with your employer if you need it.
Ask your doctor or nurse to find times for follow-up visits that dont
conflict with your other responsibilities.
Get your doctor to write a letter to your employer or personnel
officer explaining how, if at all, your cancer may affect your work
or your schedule.

You have no legal obligation to talk about your cancer history unless your
past health has a direct impact on the job you seek.
51
 My boss has been
good about the time
off Ive takenso far.
But I still worry that
questions about my
health will hurt my
future here. LISA

52
 Friends and Coworkers

When you say the C word, it just turns

some people right off, and they will mumble
something and walk off. JACK

The response of friends, coworkers, or people at school after your cancer

treatment may differ. Some may be a huge source of support, while others may
be a source of anger or frustration. Some people mean well, but they do not
know the right thing to say. Maybe they just dont know how to offer support.
Others dont want to deal with your cancer at all.

If friends and coworkers seem unsupportive, it could be because they are

anxious for you or for themselves. Your cancer experience may threaten them
because it reminds them that cancer can happen to anyone. Try to understand
their fears and be patient as you try to regain a good relationship.

Many survivors say that acting cheerful around others for their comfort is a
strain. I dont want to smile any more, one melanoma survivor said. I dont
have the energy to be upbeat all the time. A prostate cancer survivor noted,
You know if you complain sometimes, for some people, it turns them off. So I
try not to do that.

As survivors sort out what matters most, they may even decide to let some
casual friendships go, to give more time to the meaningful ones. One brain
cancer survivor found that after cancer, You really know how many true
friends youve got. And they dont stop calling just because they hear youre
in remission. They really love you and think something of you. A kidney
cancer survivor found that letting weak friendships go was hard, but I also
got support I didnt expect from people at work and in church.

On the job or where you volunteer, some people may not understand about
cancer and your ability to perform while recovering from treatment. They may
think you arent able to work as hard as before or that your having had cancer
means you are going to die soon. Sometimes, fear and lack of knowledge result
in unfair treatment.

53
 Getting Help
If you find that a friend or coworkers feelings about cancer are hurting you, try
to resolve the problem with that person face-to-face. If it is still affecting your
work after that, your manager, shop steward, company medical department,
employee assistance counselor, or personnel office may be able to help.

When hurtful remarks or actions get you down, talking with a friend, family
member, or counselor may help you come up with ideas for handling it. But
if coworker attitudes get in the way of doing your job, it is a problem that
management should address.

Relating to Others
How do you relate to other people in your life after cancer treatment?

Accept help. When friends or family offer to help, say yes, and have
in mind some things that they could do to make your life easier. In
this way, you will get the support you need, and your loved ones will
feel helpful. When I first started treatment, I had a lot of help, said
one colon cancer survivor. So I felt bad asking my friends for more
help when my treatment ended. But I still really needed it, so I let
them know.
Address any problems that come up when you go back to
work or school. Your supervisor (or his or her supervisor), teacher,
or coworkers may be able to help those around you understand how
you want to be treated as a cancer survivor. If problems with others
get in the way of your work or studies, you may want to talk with your
bosses, your union, the companys Human Resources department, or
the schools Student Affairs office.
Keep up contacts during your recovery. Friends and coworkers
will worry about you. If they find out about your treatment and
progress, they will be less anxious and scared. Talk to them on the
phone, send email, or appoint a trusted friend or family member to do
this for you. When you are able, have lunch with friends or stop in for
an office party. Your return to work or other activities will be easier for
you and others if you stay in touch.
Plan what youll say about your cancer. There is no right way to
deal with others about your illness, but you do need to think about what
youll say when youre back on the job. Some cancer survivors dont
want to focus on their cancer or be linked in peoples minds with the
disease. Others are very open about it, speaking frankly with their boss
or other workers to air concerns, correct wrong ideas, and decide how to
54 work together. The best approach is the one that feels right to you.
 Reflection
Reflection

courage doesnt always roar.

sometimes courage is the
quiet voice at the end of the day saying,
i will try again tomorrow.
MARY ANNE RADMACHER*

The end of treatment can be a time to look forward to

the future. New rituals and new beginnings can bring a
sense of relief and joy. It may also be a time of physical
and emotional change.

Now that treatment is over, try to take time to get

back in tune with yourself. Allow healing time for
you and your family members and caregivers. Think
about what you can do to begin living without cancer
as a main focus.

Whether good or bad, life-changing situations often

give people the chance to grow, learn, and appreciate
whats important to them.

Many people with cancer describe their experience

as a journey. Its not necessarily a journey they would
have chosen for themselves.

But it sometimes presents the opportunity to look at

things in a different way.

* used with permission 55

 Appendix

Financial and Legal Matters

The financial challenges that people with cancer and their families face are ve y real.
During an illness, you and your family may have found it hard to find the time or energy to
review your options. Yet its important to keep your family financially health .

For hospital bills, you may want to talk with a hospital financial counselo . You may be able
to work out a monthly payment plan or even get a reduced rate. You may also want to stay
in touch with your insurance company to make sure costs are covered.

For information about resources that are available, see the Resources section. You can also
go to the NCI database, Organizations That Offer Support Services, at http://www.
cancer.gov, search terms financial assistance. Or call toll-free 1-800-4-CANCER (1-800
422-6237) to ask for help.

Legal Documents
If you havent developed an advance directive, you may want to consider it. Advance
directives are legal documents that let a person decide important issues ahead of time,
including how much treatment to receive and who should make decisions if he or she
cant. Having an advance directive helps ensure that you get the treatment you want.
Understanding your wishes will also make it easier for family members if a time comes
when treatment decisions need to be made.

Advance directives:
A living will lets people know what kind of medical care patients want if they are
unable to speak for themselves.

A durable power of attorney for health care names a person to make

medical decisions for a patient if he or she cant make them. This person, chosen
by the patient, is called a health care proxy.

Other legal papers that are not part of the advance directives:
A will tells how a person wants to divide money and property among his or her
heirs. (Heirs are usually the surviving family members. Other people may also be
named as heirs in a will.)

A trust appoints the person a patient chooses to manage money for him or her.

Power of attorney appoints a person to make financial decisions for the patient
when he or she cant make them.

A lawyer does not always need to be present when you fill out these papers. Howeve , a
notary public may be needed. Each state has its own laws about advance directives. Check
with your lawyer or social worker about the laws in your state. See the Resources section on
page 57 for more information.
56
 Appendix
For a Complete List of Resources
See the database, National Organizations That Offer
Resources Support Services, at www.cancer.gov, search terms
national organizations. Or call 1-800-4-CANCER
(1-800-422-6237) to ask for help.
Federal Agencies
National Cancer Institute
NCI provides current information on cancer prevention, screening, diagnosis, treatment,
genetics, and supportive care. It also lists clinical trials and specific cancer topics in NCI s
Physician Data Query (PDQ) database. The following material may also be helpful.
To download, visit NCIs Web site or call NCIs Cancer Information Service (CIS) toll-free.

Facing Forward: Making a Difference in Cancer

Facing Forward: When Someone You Love Has Completed Cancer Treatment
Support for Caregivers

Moving Beyond Breast Cancer video (view or download online )

Cancer Information Service

CIS answers questions about cancer, clinical trials, and cancer-related services and helps
users find information on the NCI eb site. It also provides NCI printed materials.
Phone: 1-800-4-CANCER (1-800-422-6237)
Web-site: http://www.cancer.gov
Chat online: http://www.cancer.gov/help

Administration on Aging
The Administration on Aging provides information, assistance, individual counseling,
organization of support groups, caregiver training, respite care, and supplemental services.
Phone: 1-202-619-0724
TTY: 1-800-877-8339
Web-site: http://www.aoa.gov

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services provides information for consumers
about patient rights, prescription drugs, and health insurance issues, including Medicare
and Medicaid.
Phone: 1-800-MEDICARE (1-800-633-4227)
Web-site: http://www.medicare.gov (for Medicare information) or
http://www.cms.hhs.gov
(for the free booklet Medicare Basics: A Guide for Caregivers)

Equal Employment Opportunity Commission

EEOC provides fact sheets about job discrimination, protections under the Americans
With Disabilities Act, and employer responsibilities. It also coordinates investigations of
employment discrimination.
Phone: 1-800-669-4000
TTY: 1-800-669-6820
Web-site: http://www.eeoc.gov
57
 National Association of Area Agencies on Aging/Eldercare Locator
The Eldercare Locator is a nationwide directory assistance service designed to help
older persons and caregivers find local resou ces for support. Areas of support include
transportation, meals, home care, housing alternatives, legal issues, and social activities.
Phone: 1-800-677-1116
Web-site: http://www.eldercare.gov

U.S. Department of Labor/Office of Disability Empl yment Policy

The U.S. Department of Labor provides fact sheets on a variety of disability issues, including
discrimination, workplace accommodation, and legal rights.
Phone: 1-866-ODEP-DOL (1-866-633-7365)
TTY: 1-877-889-5627
Web-site: http://www.dol.gov/odep

Nonprofit Organization
American Cancer Society/National Cancer Information Center
ACS provides cancer information and support to patients, families, and caregivers. It also
supports research, community education, and advocacy and public policy issues.
Phone: 1-800-ACS-2345 (1-800-227-2345)
Web-site: http://www.cancer.org

CancerCare
CancerCare provides free, professional support services to anyone affected by cancer:
people with cancer, caregivers, children, loved ones, and the bereaved. CancerCare
programsincluding counseling, education, financial assistance and practical help
are provided by trained oncology social workers and are free of charge.
Phone: 1-800-813-HOPE (1-800-813-4673)
Web-site: http://www.cancercare.org

Cancer Hope Network

Cancer Hope Network matches patients and families with trained volunteers who have
recovered from a similar cancer experience.
Phone: 1-877-HOPENET (1-877-467-3638)
Web-site: http://www.cancerhopenetwork.org

Cancer Support Community

Cancer Support Community is a national organization that provides support groups, stress
reduction and cancer education workshops, nutrition guidance, exercise sessions, and
social events.
Phone: 1-888-793-WELL (1-888-793-9355)
Web-site: http://www.cancersupportcommunity.org

58
Family Caregiver Alliance
FCA addresses the needs of families and friends who provide long-term care at home.
Phone: 1-800-445-8106
Web-site: http://www.caregiver.org

Fertile Hope
Fertile Hope is dedicated to providing reproductive information, support, and hope to
cancer patients and survivors whose medical treatments present the risk of infertility.
Phone: 1-855-220-7777
Web-site: http://www.fertilehope.org

Livestrong
Livestrong seeks to inspire and empower people living with, through,
and beyond cancer to live strong. It provides education, advocacy, and public
health and research programs.
Phone: 1-512-236-8820 (general number)
1-866-235-7205 (LIVESTRONG SurvivorCare program)
Web-site: http://www.livestrong.org

National Coalition for Cancer Survivorship

NCCS provides information and resources on cancer support, advocacy, and quality-of-life
issues to cancer survivors and their loved ones.
Phone: 1-877-NCCS-YES (1-877-622-7937)
Web-site: http://www.canceradvocacy.org

National Family Caregivers Association

NFCA provides information, education, support, public awareness, and advocacy
for caregivers.
Phone: 1-800-896-3650
Web-site: http://www.nfcacares.org

NeedyMeds
The NeedyMeds Web site lists medicine assistance programs available from drug
companies. NOTE: Usually, patients cannot apply directly to these programs. Ask a doctor,
nurse, or social worker to contact NeedyMeds on your behalf.
Web-site: http://www.needymeds.com

Patient Advocate Foundation

PAF provides education, legal counseling, and referrals to cancer patients and survivors.
It specializes in matters related to managed care, insurance, nancial issues, job
discrimination, and debt crisis.
Phone: 1-800-532-5274
Web-site: http://www.patientadvocate.org

59
 Learning To Relax
Many people with cancer have found that
practicing deep relaxation has helped relieve Practicing
their pain or reduce their stress. The Relaxation To
exercises on the next few pages may not Relieve Pain and Stress
be right for everyone. Ask your doctor
Relaxation can help you feel betterboth
or nurse if these exercises can help
mentally and physically. For most of us, though,
you. Before trying the full exercise
it is not easy to just relax. Relaxation is a skill, and
below, first practice steps 1 through it needs to be practiced, just like any other skill.
5, so you can get used to deep
breathing and muscle relaxation. Many people wait until they are in a lot of pain or feel
a lot of stress before they try to relax, when it can be
You may find that your mind hardest to succeed. Then they might try to relax by
wanders. When you notice yourself overeating, smoking, or drinkingactivities that are
thinking of something else, gently not helpful and might even be harmful.
direct your attention back to your Take the time to learn helpful relaxation skills
deepening relaxation. Be sure to and practice them often. You can also
maintain your deep breathing. take a class or buy a relaxation
If any of these steps makes you feel tape or CD.
uncomfortable, feel free to leave it out.

Exercise 1
1. Find a quiet place where you can rest undisturbed for 20 minutes. Let others know you
need this time for yourself.

2. Make sure the setting is relaxing. For example, dim the lights if you like, and find
comfortable chair or couch.

3. Get into a comfortable position where you can relax your muscles. Close your eyes and
clear your mind of distractions.

4. Breathe deeply, at a slow and relaxing pace. People usually breathe shallowly, high
in their chests. Concentrate on breathing deeply and slowly, raising your belly, rather
than just your chest, with each breath.

5. Next, go through each of your major muscle groups, tensing (squeezing) them for
10 seconds and then relaxing. If tensing any particular muscle group is painful, skip
the tensing step and concentrate just on relaxing. Focus completely on releasing all the
tension from your muscles and notice the differences you feel when they are relaxed.
Focus on the pleasant feeling of relaxation.

In turn, tense, hold, and relax your:

Right and left arms. Make a fist and bring it up to your shoulde , tightening
your arm.

Lips, eyes, and forehead. Scowl, raise your eyebrows, pucker your lips, and
then grin.

Jaws and neck. Thrust your lower jaw out, and then relax. Then tilt your chin down
60 toward your chest.
 Shoulders. Shrug your shoulders upward toward your ears.

Chest. Push out your chest.

Stomach. Suck in your stomach.

Lower back. Stretch your lower back so that it forms a gentle arch, with your
stomach pushed outward. Make sure to do this gently, as these muscles are
often tight.

Buttocks. Squeeze your buttocks together.

Thighs. Press your thighs together.

Calves. Point your toes up, toward your knees.

Feet. Point your toes down, like a ballet dancers.

6. Review these parts of your body again and release any tension that remains. Be sure to
maintain your deep breathing.
7. Now that you are relaxed, imagine a calming scene. Choose a spot that is particularly
pleasant to you. It may be a favorite comfortable room, a sandy beach, a chair in front
of a fireplace, or any other relaxing place. Concentrate on the details

What can you see around you?

What do you smell?

What are the sounds that you hear? For example, if you are on the beach, how
does the sand feel on your feet, how do the waves sound, and how does the
air smell?

Can you taste anything?

Continue to breathe deeply as you imagine yourself relaxing in your safe,

comfortable place.

8. Some people find it helpful at this point to focus on thoughts that enhance thei
relaxation. For example: My arms and legs are very comfortable. I can just sink into
this chair and focus only on the relaxation.

9. Spend a few more minutes enjoying the feeling of comfort and relaxation.

10. When you are ready, start gently moving your hands and feet and bringing yourself
back to reality. Open your eyes and spend a few minutes becoming more alert. Notice
how you feel now that you have completed the relaxation exercise, and try to carry
these feelings with you into the rest of your day.

Exercise 2
1. Sit comfortably. Loosen any tight clothes. Close your eyes. Clear your mind and relax
your muscles using steps 4 and 5 above.

2. Focus your mind on your right arm. Repeat to yourself, My right arm feels heavy and
warm. Stick with it until your arm does feel heavy and warm.

3. Repeat with the rest of your muscles until you are fully relaxed.

61
 NIH Publication No. 14-2424
Revised May 2014

NIH...Turning Discovery Into Health