Survivorship: What Now?Melissa C Palmer, LCSW, ACHP-SW, APHSW-C, JD Apr 27, 2021
A clean bill of health. The cancer is gone. Next check up in a year. Your transplant surgery is a success. These are the words all people living with cancer or transplant long to hear. The new goal is getting back to “normal”. The thing is, most of the time, returning to the way things were before diagnosis is not an option. After the initial euphoria of realizing “I beat cancer!” or “I got the transplant!”, survivors have to re-learn how to live and adapt to the fantastic and not so great aspects of life after a serious illness.
Many of the survivors I have met with over the years say they live in worry or fear that the cancer will come back. Maybe not this month or this year, but someday. Some survivors admit that this possibility allows them to live fully in the moment, but others shared that it makes it difficult to really relax and enjoy things. I have also heard that living through a serious illness helps survivors “clean house” emotionally and existentially and only keep what is really meaningful in their lives. But they can also feel a sense of loss and grief for the people and their own functioning they have lost along the way. One patient I recall in particular who had breast cancer immediately resumed chain smoking after treatment; when I asked about this she said, “If I am going to die someday anyway, I want to enjoy the ride”.
People who receive transplants such as bone marrow, liver, kidney, and other organs have a complicated and long road ahead; their lives are affected by the efficacy of the plethora of life-long medications they take to keep the body from rejecting their new transplant. The focus has shifted from “making it to the transplant” to adjusting to the chronic nature of post-transplant life. Now the focus is on trying to regain strength and functioning from deconditioning and healing that occurs after transplant.
Survivors have told me that in spite of all the logical evidence to the contrary, people around them are afraid to be close (the magical thinking of cancer by association) or don’t know what to say so they back off. Thankfully survivor support groups can be helpful; the members have a shared experience and can understand one another on a deep level.
Returning to “normal” is not an option for many survivors, and they adjust to varying degrees depending on the level of functional, cognitive and physical changes. The people I have seen really struggle are those who have disfigurement, profound physical functional changes, and severe cognitive impairment. Post traumatic growth can occur in people who are optimistic, have social supports and have overall healthy coping.
Melissa C Palmer, LCSW ACHP-SW APHSW-C JD
The articles below address more about survivorship:
Burney, S. (2019) Psychological Issues in Cancer Survivorship. Climacteric, 22(6), 584-588.
Lai, J. (2020) Liver Transplant Survivorship. Liver Transplantation, 22, 1030-1033.