How to deal with your emotions when your cancer comes back

You may feel disappointment too. After all the time and effort that you and your medical team have put in to beat your cancer, you seem to be right back where you started. What has just happened, and, more importantly, where to next?

"Facing cancer is extremely challenging," explains Linda Greeff - ovarian cancer survivor and oncology social work manager at CancerCare. "And, the process of learning to come to terms with this illness - especially a second or third time round - requires a great deal of courage, tenacity and strength".

"Disappointment is probably the biggest and most prominent emotion when your cancer comes back," says Dr Vanessa Marais, a clinical psychologist who specialises in cancer, oncology, depression and anxiety. "Whether you were in remission for a short or longer time, a recurrence is always a huge disappointment that's met with shock and fear, and is often accompanied by negative emotions such as depression, anxiety and guilt."

Listen to our podcast on Emotional Support at all stages of a cancer journey, here.

What you're experiencing is neither right nor wrong

All of these negative emotions are part and parcel of every cancer journey and need to be dealt with upfront, adds Greeff. "Everyone's story is different and the emotions that you are experiencing are neither right nor wrong. They are true to you and they are very real but they do need to be expressed constructively because a destructive attitude will be of no help as you try to find ways to cope with where you are right now."

The trick here, according to Dr Marais, is to seek professional help and find a safe place to unpack all these negative emotions, so that you can be better focussed for what lies ahead.

Dr Marais offers the following guidelines:

• Feeling like you have been through the journey before and that you know what to expect on a next round of cancer, may make the process even scarier than that first time in your mind. Rather, try using the knowledge you have to prepare yourself and "organise" your support system (friends and family) in advance to help you through this journey again
• Make sure that you ask your oncology team about the prognosis and possible progression of the cancer and what the treatment is going to entail so that you know how and for what (more or less) to prepare, and to enable you to deal with your future with hope, and with realistic expectations
• Because cancer, especially cancer that has reoccurred, forces you to confront your own mortality and an uncertain future, it's normal to develop (or feel) depression and anxiety. If you are too anxious or depressed you will not be able to concentrate on your treatment, so never be ashamed to discuss these feelings with your medical team and ask to be referred to a psychologist or psychiatrist.

Ditching the guilt - and other emotions

"It's normal to have feelings of guilt as a cancer patient," adds Dr Marais. "You may feel that it was somehow your fault that you got cancer or that it came back and that because of you, your family have to go through feelings of pain and distress. You may also feel that you are a liability to them or that you will become a liability. It's important to discuss these emotions with your family, to tell them how you feel and to listen to their thoughts and feedback. “Feelings of guilt are often intensified and become invasive, especially if you are young and have young children. This, for a whole host of reasons including your lack of strength to maintain your parental role due to treatment side-effects.”

Try to reduce your feelings of guilt by:

• Seeking professional help. You can only cope effectively with your cancer and treatment if you are willing to acknowledge and accept your emotions and to deal with them
• Working with your symptoms instead of fighting them. Plan around your treatment dates and side-effects such as pain and fatigue, and use the days that you feel good and strong to do family activities
• Setting practical goals in terms of your own life and responsibilities, your job and your family - but they do need to be realistic. Set small goals around your treatment - such as going to watch an important cricket match or ballet concert after a treatment, and making this happen to celebrate getting through to that stage of treatment. Doing this is a key source of emotional well-being
• Never losing hope because hope will help you to manage uncertainty. It allows you to feel scared, anxious and full of despair and to still remain positive, with the knowledge of treatment and reliable statistics of survivorship keeping you hopeful at the same time.

How to build hope

Greeff offers the following suggestions on how to build, and maintain, hope.

Work on limiting the following to avoid losing hope:

• Cynicism – that comes from self, others, media and social media
• Loneliness – build your support system and ask for help
• Overwhelming fear
• Constant conflict
• Anxiety /tension/stress
• Depression

Constantly build hope by:

• Surrounding yourself with people who help you to do so
• Setting small achievable goals
• Practicing gratitude
• Doing something creative
• Facing difficult conversations
• Telling your loved ones you love them
• Asking for what you need.