Part 5: Cancer, the gift that keeps on giving

By Debbie Kerr

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I only use the tagline, “the gift that keeps on giving” because it’s the one that's been used in commercials over the years. A camera is a gift that keeps on giving with every picture taken. An oven or stove is the gift that keeps on giving with every meal made.  Cancer, while not a gift, does keep on giving, even once active treatments end. For example, bad gifts (like clothes when you want toys) include fears of recurrence as well as side effects from both active treatment (like chemo, surgery, radiation) and medications used to keep cancer from returning. Good gifts are those items you really want (or find out you want after you receive them). For example, my gift from cancer was learning the following:

• I'm a lot stronger emotionally than I thought I could be.
• My sense of humour is actually a good thing.
• I shouldn’t be afraid to try new things because I've already dealt with the fear associated with cancer.  

Unfortunately, when it comes to cancer, we can’t return the bad gifts. We certainly can't re-gift them. Our only option is to figure out what to do with them. 

Physical Pain
For those people whose cancer was hormone driven, the option is available to take medication that will help prevent a cancer recurrence…at least that’s the hope. There are no guarantees. Unfortunately, like any medication, there are potential side effects. Some women, like Joanne, say, “Yes, the estrogen blocker I am taking has many side effects but I decided that I wanted to get back to my normal life as soon as possible; so I ignore those side effects and only focus on what makes me happy (I got used to the drugs after two months).” Dee on the other hand says, “I have been done with active treatment for about four years and I have been taking Tamoxifen on and off. I have horrible joint pain and depression. I am on pain meds and shots for my knees. I feel worse now than when I first finished my treatments.”

Some women will have very few side effects. Others will have side effects that they soldier through. Others will not get used to the side effects and may stop taking their medication because they feel that their quality of life is too adversely affected. Others may ask their doctors to switch them to a different medication. These are all options, but if you’re thinking about switching to a different medication, go to breastcancer.org to see a summary of medication options and their potential side effects. When looking at the chart, remember that some medications can have two names, as shown below:

• Arimidex = anastrozole
• Aromasin = exemestane
• Femara = letrozole
• Tamoxifen
• Evista = raloxifene
• Fareston = toremifene
• Faslodex = fulvestrant

Notice that many of the side effects of these medications are actually symptoms of menopause, which is when estrogen levels drop. This is good news for cancer patients who were hormone receptor positive.  

Emotional Pain
No one can truly appreciate what it’s like to have cancer until they’ve experienced it and, even when you experience it, you don’t expect the emotional impact of cancer to continue well after the active treatments end. 

After my last active treatment (radiation), depression hit me for the first time in my cancer journey. It surprised me.  No one warned me that this was a feeling I might have and that it was perfectly normal. I thought I might be depressed early or during my journey, but never after the treatments were done.

Lianne, a seven year cancer survivor, explains the reason for this feeling. “When I was in treatment it was like a job. I had a goal, I had appointments to go to, I was being checked on regularly by medical professionals and then that last day of radiation hit and I was sent on my way. I was completely lost and didn't know what I should be doing. I certainly wasn't feeling as celebratory as I thought I would. Everyone around me was happy and assumed things would all be the same as they were before treatment.” 

For any number of reasons, some women talk about wanting to cry. Rebecca says, “It seems like everything just gets to me and I want to cry.” She feels strongly that it’s the medication, “Although my medical oncologist said the research said Tamoxifen doesn't cause depression, I greatly disagree. I suppose it could be more of a Post-Traumatic Stress Disorder (PTSD) thing, but I blame it more on the medication, because I didn't have these issues after surgery or during radiation. I did lots of crying and lots of arguing with my family until my radiation oncologist prescribed Effexor.”

Sally says, “I’m not usually a whiner, but I've never been so miserable.” She has both physical and emotional pain. Like others, she believes her issues are tied to the hormone blockers she takes.

Sharlene believes there are other reasons for her pain. She believes “The lack of compassion and care I received led to me losing my job, my life as I knew it, and my soul.”

These are all very powerful statements about some very strong emotions. The words are direct and honest. They demonstrate how critical it is for women to receive ongoing support, even after active treatment has ended.

These strong emotions may be the result of the cancer experience itself, the side effects of medication, the symptoms of menopause or a combination. These are the bad gifts that we have to learn how to handle.

Like cancer, everyone has their own unique experience. Not everyone experiences the same emotional pain. Margie is one of those people. “I've met everything head-on with a positive attitude. I've never broken down. I refuse to let it get to me. If it wasn't for the hair loss and a little tiredness, no one would ever have known that I had breast cancer.”

My friend, Rosanne, who has Stage IV breast cancer, uses the line, “It is what it is.” Her belief is that you have to roll with the punches. There’s no sense in getting really upset about the circumstances. She just celebrates when test results show a spot has either shrunk or not grown. She keeps things in perspective. Her focus is on her grandson and the upcoming wedding of one of her daughters.

I automatically found humour during my cancer experience and, ironically, sometimes I find it harder to laugh now about everyday events than I did about cancer. Like other people who have had breast cancer, I think about a recurrence at mammogram time, when I have a cough that won’t go away, or when I have aches and pain, but I try to put these thoughts to the back of mind.

People talk about the quality of life associated with physical pain, but the quality of your life can also suffer if you don’t take steps to deal with fear, anxiety, depression, and even post-traumatic stress disorder (PTSD). You have to know when you need help and be willing to accept it.  

Recommendations
Here are some recommendations from people who have been through what you may be going through:

• Consider counselling: Lianne said, “I thought I didn't need counselling because I had such an excellent support system around me but I did attend my cancer centre and it really helped. Ann is being proactive. Rather than waiting to see if she may need emotional support now that her active treatment has ended, she has already booked an appointment  with the social worker associated with the cancer centre where she went for treatment. 
• Look for books that may help you: Lianne also discovered a book that really helped her called Picking up the Pieces - Moving Forward after Surviving Cancer by Kathy Scalzo and Sherri Magee.  Ann, too, likes the books and says, “I am doing the daily journals and scans right now. It is helpful!”
• Read booklets: Different countries will provide different booklets to their cancer patients. On the Canadian Cancer Society there are a lot of booklets that you may find helpful. For example, you may want to check out “Pain Relief: A guide for people with cancer” and “Life After Cancer Treatment.”
• Read articles and websites: Lacey provided a link to an article about Post Traumatic Stress Disorder (PTSD) from the Globe and Mail newspaper and more information can be found through the American Cancer Society.
• Exercise: Joanne says, “I have always exercised through all my treatments to keep myself energized, happy and in shape.” Ann says she will be taking advantage of the UW Well-Fit program at the University of Waterloo (Ontario, Canada). If you don’t live in the area, see if your cancer centre has suggestions about where you can access an exercise program that is for people who have had cancer.
• Find your inner peace: Denise says, “I found Qigong. This daily practice is a foundation for me every day to live with resilience and empowerment, regardless of what’s happening outside of me.” 
• Keep your sense of humour: Never underestimate the power of laughter, even if you have to dig deep.
• Give yourself time: Give yourself enough time to adjust to your new life and, if applicable, your new medication. Laura can attest to this. “I did have some leg pain when I first started the Tamoxifen, now it's just occasional Charlie horses at night.” If you feel emotional pain because of how you look or feel, these feelings may change with time.
• Keep an open mind: Don’t decide what your reaction will be to medication before you try it. Fear can make pain more intense than it really has to be. 
• Accept change: Accept that cancer changes everything. Some things will go back to some kind of normal and other things will never be the same. As Mary says, “I look at everything differently. I am different. I miss the before-cancer me. But I’m also thankful for everything.”
• Try complementary treatments and techniques: You may want to try yoga, meditation or acupuncture to help with both your emotional and physical pain.
• Pay it forward: Help others who are going through what you’ve been through. When you focus on others, it helps you to forget some of what you don’t like about life after cancer. Focus on the good you can do and not the things you can’t do.
• Focus on the present: Don’t let fear ruin your today by worrying about tomorrow and a potential recurrence.
• Keep busy: Sometimes having too much time on your hands can mean more time to worry and focus on the negatives instead of the positives about life after cancer.
• Remember the Prize: You are alive.

​Take control of your life. If you feel like you can’t take it anymore, and we all feel like that sometimes, you have to take action. Use your newfound strength to improve your quality of life. Try some of the recommendations and maybe you'll find something that works for you.

To see previous posts from the series on pain, look for Parts 1 to 4 in the side navigation panel.

Part 1: The Emotional Pain of Cancer
Part 2: Cancer and Surgical Pain, What a Drain
Part 3: Chemo Pain…cancer’s untold story
Part 4: Radiation…cancer’s sunburn