Topic Overview

"In my head, I felt I was cured. After I recovered from my breast cancer surgery, that's how I thought of myself. So when my doctor told me last month that my cancer had come back, my world came crashing down, hard."—Kelly, 42

"When my doctor told me that my cancer had spread, I felt ready to give up then and there. But my friends and family have given me incredible support. I know I'll be spending the time I have left being cared for and loved. I'm learning to cherish every day."—Andy, 53

Getting that first cancer diagnosis was bad enough. But hearing that cancer has come back or spread can take an even bigger toll.

You're likely feeling your way through a maze of emotions. As powerless as you may feel, it can help to remember there are things you still have control over. You can:

• Deal with the stress.
• Get support.
• Find the positive side.
• Take back control.

Dealing with the stress

It's hard to imagine many things that could be more stressful than learning that your cancer has come back or has spread. You may worry about the future, about more treatment and more side effects, about your job, about your family.

Relaxing your mind and body with deep breathing and guided imagery can help you manage your worries and feel better.

Some people need more than relaxation techniques. If your emotions are getting in the way of your daily life or your ability to take care of yourself, you can get help from a counsellor with expertise in this area. Ask your doctor to help you find one.

Getting support

Relationships take on new importance when you're faced with cancer that has come back or has spread. Maybe you had an army of people supporting you the first time your cancer appeared. Or maybe you went through it alone. But now you need other people more than ever.

Reach out to your family and friends. They want to help, but some of them may not know what to do. Tell them how they can help. Ask them to:

• Listen to you and give you encouragement. This can keep you from feeling hopeless or alone.
• Help with small daily tasks or with bigger problems. A helping hand can keep you from feeling overwhelmed.
• Go to doctor visits with you. Your loved ones can offer support by being involved in your medical care.

You can also look for help from other sources.

• Counselling can help you cope with cancer, cancer treatments, and the effect cancer is having on your life.
• Your health care team should be supportive. Be open and honest about your fears and concerns. Your doctor can help you get the right medical treatments, including counselling.
• Spiritual or religious groups can provide comfort and may be able to help you find counselling or other social support services.
• Social groups can help you meet new people and get involved in activities you enjoy.
• Community support groups give you the chance to talk to others who have dealt with the same problems as you have. You can encourage one another and learn ways of coping with tough emotions.

Finding the positive side

Having someone tell you to "stay positive" might make you just plain mad at first. But staying positive can actually help you feel better.

Research shows that what your brain produces depends in part on your thoughts, feelings, and expectations. If you're sick but you have hope and a positive attitude and you believe that you'll get better, your brain is likely to produce chemicals that will boost your body's healing power.^{footnote 1}

You can learn to be more positive by changing how you think and act. And when you take control of your outlook, you gain a little more control over your life.

Change how you think

• Face your fear. It's normal to be afraid. But it's important to acknowledge your fears—talk about them, even—and then try not to dwell on them.
• Stay present. Notice when you are telling yourself things about your future, and then try to bring yourself back to the present.
• Take control. Think about the things in your life that you have control over, and take control over them. For example, you can control whether or not you have visitors.

Change how you act

• Seek out people who make you feel better. Develop a support network.
• Believe in yourself. Do things to gain self confidence and build self-esteem.
• Do things that you enjoy. See a movie. Laugh with your friends. Know what's important to you.
• Be thankful for the good you see around you.

Using what you know

You've coped with cancer before. You know a lot about it and about your coping skills. You can use that knowledge now.

It may feel like cancer is controlling your life, but you're still in charge. Think about what worked—and what didn't work—during past treatments:

• What side effects did you have? What can you do to plan for managing those side effects in the future?
• Who was in your support network? Make sure those people are on your team again this time around.
• What things were hardest to cope with before? What can you do this time to make it easier?

Setting goals—large and small—is another way to stay in charge. For example, if one of your goals is to attend a family wedding in 2 months, make a list of the smaller goals that will get you there, like eating a healthy diet and getting some exercise every day.

Being an active patient is a way to feel more in control. Talk to your doctor about your feelings, and ask lots of questions. Ask for copies of your medical records. Know what your treatment is going to be and why your doctor is recommending it.

Where to learn more

The Canadian Cancer Society and the U.S. National Cancer Institute websites offer lots of help for coping with cancer. The following articles may help you:

From the Canadian Cancer Society:

• "Living With Cancer: A Guide for People With Cancer and Their Caregivers," www.cancer.ca/Canada-wide/Publications/Alphabetical list of publications/Living with cancer A guide for people with cancer and their caregivers.aspx?sc_lang=en
• "Living With Advanced Cancer," www.cancer.ca/Canada-wide/Publications/Alphabetical list of publications/Living with advanced cancer.aspx?sc_lang=en

From the U.S. National Cancer Institute:

• "When Cancer Returns," www.cancer.gov/cancertopics/coping/when-cancer-returns
• "Coping With Advanced Cancer," www.cancer.gov/cancertopics/coping/advancedcancer