After effects of cancer
Hester Hill Schnipper, LICSW, OSW-C Program Manager Emeritus, Oncology Social Work
APRIL 15, 2019
Over the past few weeks, I have been in multiple conversations in my group as well as in individual sessions about the many ways that cancer continues to be a presence in our lives. The flip description is: Cancer: the gift that keeps on giving. This is a phrase that can only be used by others who have been through the experience, definitely not something that should be uttered by others.
There are the serious issues that usually fill our hearts and minds: worry about a possible recurrence, possible cardiac damage from left-side radiation or particular chemo drugs, chronic GI issues from abdominal radiation, or never-ending mouth issues from radiation to the mouth or face. This is just part of the list, but the importance of these very real difficulties cannot be over-estimated. Blessedly, most of us have authentic worries about possibilities, but don't have to contend with the realities.
The next category is the opposite end of the worry spectrum: things that are annoying, but definitely not critical. This list includes things like thinner eyelashes or eyebrows that grow back after chemo hair loss. Many women feel that their hair is changed, occasionally someone likes her post-chemo hair better, but, more often, we think that it is less thick or the texture is different, and there may well be more gray than before. We learn to deal with the thinner lashes and brows, and share tips. For example, using eye shadow to draw in brows looks better than using brow pencil. There are mascaras that claim to lengthen lashes, and some women have eyelid tattoos or semi-permanent lashes done.
Somewhere in the middle are things like adapting to changed bodies and, sometimes, chronic fatigue or, at least, less energy. I am currently working with several women who had bilateral mastectomies without reconstruction. They all feel that they made the right choice for themselves, but adapting to a new body is difficult. As the weather becomes warmer, and winter dressing in layers becomes impossible, there are new questions about what to wear. One is especially concerned about going to the beach with her kids and what kind of bathing suit may be possible. Other people have other body modifications that require adjustments, and those that are apparent to the world are especially challenging. Among the hardest are people who have had surgery for head or neck cancers and have very visible changes in their faces.
Many of us are heavier post cancer. Whether those extra pounds are due to medications or to menopause or to stress eating and less exercise, we generally don't like the extra pounds. Losing weight can be even harder than ever, and there is a point of graceful acceptance that is an important goal. Yes, we know that maintaining a healthy weight is very important and may reduce the risk of a recurrence, but it also isn't psychologically wise to be obsessed with the scale and the belt hole that we can fasten. Trying to find the sweet spot of maintaining a healthy weight, but still enjoying life is a shared goal.
Fatigue is also age-related in addition to maybe being treatment-related. We are all older than we used to be, and there is no way to know what our baseline energy level would be if we had not had cancer. I know a number of people who are convinced that they never regained their pre-cancer endurance level, but there is no certainty about that. The best response is the one we all know: stick with exercise and try to gradually increase your stamina and your strength. It's the old Use it or lose it.
There is an often-used phrase that I personally dislike: the new normal. It is real, however, that we are changed by cancer, and there are likely to be continuing issues or souvenirs of what we have experienced.