Facing Forward

Life After Cancer Treatment

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U.S. DEPARTMENT

OF HEALTH AND

HUMAN SERVICES

National Institutes

of Health
A Note About Cancer Survivors

There are more than 10 million people in the U.S. today 

who are cancer survivors. Three out of every four American

families will have at least one family member diagnosed 

with cancer. To help support survivors’ unique needs, the

National Cancer Institute (NCI) formed the Office of 

Cancer Survivorship (OCS) in 1996. The office is dedicated 

to enhancing the length and quality of life of people with

cancer. OCS also promotes research that looks at the longand short-term effects of cancer and its treatment. For more

information about survivorship issues and OCS, visit online 

at www.survivorship.cancer.gov.

Acknowledgments

We would like to offer a sincere thank you to the extraordinary

survivors who contributed to the development and review of

this booklet.

NCI extends a special thanks to the following researchers for

their pivotal work in the area of cancer survivorship under 

NCI Grant No. CA63018. Facing Forward was adapted from

materials used in the study, Moving Beyond Cancer. 

■ Patricia A. Ganz, M.D., Professor, UCLA Schools of 

Medicine and Public Health and Division of Cancer

Prevention & Control Research, Jonsson Comprehensive

Cancer Center, Los Angeles, CA

■ Beth Leedham, Ph.D., Clinical Psychologist, private

practice, Encino, CA

■ Beth E. Meyerowitz, Ph.D., Professor, Department of

Psychology, University of Southern California, 

Los Angeles, CA

This booklet is also available in Spanish 

(visit www.cancer.gov or call 1-800-4-CANCER). 

Este folleto también se puede obtener en español.
Facing Forward

Life After Cancer Treatment

“While I was having chemo, I quit doing

almost everything. So when treatment

ended, the challenge for me was, what

am I going to do now with my life?

What should I go back to doing?” —LEN
Now that treatment is over ...

Many cancer survivors have told us

that while they felt they had lots of

information and support during their

illness, once treatment stopped, they

entered a whole new world—one

filled with new questions. This

booklet was written to share common

feelings and reactions that many

people just like you have had after

treatment ended. 

It also offers some practical tips to

help you through this time. Use this

booklet in whatever way works best

for you. You can read it from

beginning to end. Or you can just

refer to the section you need. 

This booklet shares what we have

learned from other survivors about life after cancer: practical ways of dealing

with common problems and guidelines for managing your physical, social,

and emotional health. When possible, we include specific information from

research with cancer survivors.

While cancer is a major event for all who are diagnosed, it brings with it the

chance for growth. As hard as treatment can be, many cancer survivors have

told us that the experience led them to make important changes in their lives.

Many say they now take time to appreciate each new day. They also have

learned how to take better care of themselves and value how others care for

them. Others draw from their experience to become advocates to improve

cancer research, treatment, and care. 

We hope that this booklet will serve as a resource and inspiration to you as

you face forward to your life after cancer.

Who is a survivor?

This booklet uses the term “cancer

survivor” to include anyone who

has been diagnosed with cancer,

from the time of diagnosis through

the rest of his or her life. Family

members, friends, and caregivers are

also part of the survivorship

experience. 

You may not like the word, or you

may feel that it does not apply to

you, but the word “survivor” helps

many people think about embracing

their lives beyond their illness.

For ease of reading, rather than listing the many professionals that you may

see as part of your medical care, you’ll find the term “doctor” used in the

booklet to describe all medical interactions.
Table of Contents

Congratulations on Finishing Your Cancer Treatment ......................1

What Is “Normal” After Treatment?............................................................1

Getting Follow-up Medical Care.........................................................2

What Is Follow-up Care? .............................................................................3

Which Doctor Should I See Now? How Often? ..........................................5

A Survivor’s Wellness Plan...........................................................................5

Talking With Your Doctor............................................................................7

Questions About Your Follow-up Plan ......................................................10

Guidelines for Follow-up Care...................................................................11

Ways To Manage Physical Changes...................................................15

Fatigue ........................................................................................................16

Memory and Concentration Changes.......................................................18

Pain.............................................................................................................20

Nervous System Changes (Neuropathy)....................................................23

Lymphedema or Swelling ..........................................................................24

Mouth or Teeth Problems ..........................................................................26

Changes in Weight and Eating Habits ......................................................28

Trouble Swallowing....................................................................................29

Bladder or Bowel Control Problems ..........................................................29

Menopause Symptoms...............................................................................30

Body Changes and Intimacy.............................................................32

Your Feelings.....................................................................................37

Social and Work Relationships.........................................................49

Reflection ..........................................................................................55

Appendix ...........................................................................................56

Financial and Legal Matters.......................................................................56

Resources ....................................................................................................57

Learning To Relax ......................................................................................60
“I thought when I’d finished

treatment—when they looked at my 

tests and they said it looked good—

I thought, OK, I’m done. 

But now I’m starting to realize 

that it’s not over.” — J ANE
1

Congratulations on Finishing 

Your Cancer Treatment

The end of cancer treatment is often a time to rejoice. You are probably relieved to

be finished with the demands of treatment and are ready to put the experience

behind you. Yet at the same time, you may feel sad and worried. It’s common to 

be concerned about whether the cancer will come back and what you should do

after treatment.

When treatment ends, you may expect life to return to the way it was before you

were diagnosed with cancer. But it can take time to recover. You may have

permanent scars on your body, or you may not be able to do some things you

once did easily. Or you may even have emotional scars from going through so

much. You may find that others think of you differently now—or you may view

yourself in a different way.

One of the hardest things after treatment is not knowing what happens next. 

“Because the doctors and nurses never told 

me what to expect, I had very unrealistic 

expectations of wellness, and so did my 

family and friends. This led to a great deal 

of worry.” —BOB

What Is “Normal” After Cancer Treatment?

Those who have gone through cancer treatment describe the first few months as

a time of change. It’s not so much “getting back to normal” as it is finding out

what’s normal for you now. People often say that life has new meaning or that

they look at things differently now. You can also expect things to keep changing

as you begin your recovery. 

Your new “normal” may include making changes in the way you eat, the things

you do, and your sources of support, all of which are discussed in this booklet.
2

If you don’t have health insurance, Medicare, or Medicaid, you may feel that some of

the information in this booklet won’t be helpful to you. You may have already

struggled just to get treated and now see follow-up care as another battle. It can be

hard to get care if you don’t have good medical coverage, but you must make sure you

continue to get the care you need—especially now that treatment is over.

There may be resources in your community to help you get these services. Talk with

your doctor, social worker, or the business office at your local hospital or clinic. There

are also organizations listed in the Resources section on page 57 that may be able to

help you with health care costs.

Getting Follow-up Medical Care

All cancer survivors should have follow-up care. Knowing what to expect after

cancer treatment can help you and your family make plans, lifestyle changes,

and important decisions. 

Some common questions you may have are:

■ Should I tell the doctor about symptoms that worry me?

■ Which doctors should I see after treatment?

■ How often should I see my doctor?

■ What tests do I need?

■ What can be done to relieve pain, fatigue, or other problems after

treatment?

■ How long will it take for me to recover and feel more like myself?

■ Is there anything I can or should be doing to keep cancer from coming back?

Coping with these issues can be a challenge. Yet many say that getting involved

in decisions about their medical care and lifestyle was a good way for them to

regain some of the control they felt they lost during cancer treatment. Research

has shown that people who feel more in control feel and function better than

those who do not. Being an active partner with your doctor and getting help

from other members of your health care team is the first step.
3

What Is Follow-up Care?

Follow-up care means seeing a doctor for regular medical checkups. Your followup care depends on the type of cancer and type of treatment you had, along

with your overall health. It is usually different for each person who has been

treated for cancer.

In general, survivors usually return to the doctor every 3 to 4 months during the

first 2 to 3 years after treatment, and once or twice a year after that. At these visits,

your doctor will look for side effects from treatment and check if your cancer has

returned (recurred) or spread (metastasized) to another part of your body.

At these visits, your doctor will:

■ Review your medical history

■ Give you a physical exam

Your doctor may run follow-up tests such as:

■ Blood tests

■ MRI or CT scans. These scans take detailed pictures of areas inside the

body at different angles.

■ Endoscopy (en-DOSS-koh-pee). This test uses a thin, lighted tube to

examine the inside of the body.

At your first follow-up visit, talk with your doctor about your follow-up schedule.

See page 11 for a list of organizations and programs that give follow-up care

guidelines for survivors or Resources on page 57 for a detailed list of cancerrelated organizations.

Follow-up care can also include home care, occupational or vocational therapy,

pain management, physical therapy, and support groups. (See pages 12–13 for a

description of these services.)

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Medical Records and Follow-up Care 

Be sure to ask your oncologist for a written summary of your treatment. In

the summary, he or she can suggest what aspects of your health need to be

followed. Then, share this summary with any new doctors you see,

especially your primary care doctor, as you discuss your follow-up care plan.

Many people keep their medical records in a binder or folder and refer to

them as they see new doctors. This keeps key facts about your cancer

treatment in the same place. Other kinds of health information you

should keep include:

✔ The date you were diagnosed

✔ The type of cancer you were treated for

✔ Pathology report(s) that describe the type and stage of cancer

✔ Places and dates of specific treatment, such as:

• Details of all surgeries

• Sites and total amounts of radiation therapy

• Names and doses of chemotherapy and all other drugs

• Key lab reports, x-ray reports, CT scans, and MRI reports

✔ List of signs to watch for and possible long-term effects of treatment

✔ Contact information for all health professionals involved in your

treatment and follow-up care

✔ Any problems that occurred during or after treatment

✔ Information about supportive care you received (such as special

medicines, emotional support, and nutritional supplements)

4

Be sure to give any new doctors that you see a copy of your treatment summary 

or medical records.
Which Doctor Should I See Now? How Often?

You will need to decide which doctor will provide your follow-up cancer care

and which one(s) you will see for other medical care. For follow-up cancer care,

this may be the same doctor who provided your cancer treatment. For regular

medical care, you may decide to see your main provider, such as a family doctor.

For specific concerns, you may want to see a specialist. This is a topic you can

discuss with your doctors. They can help you decide how to make transitions 

in care.

Depending on where you live, it may make more sense to get follow-up cancer

care from your family doctor, rather than your oncologist. It’s important to note

that some insurance plans pay for follow-up care only with certain doctors and

for a set number of visits. 

In coming up with your schedule, you may want to check your health insurance

plan to see what follow-up care it allows. No matter what your health coverage

situation is, try to find doctors you feel comfortable with. 

Always tell any new doctors you see about your history of cancer. The type of cancer you

had and your treatment can affect decisions about your care in the future. They may not

know about your cancer unless you tell them. 

A Survivor’s Wellness Plan

After cancer treatment, many survivors want to find ways to reduce the chances

of their cancer coming back. Some worry that the way they eat, the stress in

their lives, or their exposure to chemicals may put them at risk. Cancer survivors

find that this is a time when they take a good look at how they take care of

themselves. This is an important start to living a healthy life.

When you meet with your doctor about follow-up care, you should ask about

developing a wellness plan that includes ways you can take care of your physical,

emotional, social, and spiritual needs. If you find that it’s hard to talk with your

doctor about these issues, it may be helpful to know that the more you do it, the

easier it becomes. And your doctor may suggest other members of the health

care team for you to talk with, such as a social worker, clergy member, or nurse.

For tips on talking with your doctor, see pages 7–9.

5
Changes You May Want To Think About Making

✔ Quit smoking. Research shows that smoking can increase the

chances of getting cancer at the same site or another site. 

✔ Cut down on how much alcohol you drink. Research shows that

drinking alcohol increases your chances of getting certain types of cancers.

✔ Eat well. Healthy food choices and physical activity may help reduce

the risk of cancer or recurrence. Talk with your doctor or a nutritionist

to find out about any special dietary needs that you may have. The

American Cancer Society and the American Institute for Cancer

Research have developed similar diet and fitness guidelines that may

help reduce the risk of cancer:

• Eat a plant-based diet and have at least 5–9 servings of fruit and

vegetables daily. Try to include beans in your diet, and eat whole

grains (such as cereals, breads, and pasta) several times daily.

• Choose foods low in fat and low in salt.

• Get to and stay at a healthy weight. 

For more tips on nutrition and healthy eating, go to www.aicr.org and

click on “Cancer Survivors,” or go to www.cancer.org and click on

“Survivors.”

✔ Exercise and stay active. Several recent reports suggest that

staying active after cancer can help lower the risk of recurrence and can

lead to longer survival. Moderate exercise (walking, biking, swimming)

for about 30 minutes every—or almost every—day can: 

• Reduce anxiety and depression

• Improve mood and boost self-esteem

• Reduce fatigue, nausea, pain, and diarrhea

It is important to start an exercise program slowly and increase activity

over time, working with your doctor or a specialist (such as a physical

therapist) if needed. If you need to stay in bed during your recovery,

even small activities like stretching or moving your arms or legs can

help you stay flexible, relieve muscle tension, and help you feel better.

Some people may need to take special care in exercising. Talk with your

doctor before you begin any exercise program.

6
Talking With Your Doctor

During cancer treatment, you had a lot of practice in getting the most out of

every doctor’s visit. These same skills now apply to you as a survivor and are

especially helpful if you are changing doctors or going back to a family or

primary care doctor you may not have seen for a while. 

It is important to be able to talk openly with your doctor. Both of you need

information to manage your care. Be sure to tell your doctor if you are having

trouble doing everyday activities, and talk about new symptoms to watch for and

what to do about them. If you are concerned that the treatment you had puts

you at a higher risk for having health problems, be sure to discuss this with your

doctor as you develop your follow-up plan. 

At each visit, mention any health issues you are having, such as:

■ New symptoms

■ Pain that troubles you

■ Physical problems that get in the way of your daily life or that bother you,

such as fatigue, trouble sleeping, sexual problems, or weight gain or loss

■ Other health problems you have, such as heart disease, diabetes, or arthritis

■ Medicines, vitamins, or herbs you are taking and other treatments you 

are using

■ Emotional problems, such as anxiety or depression, that you may have

now or that you’ve had in the past

■ Changes in your family’s medical history, such as relatives with cancer

■ Things you want to know more about, such as new research or side effects

Just because you have certain symptoms, it doesn’t always mean the cancer has come

back. Symptoms can be due to other problems that need to be addressed. 

7
Considering Complementary and Alternative Medicine 

Complementary and alternative medicine includes many different healing

approaches that people use to prevent illness, reduce stress, prevent or reduce

side effects and symptoms, or control or cure disease. An approach is generally

called “complementary” when it is used in addition to treatments prescribed by a

doctor. When it is used instead of treatments prescribed by a doctor, it is often

called “alternative.” Research has shown that more than half of all people with a

history of cancer use one or more of these approaches. 

Some common methods include imagery or relaxation (see page 60), acupressure

and massage, homeopathy, vitamins or herbal products, special diets,

psychotherapy, prayer, yoga, and acupuncture.

Even though you have finished your cancer treatment, if you are thinking about

using any of these methods, discuss it with your doctor or nurse first. Some

complementary and alternative therapies may interfere or be harmful when used

with medicines normally prescribed by a doctor. For more information, see the

Resources section on page 57 to order the NCI brochure Thinking About

Complementary & Alternative Medicine: A Guide for People With Cancer.

Asking About Your Family’s Cancer Risk

You may worry that having cancer might increase your children’s risk. It’s

important to know that most cancer is not passed down through families. Only

about 5–10 percent of the most common cancers (such as breast, colon, and

prostate) are inherited. In most of the families that have inherited cancers,

researchers have found relatives who may have had:

■ Cancer before they were 50 years old

■ Cancer in two of the same body parts (like both kidneys or both breasts)

■ Other risk factors for cancer (such as colon polyps or skin moles)

If you think that your cancer may be inherited, talking with a cancer genetic

counselor can help answer your questions and those of your family. He or she

can also help you and your doctor decide on the medical care that you and

your family might need if a genetic link is found. Genetic testing can

determine whether the cancers that occur in your family are due to genes or

to other factors. 

8
Getting the Most From Your Follow-up Visits

Here are some ideas that helped others with their follow-up care:

■ Ask someone to come with you to your doctor visits. A friend or family

member can help you think about and understand what was said. He or

she also may think of new questions to ask.

■ Make a list of questions ahead of time and bring it with you.

■ Take notes or ask if you can tape-record the answers.

■ Ask your most important questions first, in case the doctor runs out of time. 

■ Don’t be afraid to ask for more time when you make your next appointment.

Or ask the doctor to suggest a time when you could call and get answers to

your questions.

■ Ask to talk with the doctor or nurse in a private room with the door closed. 

■ Express yourself clearly.

■ Describe your problem or concern briefly.

■ Tell the doctor how your problem or concern makes you feel.

■ Ask for what you want or need, for example, “I am tired most of the time

each day. I’ve tried napping, but it doesn’t help. My fatigue gets in the

way of my daily life. What can be done to help me with this problem?”

■ Tell your doctor if you need more information.

■ Ask for booklets or other materials to read at home.

■ Ask the doctor to explain what he or she said in terms you understand.

■ Repeat back in your own words what you think the doctor meant. 

■ Ask your doctor or pharmacist about the best way to take your medicine

and about possible side effects.

■ Keep your own set of records about any follow-up care you have. 

9
Questions About Your Follow-up Plan

1. How often should I see 

my doctors?

2. What follow-up tests, 

if any, should be done 

(for example, CT scan, 

MRI, bone scan)? 

How often?

3. Are there symptoms that 

I should watch for?

4. If I develop any of 

these symptoms, 

whom should I call?

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Doctor’s Name How Often

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Test How Often

______________________________ ___________

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______________________________ ___________

______________________________ ___________

______________________________ ___________

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Guidelines for Follow-up Care

These organizations have follow-up care guidelines for some cancers. You can use

them as you talk with your doctor—they aren’t meant to contradict or take the

place of your doctor’s knowledge or judgment.

Cancer: Keys to Survivorship

Hosted by the National Coalition of Cancer Survivorship and the Leukemia &

Lymphoma Society, this program teaches survivors, families, and caregivers the

necessary skills to help live with, through, and beyond cancer. A series of

seminars focuses on leading healthy lives, preparing for doctor visits, managing

side effects, and handling insurance and employment issues. Seminars can be

viewed online at www.canceradvocacy.org/programs/keys.aspx.

Children’s Oncology Group Long-Term Follow-up Guidelines

The Children‘s Oncology Group offers long-term follow-up guidelines for

survivors of childhood, adolescent, and young adult cancers at

www.survivorshipguidelines.org.

Life After Cancer Care

M.D. Anderson’s Cancer Center Web site lists follow-up guidelines for 15

different disease sites at www.mdanderson.org/departments/lacc, and click on 

“Follow-up Guidelines by Disease.”

People Living With Cancer

The American Society of Clinical Oncology has a series of follow-up care 

guides focused on breast, colorectal, and lung cancer. They can be viewed at

www.plwc.org.
Services To Think About

Talk with your doctor to help you locate services such as these:

■ Couples Counseling

You and your partner work with trained specialists who can help you talk

about problems, learn about each other’s needs, and find ways to cope.

Counseling may include issues related to sex and intimacy.

■ Faith or Spiritual Counseling

Some members of the clergy are trained to help you cope with cancer

concerns, such as feeling alone, fear of death, searching for meaning, and

doubts about faith.

■ Family Support Programs 

Your whole family may be involved in the healing process. In these programs,

you and your family members take part in therapy sessions with trained

specialists who can help you talk about problems, learn about each other’s

needs, and find answers. 

■ Genetic Counseling

Trained specialists can advise you on whether to have genetic testing for

cancer and how to deal with the results. It can be helpful for you and for

family members who have concerns about their own health. 

■ Home Care Services

State and local governments offer many services that you may find useful

after cancer treatment. For example, a nurse or physical therapist may be able

to come to your home. You may also be able to get help with housework or

cooking. Check the phone book under the categories Social Services, Health

Services, or Aging Services.

■ Individual Counseling

Trained mental health specialists can help you deal with your feelings, such

as anger, sadness, and concern for your future.

■ Long-Term Follow-up Clinics

All doctors can offer follow-up care, but there are also clinics that specialize in

long-term follow-up after cancer. These clinics most often see people who are

no longer being treated by an oncologist and who are considered disease-free.

Ask your doctor if there are any follow-up cancer clinics in your area.

■ Nutritionists/Dietitians

They can help you with gaining or losing weight and with healthy eating.

■ Occupational Therapists 

They can help you regain, develop, and build skills that are important for

day-to-day living. They can help you relearn how to do daily activities, such

as bathing, dressing, or feeding yourself, after cancer treatment. 12
■ Oncology Social Workers

These professionals are trained to counsel you about ways to cope with

treatment issues and family problems related to your cancer. They can tell

you about resources and connect you with services in your area.

■ Ostomy Information and Support 

The United Ostomy Association provides education, information, and support

for people with intestinal/urinary diversions. Call 1-800-826-0826, or visit

online at http://www.uoa.org.

■ Pain Clinics (also called Pain and Palliative Care Services)

These are centers with professionals from many different fields who are

specially trained in helping people get relief from pain.

■ Physical Therapists

Physical therapists are trained to understand how different parts of your body

work together. They can teach you about proper exercises and body motions

that can help you gain strength and move better after treatment. They can

also advise you about proper postures that help prevent injuries.

■ Quitting Smoking (Smoking Cessation Services)

Research shows that the more support you have in quitting smoking, the

greater your chance for success. Ask your doctor, nurse, social worker, or

hospital about available programs, or call NCI’s Smoking Quitline at 

1-877-44-U-QUIT (1-877-448-7848).

■ Speech Therapists

Speech therapists can evaluate and treat any speech, language, or swallowing

problems you may have after treatment.

■ Stress Management Programs

These programs teach ways to help you relax and take more control over

stress. Hospitals, clinics, or local cancer organizations may offer these

programs and classes.

■ Support Groups for Survivors

In-person and online groups enable survivors to interact with others in

similar situations. (See pages 44–45.)

■ Survivor Wellness Programs

These types of programs are growing in number, and they are meant for

people who have finished their cancer treatment and are interested in

redefining their life beyond cancer. 

■ Vocational Rehabilitation Specialists 

If you have disabilities or other special needs, these specialists can help you

find suitable jobs. They offer services such as counseling, education and skills

training, and help in obtaining and using assistive technology and tools.

13
“I thought I could get right back

into my normal work routine, but I’m

finding that I just don’t have the

same energy that I used to.” —BILL 
Ways To Manage Physical Changes 

“If I could stop feeling so tired all the time, 

I think I’d be fine. I’ve started getting 

used to everything else.” —ROSA

Some have described survivorship as being “disease-free, but not free of your

disease.” What you experience with your body may be related to the type of

cancer you had and the treatment you received. It’s important to remember 

that no two people are alike, so you may experience changes that are very

different from someone else’s, even if that person had the same type of cancer

and treatment.

You may find that you are still coping with the effects of treatment on your body.

It can take time to get over these effects. You may wonder how your body should

feel during this time and what are signs that cancer is coming back. This section

describes some of the problems that can occur when treatment is over. Some of the

most common problems that people report are:

■ Fatigue

■ Memory and concentration changes

■ Pain

■ Nervous system changes (neuropathy)

■ Lymphedema, or swelling

■ Mouth or teeth problems

■ Changes in weight and eating habits

■ Trouble swallowing

■ Bladder or bowel control problems

■ Menopause symptoms

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Fatigue

Some cancer survivors report that they still feel tired or worn out. In fact, fatigue

is one of the most common complaints during the first year of recovery.

Rest or sleep does not cure the type of fatigue that you may have. Doctors do not

know its exact causes. The causes of fatigue are different for people who are

receiving treatment than they are for those who have finished.

■ Fatigue during treatment can be caused by cancer therapy. Other problems

can also play a part in fatigue, like anemia (having too few red blood cells)

or having a weak immune system. Poor nutrition, not drinking enough

liquids, and depression can also be causes. Pain can make fatigue worse.

■ Researchers are still learning about what may cause fatigue after treatment.

How long will fatigue last? There is no normal pattern. For some, fatigue gets

better over time. Some people, especially those who have had bone marrow

transplants, may still feel energy loss years later.

Some people feel very frustrated when fatigue lasts longer than they think it

should and when it gets in the way of their normal routine. They may also

worry that their friends, family, and coworkers will get upset with them if they

continue to show signs of fatigue.

Getting Help 

Talk with your doctor or nurse about what may be causing your fatigue and what

can be done about it. Ask about:

■ How any medicines you are taking or other medical problems you have

might affect your energy level

■ How you can control your pain, if pain is a problem for you

■ Exercise programs that might help, such as walking

■ Relaxation exercises 

■ Changing your diet or drinking more fluids 

■ Medicines or nutritional supplements that can help

■ Specialists who might help you, such as physical therapists, occupational

therapists, nutritionists, or mental health care providers
Coping With Fatigue

Here are some ideas:

✔ Plan your day. Be active at the time of day when you feel most alert

and energetic.

✔ Save your energy by changing how you do things. 

For example, sit on a stool while you cook or wash dishes.

✔ Take short naps or rest breaks between activities.

✔ Try to go to sleep and wake up at the same time every day.

✔ Do what you enjoy, but do less of it. Focus on old or new

interests that don’t tire you out. For example, try to read something

brief or listen to music.

✔ Let others help you. They might cook a meal, run errands, or do

the laundry. If no one offers, ask for what you need. Friends and family

might be willing to help but may not know what to do.

✔ Choose how to spend your energy. Try to let go of things that

don’t matter as much now.

✔ Think about joining a support group. Talking about your fatigue

with others who have had the same problem may help you find new

ways to cope.

17
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Memory and Concentration Changes

“Not being able to concentrate the way I used to 

has been the hardest for me. I’m hoping it doesn’t

affect my work.” —JOSH

Research shows that one in four people with cancer reports memory and

attention problems after chemotherapy. This is sometimes called “chemobrain.”

Many survivors describe this as “brain fog,” which can lead to problems paying

attention, finding the right word, or remembering new things.

These effects can begin soon after treatment ends, or they may not appear until

much later. They don’t always go away. If a person is older, it can be hard to tell

whether these changes in memory and concentration are a result of treatment or

of the aging process. Either way, some feel they just can’t focus as they once did.

Research is starting to explore why some people develop problems with memory

and concentration while others don’t. It seems that people who have had

chemotherapy or have had radiation to the head area are at higher risk for these

problems. People who had high doses of chemotherapy may have memory

problems, but even those who had standard doses have reported memory changes.

Getting Help

Your doctor can help you with memory and concentration problems. Talk with

him or her if:

■ You are still having memory and thinking problems. You may

want to ask about seeing a specialist (called a neuropsychologist) to help

you with these problems.

■ You think a medicine you are taking could be causing or

adding to your problem.

■ You think you suffer from depression or anxiety. These problems

can affect attention, concentration, and memory.

■ You are going through menopause. Some memory and

concentration problems can be related to menopause.
Improving Memory and Concentration

Cancer survivors have found many ways to help improve their memory

after cancer treatment. See if any of these ideas work for you:

✔ Jot it down. You can write down each task, how long it will take,

and where you need to go in a notebook or pocket calendar. Plan your

whole day. Keep it simple, and be realistic about how much you can do

in a day.

✔ Set up reminders. Put small signs around the house to remind you

of things to do, such as taking out the trash or locking the door. 

✔ Group long numbers into chunks. For example, the phone number

812-5846 can be repeated as “eight-twelve, fifty-eight, forty-six.”

✔ Talk yourself through tasks. When doing a task with a number of

steps, such as cooking or working on a computer, whisper each step to

yourself.

✔ Manage stress. Managing stress better may improve your memory

and attention. And learning how to relax can help you remain calm

even in stressful moments. 

✔ Go over what you plan to say. Before you go to family events or

work functions, go over names, dates, and key points you want to make.

✔ Repeat what you want to remember. Saying it a couple of times

can help your mind hold on to the information.

19

For more information about chemobrain, see CancerCare’s listing in the Resources

section on page 57 or view the fact sheet “Cognitive Problems After Chemotherapy”

online at www.cancercare.org/pdf/fact_sheets/fs_chemobrain_cognitive.pdf. 
Pain

Some people have a lot of pain after treatment, while others have less. Everyone

is different. Types of pain you may feel after cancer treatment include:

■ Pain or numbness in the hands and feet due to injured nerves.

Chemotherapy or surgery can damage nerves, which can cause severe

pain. For more information on nervous system changes, see page 23. 

■ Painful scars from surgery.

■ Pain in a missing limb or breast. While doctors don’t know why this

pain occurs, it is real. It’s not just “in your mind.” This is sometimes called

phantom pain.

Getting Help

If you find that you still have pain after treatment ends, your doctor can help

find the source of your pain and get relief. You do not have to be in pain. And

wanting to control pain is not a sign of weakness. It’s a way to help you feel

better and stay active. Pain may be caused by treatment or other health issues,

such as arthritis. 

With your help, your doctor can assess how severe your pain is and may

recommend one or more of the following approaches:

■ Pain-relief medicines. In most cases, doctors will try the mildest

medicines first. Then they will work up to stronger ones if you need them.

The key to getting relief is to take all medicines just as your doctor

prescribes. To keep pain under control, do not skip doses or wait until you

hurt to take these medicines. 

You may be afraid that if you use these medicines you’ll become addicted, but this

rarely happens if you take the correct dose and see your doctor regularly.

■ Antidepressant medicines. Some of these are prescribed to reduce pain

or numbness from injured nerves.

■ Physical therapy. Going to a physical therapist may help relieve your

pain. The therapist may use heat, cold, massage, pressure, and/or exercise

to help you feel better.

■ Braces. These limit movement of a painful limb or joint.

■ Acupuncture. This is a proven method that uses needles at pressure points

to reduce pain.

20
21

■ Hypnosis, meditation, or yoga. Any of these may help your pain. A

trained specialist can teach you these approaches.

■ Relaxation skills. Many people with cancer have found that practicing

deep relaxation helps relieve their pain or reduce their stress. 

■ Nerve blocks or surgery. If you don’t get relief from the other

approaches in this section, you may want to ask your doctor about these.

Nerve blocks or surgery often help if you have persistent, limiting pain,

but they may put you at risk for other problems. They may also require

you to stay in the hospital.

Talking With Your Doctor About Pain

There are different ways you can describe your pain to your doctor:

✔ Use numbers. Talk about how strong the pain feels on a scale of 0 to

10, with 0 being no pain and 10 being the worst pain you could have.

✔ Describe what the pain feels like. Is it sharp, dull, throbbing, steady?

✔ Point out the exact places it hurts, either on your body or on a

drawing. Note whether the pain stays in one place or whether it moves

outward from the spot.

✔ Explain when you feel pain. Note when it starts, how long it lasts,

if it gets better or worse at certain times of the day or night, and if

anything you do makes it better or worse.

✔ Describe how your pain affects your daily life. Does it stop you

from working? Doing household chores? Seeing friends and family?

Going out and having fun?

✔ Make a list of all the medicines you are taking (for any

reason). If you are taking any for pain relief, how much do they help?

✔ Talk about any side effects you have from your pain control

medicine, such as constipation or other changes in bowel habits, or

feeling groggy or “out of it.” Many of these problems can be helped.

✔ Keep a record of your pain. Jotting down notes about your pain can

help you track changes over time. It can also show how you respond to

any pain control medicine or other treatment you receive. 

Make sure your insurance covers the pain relief approaches your doctor recommends.
Pain Diary

Use this pain diary and pain rating scale to record your pain. 

(You may want to photocopy this sheet before writing on it.)

22

0 1 2 3 4 5 6 7 8 9 10

No

pain

Worst pain

imaginable

Date Time Pain

rating

(0–10)

Pain medication

(name, dose, 

how often taken)

Other pain-relief

methods tried

Side effects

from pain

medication

6/8

(example)

8 a.m. 8 Morphine 30 mg every 4 hrs massage constipation
Nervous System Changes (Neuropathy)

Sometimes cancer treatment can cause damage to your nervous system. This is

called neuropathy (new-RAH-path-ee), or problems with nerve function.

Sometimes these symptoms can be made worse by other conditions, such as

diabetes, kidney failure, alcoholism, and malnutrition. Most people first notice

symptoms in their hands or feet, usually starting with their fingertips and toes.

Sometimes, the tingling and pain move up the fingers to the hands or from the

toes to the feet. 

Common symptoms include tingling, burning, weakness, or numbness in your

hands or feet; sudden, sharp, stabbing, or electric shock pain sensations; loss of

sensation of touch; loss of balance or difficulty walking; clumsiness; trouble

picking up objects or buttoning clothes; hearing loss; jaw pain; constipation; and

being more—or less—sensitive to heat and cold.

Symptoms can start when you begin chemotherapy or after treatment. If they do,

tell your health care team right away. Symptoms can improve over time, but it may

take up to a year or more. 

Getting Help

■ Treatments include medications, topical creams, and pain patches. 

■ Other approaches include acupuncture, physical therapy, and exercise.

Managing Nervous System Changes

✔ Be careful when handling knives, scissors, and other sharp objects. 

✔ Avoid falling. Walk slowly, hold onto handrails, and put no-slip bath

mats in your tub or shower. Remove area rugs or cords you could trip over.

Steady yourself when you walk by using a cane or other device.

✔ Wear tennis shoes or other footwear with rubber soles.

✔ Use a thermometer and gloves instead of your bare hand.

These can help you avoid being burned when checking water temperature.

If possible, lower the temperature setting on your hot water heater.

✔ Allow yourself time to rest.

23
Lymphedema or Swelling

Lymphedema (LIMF-eh-DEE-ma) is a swelling of a part of the body caused by the

buildup of lymph fluids. It often happens in the arm, leg, face, or neck. It can be

caused by cancer or its treatment. There are many different types of lymphedema.

Some types happen right after surgery, are mild, and don’t last long. Other types

can occur months or years after cancer treatment and can be quite painful. These

types can also develop after an insect bite, minor injury, or burn.

People who are at risk for lymphedema are those who have had:

■ Breast cancer. If you had radiation therapy, or had your underarm

lymph nodes removed, or had radiation in the underarm area after your

lymph nodes were removed

■ Melanoma of the arms or legs. If you had lymph nodes removed

and/or had radiation therapy

■ Prostate cancer. If you had surgery or radiation therapy to the 

whole pelvis

■ Cancer of the female or male reproductive organs. If you had

surgery to remove lymph nodes or had radiation therapy

■ Other cancers that have spread to the lower abdominal area.

The pressure from the growing tumor can make it hard for your body to

drain fluid.

Getting Help

Your doctor or nurse may be able to help you find ways to prevent and relieve

lymphedema. Ask about:

■ Skin care. It’s important to keep your skin clean. You should also use

lotion to keep it moist. 

■ Exercise. Find out about exercises to help the body drain lymph fluid

and what types of exercise you should not do.

24
■ Ways to treat lymphedema. Your doctor may suggest:

• Keeping the arm or leg raised above your chest for periods of time

• Having special types of massage that can help by moving the lymph

fluid from where it has settled

• Wearing special elastic sleeves and clothing that can help lymph 

fluid drain 

• Losing weight 

• Finding sources of emotional support to help you cope

• Avoiding procedures done in the area with lymphedema, such as

shots or blood tests

Preventing or Relieving Lymphedema

Other cancer survivors have found these tips helpful:

✔ Watch for signs of swelling or infection (redness, pain, heat,

fever). Tell your doctor or nurse if your arm or leg is painful or swollen.

✔ Keep your arm or leg free of cuts, insect bites, and sunburn.

Try not to have shots or blood tests done in that area.

✔ Eat a well-balanced, protein-rich, low-salt diet.

✔ Keep regular follow-up appointments with your doctor.

✔ Wear loose-fitting clothing on your arm or leg.

✔ Protect the area. Try not to use that arm or leg to figure out how

hot or cold something is, such as bath water or cooked food. You may be

less able to feel hot and cold now.

25
Mouth or Teeth Problems

Many people who have been treated for cancer develop problems with their

mouth or teeth. Some problems go away after treatment. Others last a long time,

while some may never go away. Some problems may develop months or years

after your treatment has ended. 

Radiation or surgery to the head and neck can cause problems with your teeth

and gums; the soft, moist lining of your mouth; glands that make saliva (spit);

and jawbones. If you were treated with certain types of chemotherapy, you may

also have these problems. This can cause:

■ Dry mouth

■ Cavities and other kinds of tooth problems

■ Loss of or change in sense of taste

■ Painful mouth and gums

■ Infections in your mouth

■ Jaw stiffness or jawbone changes 

Who Has These Problems? 

■ Almost all people who have had radiation therapy to the head and neck 

■ Most people who have had bone marrow transplants 

■ About two out of every five people treated with chemotherapy

Getting Help

If you find that problems persist after cancer treatment ends, talk with your

doctor about possible causes and ways to control mouth pain.

Try to see your dentist soon after you are done with treatment. Ask how often

you should have checkups and ways to take care of your mouth and teeth.

26
27

Preventing or Relieving Mouth or Teeth Problems

✔ Keep your mouth moist.

• Drink a lot of water.

• Suck on ice chips.

• Chew sugarless gum or suck on sugar-free hard candy.

• Use a saliva substitute to help moisten your mouth.

✔ Keep your mouth clean.

• Brush your teeth, gums, and tongue with an extra-soft toothbrush

after every meal and at bedtime. If it hurts, soften the bristles in

warm water.

• Ask your dentist for tooth sponges, such as Toothettes® or Dentips®,

that you can use in place of a toothbrush.

• Use a mild fluoride toothpaste (like children’s toothpaste) and a

mouthwash without alcohol.

• Floss your teeth gently every day. If your gums bleed or hurt, stay

away from the areas that are bleeding or sore, but keep flossing your

other teeth.

• Rinse your mouth several times a day with a solution of 1/4 teaspoon

baking soda and 1/8 teaspoon salt in 1 cup of warm water. Follow with

a plain water rinse.

• If you have dentures, clean, brush, and rinse them after meals. Have

your dentist check them to make sure they still fit you well.

✔ If your mouth is sore, remember to stay away from:

• Sharp, crunchy foods, like chips, that can scrape or cut your mouth

• Foods that are hot, spicy, or high in acid, like citrus fruits and juices,

which can irritate your mouth

• Sugary foods, like candy or soda, that can cause cavities

• Toothpicks (they can cut your mouth)

• All tobacco products 

• Alcoholic drinks
28

Changes in Weight and Eating Habits

Some survivors who have had certain kinds of chemotherapy or medicines have

problems with weight gain. Sometimes the added pounds stay on even when

treatment ends. Breast cancer survivors who have had certain types of

chemotherapy gain weight in a different way—they may lose muscle and gain 

fat tissue. 

Unfortunately, the usual ways people try to lose weight may not work for them.

Try to be patient with yourself. Look for the positive things that you can control,

such as eating a healthy diet. Try to focus on the fact that treatment is over, and

you are trying to get stronger with time.

Some cancer survivors have the opposite problem: they have no desire to eat,

and they lose weight. Some men say that weight loss or loss of muscle tone is a

bigger concern for them than weight gain. It makes them feel less strong and like

less of a man.

Managing a Healthy Weight

For weight issues, ask your doctor or nurse about:

■ Doing strength-building exercises, if you have lost muscle or gained 

fat tissue

■ Talking to a dietitian or nutritionist who can help you plan a healthy diet

that won’t add extra pounds

Regaining a Lost Appetite

Here are some tips that have helped others improve their appetites:

✔ Start with small meals. Five small meals a day may be easier to

manage than three larger ones. 

✔ Focus on your favorite foods. If the thought of eating still lacks

appeal, try the foods you really liked before treatment to jump-start your

appetite. Try adding some fresh fruit, juice, or other flavoring to improve

the taste.

✔ Stay active. A short walk before a meal can help you feel hungry.
Trouble Swallowing

Some people who have had radiation therapy or chemotherapy may find it hard

to eat because they have trouble swallowing. People who have had radiation

therapy to the head, neck, breast, or chest or those who have had surgery

involving the larynx may also have this problem. 

Getting Help 

■ Eat soft, bland foods moistened with sauces or gravies. Puddings, ice cream,

soups, applesauce, and bananas and other soft fruits are nourishing and

usually easy to swallow. 

■ Use a blender to process solid foods. 

■ Ask for advice from your health care team, including your doctor, nurse,

nutritionist, and/or speech pathologist.

■ Tilt your head back or move it forward while you are eating. 

■ Have a sip of water every few minutes to help you swallow and talk more

easily. Carry a water bottle with you so you always have some handy.

Bladder or Bowel Control Problems

Bladder and bowel problems are among the most upsetting issues people face

after cancer treatment. People often feel ashamed or fearful to go out in public.

“Going back to work was the hardest thing,” one prostate cancer survivor noted. 

This loss of control can happen after treatment for bladder, prostate, colon,

rectal, ovarian, or other cancers. Your surgery may have left you with no bladder

or bowel control at all. Or perhaps you still have some control, but you make

lots of sudden trips to the bathroom. The opposite problem can happen when a

medicine you are taking for pain causes constipation.

Getting Help

It is very important to tell your doctor about any changes in your bladder or

bowel habits. Ask your doctor or nurse about:

■ Problems with constipation

■ Kegel exercises (see page 34 on muscle weakness) 

■ Medicines that may help

■ Help in coping with ostomies. If you have an ostomy, an opening from

inside the body to the outside to pass urine or waste material, there are

services and support groups to help you cope with changes (see page 13).

29
Menopause Symptoms 

After chemotherapy, some women stop getting their periods every month—or stop

getting them altogether. Some cancer treatments (and the medicines tamoxifen

and raloxifene) can cause changes in women’s bodies and reduce the amount of

hormones they make. These changes can cause your periods to stop, as well as

cause other symptoms of menopause (also called “the change” or “change of life”). 

Over time, some women will start getting their periods again (this is more likely

for younger women), but others will not. Even though your doctor may have

discussed early menopause with you, give yourself permission to mourn the loss

of your fertility. 

Some common signs of menopause are:

■ Irregular periods. One of the first signs is a change in your periods.

They may become less regular. They could be lighter. Some women have

short times of heavy bleeding. Sometimes, they stop all of a sudden.

■ Hot flashes. Hot flashes are often worse at night and can affect sleep or

cause mood changes. 

■ Problems with your vagina or bladder. Tissues in these areas

become drier and thinner. You may be more likely to get vaginal

infections. As you get older, you may also have problems holding your

urine or urinary tract problems.

■ Lack of interest in having sex. These changes may make it hard for

you to become sexually aroused. 

■ Fatigue and sleep problems. You may feel tired or have trouble getting

to sleep, getting up early, or getting back to sleep after waking up in the

middle of the night. 

■ Memory and other problems, such as depression, mood swings,

and irritability. Some of these, especially memory problems, may be

related to growing older. There may be a connection between changes in

your hormone levels and your emotions. 

■ Other changes in your body. You may notice your waist getting bigger,

less muscle and more fat around your body, or thinning and loss of

elasticity of your skin.

30

Ask your doctor if you still need to use birth control, even if you are not getting 

your period.
31

Getting Help

See a gynecologist every year. Ask about:

■ Medicines, supplements, or other approaches that can help you manage

menopause symptoms

■ Tests you should have (such as a bone density test to see if you are at risk

for osteoporosis)

■ Ways you can reduce your chance of getting:

• Osteoporosis. Menopause can put you at risk for losing bone tissue,

which can weaken your bones and make them easier to break. 

• Heart disease. Menopause can also lead to higher cholesterol, which

can increase your risk of diseases that affect your heart and blood vessels.

Relieving Hot Flashes

Here are some tips that have helped others deal with hot flashes:

✔ Quit smoking.

✔ Drink plenty of water.

✔ Through exercise and diet, try to maintain a healthy weight.

Exercise most days of the week, doing both weight-bearing and musclestrengthening activities. Eat wisely. A balanced diet will provide most of

the nutrients and calories your body needs to stay healthy. 

✔ If you are having hot flashes, try to write down when they happen

and what may cause them. This may help you find out what to avoid. 

You may also want to:

• Sleep in a cool room to avoid being awakened by hot flashes. 

• Dress in layers that you can take off if you get warm. 

• Use cotton sheets, and wear clothing that lets your skin “breathe.”

• Try having a cold drink or turning on a fan at the beginning of a 

hot flash.

• Try not to eat a lot of spicy foods. 

• Limit the alcohol and caffeine you drink.
32

Body Changes and Intimacy 

Some body changes are short-term, and others will last forever. Either way, your

looks may be a big concern after treatment. For example, people with ostomies

after colon or rectal surgery are sometimes afraid to go out. They may feel

ashamed or afraid that others will reject them. They may worry about the idea of

having an “accident” in social situations. 

Others don’t like people being able to see treatment effects such as scars, skin

changes, loss of limbs, and changes in weight. Even if your treatment doesn’t

show, your body changes may trouble you. Feelings of anger and grief are

natural. Feeling bad about your body can also lower your sex drive. This loss of

or reduction in your sex life may make you feel even worse about yourself. 

Changes in the way you look can also be hard for your loved ones, which can be

hard on you. Parents and grandparents often worry about how they look to a child

or grandchild. They fear that changes in their appearance may scare the child or

get in the way of their staying close.

Getting Help

How do you cope with body changes? 

■ Mourn your losses. They are real, and you have a right to grieve.

■ Try to focus on the ways that coping with cancer has made you stronger,

wiser, and more realistic.

■ If you find that your skin has changed from radiation, ask your doctor

about ways you can care for it. 

■ Look for new ways to enhance your appearance. A new haircut, hair color,

makeup, or clothing may give you a lift.

■ If you choose to wear a breast form (prosthesis), make sure it fits you well.

Your health insurance plan may pay for it.

■ Try to recognize that you are more than your cancer. Know that you have

worth—no matter how you look or what happens to you in life.
33

Changes in Sex Life

You may have changes in your sex life after cancer treatment—many people do.

Depending on the cancer you had, these problems may be short-term or longterm. For example, about half of women who have had long-term treatment for

breast and reproductive organ cancers and more than half of men treated for

prostate cancer report long-term sexual problems. Many cancer survivors say

they were not prepared for the changes in their sex lives.

Sexual problems after cancer treatment are often caused by changes to your

body—from surgery, chemotherapy, or radiation, or by the effects of certain

medicines. Sometimes emotional issues can be the cause of sexual problems. Some

examples include anxiety, depression, feelings of guilt about how you got cancer,

changes in body image after surgery, and stress between you and your partner.

Your past sex life is not related to your current sexual problems.

What types of problems occur? People report these main concerns:

■ Worrying about intimacy after treatment. Some may struggle with

their body image after treatment. Even thinking about being seen without

clothes may be stressful. People may worry that having sex will hurt or that

they won’t be able to perform or will feel less attractive. Pain, loss of interest,

depression, or cancer medicines can also affect sex drive.

■ Not being able to have sex as you did before. Some cancer

treatments cause changes in sex organs that also change your sex life. 

• Some men can no longer get or keep an erection after treatment for

prostate cancer, cancer of the penis, or cancer of the testes. Some

treatments can also weaken a man’s orgasm or make it dry. 

• Some women find it harder, or even painful, to have sex after cancer

treatment. Some cancer treatments can cause these problems;

sometimes, there is no clear cause. Some women also have a loss of

sensation in their genital area. 

■ Having menopause symptoms. When women stop getting their

periods, they can get hot flashes, dryness or tightness in the vagina,

and/or other problems that can affect their desire to have sex. 

■ Losing the ability to have children. Some cancer treatments can cause

infertility, making it impossible for cancer survivors to have children.

Depending on type of treatment, age, and length of time since treatment,

you may still be able to have children. For more information about fertility,

see the Resources section on page 57.

B

o

d

y

C

h

a

n

g

es a

n

d Intim

acy
Getting Help

“I knew about the chance of impotence. What 

I didn’t expect was my total loss of interest in 

sex, which really caused some problems between 

my wife and me.” —MITCH

Your doctor may be able to help you deal with these problems, but he or she

may not bring up the subject. You may have to mention it yourself. If you think

you might have trouble getting started, bring this booklet with you.

Often, sexual problems will not get better on their own. To get help with many

of these problems, it’s important to tell your doctor about any changes in your

sex life. Sometimes there can be an underlying medical problem that causes

changes, such as:

■ Erection problems. Medicine, assistive devices, counseling, surgery, or

other approaches may help.

■ Vaginal dryness. Dryness or tightness in the vagina can be caused by

menopause. Ask whether using a water-based lubricant during sex, using

vaginal dilators before sex, and/or taking hormones or using a hormone

cream are options for you.

■ Muscle weakness. You can help strengthen muscles in your genital area

by doing Kegel exercises. Practice by controlling your muscles to stop the

flow of urine. You can do these exercises even when you are not urinating.

Just tighten and relax the muscles as you sit, stand, or go about your day.

Other issues you may want to discuss include:

■ Concerns about having children. Discuss family planning concerns

with your doctor. If you’re a woman, ask if you still need to use birth

control, even if you are not getting your period.

■ Talking with a counselor or a psychologist. You may feel that some

of your sexual problems are due to your emotions, like stress or body

image. Some people find that sexual problems related to cancer start to

strain their relationship with their partner. If this is the case, ask a nurse or

social worker if you can talk to a counselor. Talking to someone alone, or

with your partner, may help.

■ Seeing a sex therapist. He or she may be able to help you talk openly

about your problems, work through your concerns, and come up with new

ways to help you and your partner. 34
35

Talking With Your Partner

Even for a couple that has been together a long time, staying connected can be a

major challenge at first. It may be comforting to learn that very few committed

relationships end because of ostomies, scars, or other body changes. Divorce

rates are about the same for people with and without a cancer history.

Tell your partner how you feel about your sex life and what you would like to

change. You might want to talk about your concerns, your beliefs about why

your sex life is the way it is, your feelings, and what would make you feel better.

Approaching it openly avoids blame, stays positive, and gives your partner a

better sense of how you are feeling. Here is an example of how you might start

your discussion:

“I know it’s tough to talk about, but I think we should discuss our sex life.

We’ve only made love a few times lately. I miss being close to you. I worry

that my scars might be a problem. Can you tell me how you feel?” 

Try to be open minded as you listen to your partner’s point of view:

■ Focus on your partner’s comments, not on what you plan to say in

response.

■ Repeat what he or she says in your own words.

■ Ask questions to better understand your partner’s concerns.

■ Acknowledge that your partner’s views matter to you. Say things like “I see

why you might think that” or “I never thought of it that way before.”

Feeling Intimate After Treatment

✔ Be proud of your body. It got you through treatment!

✔ Think of things that help you feel more attractive and confident. 

✔ Focus on the positive. Try to be aware of your thoughts, since they

can affect your sex life.

✔ Touch each other. Kiss, hug, and cuddle, even if you cannot have the

kind of sex that you used to have.

✔ Be open to change. You may find new ways to enjoy intimacy. 
36

Dating

If you’re single, body changes and concerns about sex can affect how you feel

about dating. As you struggle to accept the changes yourself, you may also worry

about how someone else will react to physical things, such as scars or ostomies.

Or you may find it awkward to bring up sexual problems or loss of fertility,

which can make feeling close even harder. 

You may wonder how and when to tell a new person in your life about your

cancer and body changes. For some, the fear of being rejected keeps them from

seeking the social life they would like to have. Others who choose not to date

may face pressure from friends or family to be more sociable. Here are some ideas

that can make it easier to get back into social situations:

■ Focus on activities that you have time to enjoy, such as taking a class or

joining a club. 

■ Try not to let cancer be an excuse for not dating or trying to meet people.

■ Wait until you feel a sense of trust and friendship before telling a new date

about your cancer. Practice what you will say to someone if you are worried

about how you will handle it. Think about how he or she might react, and

be ready with a response.

■ Think about dating as a learning process with the goal of having a social

life you enjoy. Not every date has to be perfect. If some people reject you

(which can happen with or without cancer), you have not failed. Try to

remember that not all dates worked out before you had cancer.
37

Your Feelings 

“I don’t think you ever forget the fact that 

it could come back.” —EMILY

Just as cancer treatment affects your physical health, it can affect the way you

feel, think, and do the things you like to do. It’s normal to have many different

feelings after treatment ends. Just as you need to take care of your body after

treatment, you need to take care of your emotions.

Each person’s experience with cancer is different, and the feelings, emotions,

and fears that you have are unique. The values you grew up with may affect how

you think about and deal with cancer. Some people may feel they have to be

strong and protect their friends and families. Others seek support from loved

ones or other cancer survivors or turn to their faith to help them cope. Some

seek help from counselors and others outside the family, while others don’t feel

comfortable with this approach. 

Whatever you decide, it’s important to do what’s right for you and try not to

compare yourself with others. 

Worrying About Your Health

Worrying about the cancer coming back is normal, especially during the first

year after treatment. This is one of the most common fears people have after

cancer treatment. For some, the fear is so strong that they no longer enjoy life,

sleep well, eat well, or even go to follow-up visits. “If I get it again, what am I

going to do?” one woman said. “I never thought I’d make it through the first

time.” Others may react in a more positive way. As one survivor put it, “Cancer

is just part of life, and we always have hope.”

As time goes by, many survivors report that they think about their cancer less

often. However, even years after treatment, some events may cause you to

become worried. Follow-up visits, symptoms similar to the ones you had before,

the illness of a family member, or the anniversary of the date you were

diagnosed can trigger concern.

Yo

ur Fe

elin

gs
Coping With Fear of Cancer Returning

✔ Be informed. Learning about your cancer, understanding what you

can do for your health now, and finding out about the services available

to you can give you a greater sense of control. Some studies even suggest

that people who are well-informed about their illness and treatment are

more likely to follow their treatment plans and recover from cancer more

quickly than those who are not.

✔ Express your feelings of fear, anger, or sadness. People have

found that when they express strong feelings like anger or sadness,

they’re more able to let go of them. Some sort out their feelings by

talking to friends or family, other cancer survivors, or a counselor. But

even if you prefer not to discuss your cancer with others, you can still

sort out your feelings by thinking about them or writing them down.

✔ Look for the positive. Sometimes this means looking for the good

even in a bad time or trying to be hopeful instead of thinking the worst.

Try to use your energy to focus on wellness and what you can do now to

stay as healthy as possible. 

✔ Don’t blame yourself for your cancer. Some people believe that

they got cancer because of something they did or did not do. Remember,

cancer can happen to anyone.

✔ You don’t have to be upbeat all the time. Many people say they

want to have the freedom to give in to their feelings sometimes. As one

woman said, “When it gets really bad, I just tell my family I’m having a

bad cancer day and go upstairs and crawl into bed.”

✔ Find ways to help yourself relax. The exercises on pages 60–61

have been proven to help others and may help you relax when you 

feel worried.

✔ Be as active as you can. Getting out of the house and doing

something can help you focus on other things besides cancer and the

worries it brings.

✔ Look at what you can control. Some people say that putting their

lives in order helps. Being involved in your health care, keeping your

appointments, and making changes in your lifestyle are among the

things you can control. Even setting a daily schedule can give you a

sense of control. And while no one can control every thought, some say

that they try not to dwell on the fearful ones.

38
Feeling Stress

When you were diagnosed, you may have put concerns such as family, work, or

finances aside. Now that treatment is over, these issues may begin to resurface.

Many cancer survivors also worry that stress may have played a role in their

illness. It’s important to remember that the exact cause of many cancers is still

unknown. No research shows that stress causes cancer, but we do know that

stress can cause other health problems. Finding ways to reduce or control the

stress in your life may help you feel better. Devoting time to any activities that

make you feel calm or relaxed may help.

Reducing Stress

Many survivors have found activities like the ones below useful in dealing with

their worries after treatment ends. Ask your doctor, nurse, social worker, or local

cancer organization about taking part in activities like these.

■ Exercise. Exercise is a known way to reduce stress and feel less tense—

whether you’ve had cancer or not. As one man put it, “I can feel down a

little bit, and it is a fine line with depression, but when I walk 30 or 45

minutes in the fresh air, I feel like I can take on the world sometimes.” 

See your doctor before making an exercise plan, and be careful not to

overdo it. If you can’t walk, ask about other types of movement that may

be helpful, such as chair exercises or stretching.

■ Mind-body methods. Things like meditation or relaxation may help

you lower stress by quieting your mind. Try focusing on your breathing or

repeating words or phrases to yourself. Other methods include hypnosis,

yoga, or imagery.

■ Creative outlets. Art, music, or dance gives people the chance to express

themselves in different ways. Even people who have never danced,

painted, or drawn before have found these activities helpful and fun.

■ Sharing personal stories. Telling and hearing stories about living with

cancer can help people air their concerns, solve problems, and find

meaning in what they’ve been through. See pages 44–45 for support 

group information.

39
Finding Humor and Laughing

“Is cancer life-threatening? Yes, but why die mad? 

So I joked about it all the way through, 

and I think it helped me.” —ARI

Laughter can help you relax. When you laugh, your brain releases chemicals that

produce pleasure and relax your muscles. Even a smile can fight off stressful

thoughts. Of course, you may not always feel like laughing, but other people

have found that these ideas can help:

✔ Ask people to send you funny cards.

✔ Enjoy the funny things children and pets do.

✔ Watch funny movies or TV shows.

✔ Listen to comedy tapes or CDs.

✔ Buy a funny desk calendar.

✔ Read joke books or check out jokes on the Internet.

If you don’t own a computer, use one at your local library.

You may even find that you can laugh at yourself. “I went by to help a friend

this summer, and it was really hot, so I took my wig off,” one woman said. “I got

ready to go and I couldn’t find it. After searching high and low, I found it

hanging from her dog’s mouth. But I just stuck it on my head and went home.

My husband said, ‘What happened?’ Needless to say that wig has never been 

the same.”

40
Coping With Depression and Anxiety

After treatment, you may still feel angry, tense, or sad. For most people, these

feelings go away or lessen over time. For some people though, these emotions

can become more severe. The painful feelings do not get any better, and they get

in the way of daily life. These people may have a medical condition called

depression. For some, cancer treatment may have added to this problem by

changing the way the brain works.

Getting Help

Talk with your doctor. If your doctor thinks that you suffer from depression, he

or she may treat it or refer you to other experts. Many survivors get help from

therapists who are experts in both depression and helping people recovering

from cancer. Your doctor may also give you medicine to help you feel less tense.

If you find it hard to talk about your feelings, you may want to show your doctor

this booklet. It can help you explain what you’re going through. Don’t feel that

you should have to control these feelings on your own. Getting the help you need

is important for your life and your health.

Do I Need Help?

If you have any of the following signs for more than 2 weeks, talk to your

doctor about treatment. Some symptoms could be due to physical problems,

so it’s important to be willing to talk about them with your doctor.

✔ Emotional signs:

• Feelings of worry, anxiety, or sadness that don’t go away

• Feeling emotionally numb

• Feeling overwhelmed, out of control, or shaky

• Having a sense of guilt or feeling unworthy

• Feeling helpless or hopeless

• Feeling short-tempered or moody

• Having a hard time concentrating, or feeling scatterbrained

• Crying for long periods of time or many times each day

• Focusing on worries or problems

41
• Having a hard time getting certain thoughts out of your mind

• Finding it hard to enjoy everyday things, such as food or being with

friends

• Finding yourself avoiding situations or things that you know are 

really harmless

• Thinking about hurting or killing yourself

✔ Body changes:

• Unintended weight gain or loss not due to illness or treatment

• Sleep problems, such as not being able to sleep, having nightmares, 

or sleeping too much

• Racing heart, dry mouth, increased perspiration, upset stomach,

diarrhea

• Physically slowing down

• Fatigue that doesn’t go away, headaches, or other aches and pains

Feeling Angry

Many people find themselves feeling angry about having cancer or about things

that happened to them during their diagnosis or treatment. They may have 

had a bad experience with a health care provider or with an unsupportive 

friend or relative.

Feeling angry is normal. And sometimes it can motivate you to take action. But

hanging on to it can get in the way of taking care of yourself or moving on. If

you can, look at what’s causing your anger and what you can do to lessen it. 

42
Feeling Alone

“I went to radiation treatment every day, and 

the staff became like part of my family. And then

when I finished, there was this instant separation,

and I really felt a loss.” —TOM

After treatment, you may miss the support you got from your health care team.

You may feel as if your safety net has been pulled away and that you get less

attention and support from health care providers now that treatment is over.

Feelings like these are normal any time your regular contact with people who

mean a lot to you comes to an end. 

It’s also normal to feel somewhat cut off from other people—even family and

friends—after cancer treatment. Often, friends and family want to help, but they

don’t know how. Others may be scared of the disease. You may also feel that

only others who have had cancer can understand your feelings.

Getting Help

What can you do to make yourself feel better? Try to think about how you could

replace the emotional support you used to receive from your health care team,

such as:

■ Asking one of your nurses or doctors if you could call

sometimes. This could help you stay connected and help you feel less

alone. Even just knowing you can call them may help.

■ Finding support services offered over the phone or Internet.

■ Finding new sources of support for your recovery. Friends, family,

other cancer survivors, and clergy members are a few ideas.

■ Joining a cancer support group. People who have had cancer meet in

groups to talk about their feelings and concerns. Besides sharing their own

stories, they hear what others have gone through and how other people

have dealt with the same problems they are facing. A support group may

also help members of your family cope with their concerns.

43
Joining a Support Group

“I could feel myself getting down, and I joined 

this group and we have a great time. We cry, we

laugh, we carry on.” —ELIA

Support groups can have many benefits. Even though a lot of people receive

support from friends and family, the number one reason they join a support

group is to be with others who have had similar cancer experiences. Some

research shows that joining a support group improves quality of life and

enhances survival.

Support groups can:

■ Give you a chance to talk about your feelings and work through them 

■ Help you deal with practical problems, such as problems at work or school

■ Help you cope with side effects of treatment

Types of Support Groups and Where To Find Them

There are many different types of support groups. Some may be for one type of

cancer only, while others may be open to those with any cancer. Some may be

for women or for men only. Support groups may be led by health professionals

or fellow cancer survivors.

Support groups aren’t just for people who have had cancer. Support groups can

be helpful for children or family members of survivors. These groups focus on

family concerns such as role changes, relationship changes, financial worries,

and how to support the person who had cancer. Some groups include both

cancer survivors and family members.

Not only do support groups meet in person, they also meet online. Internet

support groups can be a big help to people with computers who live in rural areas

or who have trouble getting to meetings. Some Internet groups are sponsored by

cancer organizations, while others are not monitored. With informal chat groups,

you can seek support at any time of the day or night. While these online groups

can provide valuable emotional support, they may not always offer correct

medical information. Be careful about any cancer information you get from the

Internet, and check with your doctor before making any changes that are based

on what you read.

44
Is a Support Group Right for Me?

A support group may not be right for everyone. For some people, hearing about

others’ problems can make them feel worse. Or you may find that your need for

a support group changes over time.

If you are thinking about joining a support group, here are some questions you

may want to ask the group’s contact person:

■ How large is the group?

■ Who attends (survivors, family members, types of cancer, age range)?

■ How long are the meetings?

■ How often does the group meet?

■ How long has the group been together?

■ Who leads the meetings—a professional or a survivor?

■ What is the format of the meetings?

■ Is the main purpose to share feelings, or do people also offer tips to solve 

common problems?

■ If I go, can I just sit and listen?

Before joining a group, here are questions you may want to ask yourself:

■ Am I comfortable talking about personal issues?

■ Do I have something to offer to the group?

■ What do I hope to gain by joining a group?

Support groups vary greatly, and if you have one bad experience, it doesn’t mean

support groups are not a good option for you. You may also want to find

another cancer survivor with whom you can discuss your cancer experience.

Many organizations can pair you with someone who had your type of cancer

and is close to your age and background.

45

The Association of Cancer Online Resources (ACOR) offers access to mailing lists that

provide support and information to those affected by cancer and related disorders. The

ACOR mailing lists are a group of free, unmoderated discussion lists for patients, family,

friends, researchers, and physicians to discuss clinical and other issues and advances

pertaining to all forms of cancer. Learn more online at www.acor.org.
Finding Meaning After Cancer Treatment

“After treatment for breast cancer, I knew 

my life had changed forever. Nothing could ever 

be the same. I was very sad at my losses, but I felt 

I had been given the gift of a new life.” —LINDA

Survivors often express the need to understand what having had cancer means

to their lives now. In fact, many find that cancer causes them to look at life in

new ways. They may reflect on spirituality, the purpose of life, and what they

value most.

These changes can be very positive. Many report feeling lucky or blessed to have

survived treatment and take new joy in each day. For some, the meaning of their

illness becomes clear only after they have been living with cancer for a long time;

for others, the meaning changes over time. It’s also common to view the cancer

experience both negatively and positively at the same time.

Often, people make changes in their lives to reflect what matters most to them

now. You might spend more time with your loved ones, place less focus on your

job, or enjoy the pleasures of nature. You might also find that going through a

crisis like cancer gives you renewed strength. 

“I feel good that I’ve found ways to cope,” one colon cancer survivor said. “I also

feel better able to handle any future problems that might come up. I have

strength that I didn’t know I had.”

Faith, Religion, or Spirituality

Having a serious illness can affect your spiritual outlook, regardless of whether

you feel connected to traditional religious beliefs. After treatment, you and your

loved ones may struggle to understand why cancer has entered your lives. You

may wonder why you had to endure such a trial in your life.

Cancer survivors often report that they look at their faith or spirituality in a 

new way. For some, their faith may get stronger or seem more vital. Others 

may question their faith and wonder about the meaning of life or their purpose

in it. Many say they have a new focus on the present and try to live each day 

to the fullest. 

46
Many survivors have found that their faith, religion, or sense of spirituality is a

source of strength. They say that through their faith, they have been able to find

meaning in their lives and make sense of their cancer experience. Faith or

religion can also be a way for survivors to connect with others in their

community who may share similar experiences or outlooks or who can provide

support. Studies have also shown that for some, religion can be an important

part of both coping with and recovering from cancer. 

The way cancer affects faith or spirituality is different for everyone. It’s common

to question your beliefs after cancer. These questions can be difficult, but for

some, seeking answers and searching for personal meaning in spirituality helps

them cope.

Finding Comfort and Meaning

✔ Read uplifting stories about the human spirit.

✔ Pray or meditate to help you gain perspective.

✔ Take part in community or social gatherings for your own

support and to support others.

✔ Talk with others who have had similar experiences.

✔ Find resources at a place of worship for people dealing with chronic

illnesses like cancer.

Finding Support

How can you find faith-based support in your community? Here are some ideas

that have helped other cancer survivors:

■ Contact a religious or spiritual leader in your community. Most

have been trained in counseling people with major illnesses.

■ Contact the chaplain at your local hospital or treatment

facility. Most hospitals have a staff chaplain who can provide support to

people of different faiths and religions, as well as people who do not

consider themselves religious at all. These chaplains have also been trained

to provide spiritual support to patients and families in crisis.

47
■ Talk with your hospital, health care team, or social worker.

They may know about faith-based organizations in your community that

provide specialized services for cancer survivors.

How Can You Find New Meaning in Your Life After Cancer? 

■ Assess your life. Some survivors say their cancer gave them a wake-up

call and a second chance to make life what they want it to be. Ask

yourself: do your roles in your family fulfill you, or are you doing what

people expect of you? What are things you’ve always wanted to try? Are

you happy in your job, or are you just used to it?

■ Seek spiritual support. A trusted clergy member or professional

counselor may be able to help you with life questions. 

■ Keep a journal. Write down your thoughts about what gives meaning to

your life now.

■ Think about helping others who have had cancer. For some,

reaching out and helping others helps them find meaning. Others want to

get cancer out of their minds and prefer to focus their energy in other

ways. If you want to help, many local and national cancer groups need

volunteers. Or you may prefer to reach out to people you know and spread

the word through family and friends. (The NCI booklet Facing Forward:

Ways You Can Make a Difference in Cancer gives more information. See the

Resources section on page 57 for how to order it.)

■ Think about taking part in a research study. Research studies are

trying to identify the effects of cancer and its treatment on survivors. Joining

a research study is always voluntary, and it could benefit both you and

others. If you want to learn more about studies that involve cancer survivors,

talk with your doctor or see the Resources section.

48
Social and Work Relationships 

“I think some families become stronger because 

of it. We’ve had our rough spots, but we have never

again taken each other for granted.” —DARRYL

Having cancer can change relationships with the people in your life. It’s normal

to notice changes in the way you relate to family, friends, and other people that

you are around every day—and the way they relate to you. 

Your Family

When treatment ends, families are often not prepared for the fact that recovery

takes time. In general, your recovery will take much longer than your treatment

did. Survivors often say that they didn’t realize how much time they needed to

recover. This can lead to disappointment, worry, and frustration for everyone.

Families also may not realize that the way their family works may have changed

permanently as a result of cancer. They may need help to deal with the changes

and keep the “new” family strong.

Some survivors say they would not have been able to cope without their family

members and the help they offered. And even though treatment has ended, they

still receive a lot of support. For others, problems that were present before the

cancer may still exist, or new ones may develop. You may receive less support

from others than you had hoped. 

Even though treatment has ended, you may face problems with your family. For

instance, if you used to take care of the house or yard before your treatment, you

may find that these jobs are still too much for you to handle. Yet family

members who took over for you may want life to go back to normal and expect

you to do what you used to do around the house. You may feel that you aren’t

getting the support you need.

At other times, you may expect more from your family than you receive. They

may disappoint you, which might make you angry or frustrated. For one woman,

it was a family member’s lack of support during her treatment that upset her.

“Never once, not a card, not a phone call, and I have a hard time looking at 

her today.”

49

Social a

n

d

W

ork

R

elatio

nships
50

You may still need to depend on others during this time, even though you want

to get back to the role you had in your family before. At the same time, your

family is still adjusting. It may be hard for you and your family to express

feelings or know how to talk about your cancer.

To help your family members, you may want to share NCI’s booklet for

caregivers, Facing Forward: When Someone You Love Has Completed Cancer

Treatment (see the Resources section on page 57 for how to order this booklet).

Getting Help With Family Issues

Some family members may have trouble adjusting to changes or feel that their

needs aren’t being met. Your family may want to deal with issues such as these on

its own, or you may want to consider getting help. Ask your doctor or social

worker to refer you to a counselor or therapist. An expert on family roles and

concerns after cancer treatment may be able to help your family solve its problems.

How do you cope with family issues? Here are some ideas that have helped

others deal with family concerns:

■ Let others know what you are able to do as you heal—and what not to

expect. For example, don’t feel you must keep the house or yard in perfect

order because you always did in the past. 

■ Give yourself time. You and your family may be able to adjust over time to

the changes cancer brings. Just being open with each other can help

ensure that each person’s needs are met.

■ Help the children in your family understand that you were treated for cancer

and that it may take a while for you to have the energy you used to have. 

Children of cancer survivors have said that these things are important:

■ Being honest with them

■ Speaking as directly and openly as possible

■ Allowing them to become informed about your cancer and involved in

your recovery

■ Spending extra time with them

With your permission, other family members should also be open with your

children about your cancer and its treatment.
Your Workplace 

Research shows that cancer survivors who continue to work are as productive on

the job as other workers. Most cancer survivors who are physically able to work

do go back to their jobs. Returning to work can help them feel they are getting

back to the life they had before being diagnosed with cancer. 

Some cancer survivors change jobs after cancer treatment. If you decide to look

for a new job after cancer treatment, remember that you do not need to try to do

more—or settle for less—than you are able to handle. If you have a résumé, list

your jobs by the skills you have or what you’ve done, rather than by jobs and

dates worked. This way, you don’t highlight the time you didn’t work due to

your cancer treatment. 

Whether returning to their old jobs or beginning new ones, some survivors are

treated unfairly when they return to the workplace. Employers and employees

may have doubts about cancer survivors’ ability to work. 

Handling Problems at Work 

■ Decide how to handle the problem.

• What are your rights as an employee?

• Are you willing to take action to correct a problem?

• Do you still want to work there? Or would you rather look for a 

new job?

■ If necessary, ask your employer to adjust to your needs. 

• Start by talking informally to your supervisor, personnel office,

employee assistance counselor, shop steward, or union representative.

• Ask for a change that would make it easier for you to keep your job (for

example, flextime, working at home, special equipment at work).

• Document each request and its outcome for your records.

■ Get help working with your employer if you need it. 

• Ask your doctor or nurse to find times for follow-up visits that don’t

conflict with your other responsibilities. 

• Get your doctor to write a letter to your employer or personnel 

officer explaining how, if at all, your cancer may affect your work 

or your schedule.

You have no legal obligation to talk about your cancer history unless your 

past health has a direct impact on the job you seek.

51
“My boss has been

good about the time

off I’ve taken—so

far. But I still worry

that questions about

my health will hurt

my future here.” 

—LISA
53

Friends and Coworkers

“When you say the ‘C’ word, it just turns 

some people right off, and they will mumble

something and walk off.” —JACK

The response of friends, coworkers, or people at school after your cancer

treatment may differ. Some may be a huge source of support, while others may

be a source of anger or frustration. Some people mean well, but they do not

know the right thing to say. Maybe they just don’t know how to offer support.

Others don’t want to deal with your cancer at all. 

If friends and coworkers seem unsupportive, it could be because they are anxious

for you or for themselves. Your cancer experience may threaten them because it

reminds them that cancer can happen to anyone. Try to understand their fears

and be patient as you try to regain a good relationship.

Many survivors say that acting cheerful around others for their comfort is a

strain. “I don’t want to smile any more,” one melanoma survivor said. “I don’t

have the energy to be upbeat all the time.” A prostate cancer survivor noted,

“You know if you complain sometimes, for some people, it turns them off. So I

try not to do that.”

As survivors sort out what matters most, they may even decide to let some casual

friendships go, to give more time to the meaningful ones. One brain cancer

survivor found that after cancer, “You really know how many true friends you’ve

got. And they don’t stop calling just because they hear you’re in remission. They

really love you and think something of you.” A kidney cancer survivor found

that “letting weak friendships go was hard, but I also got support I didn’t expect

from people at work and in church.”

On the job or where you volunteer, some people may not understand about

cancer and your ability to perform while recovering from treatment. They may

think you aren’t able to work as hard as before or that your having had cancer

means you are going to die soon. Sometimes, fear and lack of knowledge result

in unfair treatment. 
54

Getting Help

If you find that a friend or coworker’s feelings about cancer are hurting you, try to

resolve the problem with that person face-to-face. If it is still affecting your work

after that, your manager, shop steward, company medical department, employee

assistance counselor, or personnel office may be able to help. 

When hurtful remarks or actions get you down, talking with a friend, family

member, or counselor may help you come up with ideas for handling it. But if

coworker attitudes get in the way of doing your job, it is a problem that

management should address.

Relating to Others

How do you relate to other people in your life after cancer treatment? 

■ Accept help. When friends or family offer to help, say yes, and have in

mind some things that they could do to make your life easier. In this way,

you will get the support you need, and your loved ones will feel helpful.

“When I first started treatment, I had a lot of help,” said one colon cancer

survivor. “So I felt bad asking my friends for more help when my

treatment ended. But I still really needed it, so I let them know.”

■ Address any problems that come up when you go back to work

or school. Your supervisor (or his or her supervisor), teacher, or

coworkers may be able to help those around you understand how you

want to be treated as a cancer survivor. If problems with others get in the

way of your work or studies, you may want to talk with your bosses, your

union, the company’s Human Resources department, or the school’s

Student Affairs office.

■ Keep up contacts during your recovery. Friends and coworkers will

worry about you. If they find out about your treatment and progress, they

will be less anxious and scared. Talk to them on the phone, send email, or

appoint a trusted friend or family member to do this for you. When you are

able, have lunch with friends or stop in for an office party. Your return to

work or other activities will be easier for you and others if you stay in touch.

■ Plan what you’ll say about your cancer. There is no right way to

deal with others about your illness, but you do need to think about what

you’ll say when you’re back on the job. Some cancer survivors don’t want

to focus on their cancer or be linked in people’s minds with the disease.

Others are very open about it, speaking frankly with their boss or other

workers to air concerns, correct wrong ideas, and decide how to work

together. The best approach is the one that feels right to you.
55

Reflection 

courage doesn't always roar.

sometimes courage is the 

quiet voice at the end of the day saying, 

“i will try again tomorrow.”

—MARY ANNE RADMACHER*

The end of treatment can be a time to look forward to the future. New rituals

and new beginnings can bring a sense of relief and joy. It may also be a time of

physical and emotional change. Now that treatment is over, try to take time to

get back in tune with yourself. Allow healing time for you and your family

members and caregivers. Think about what you can do to begin living without

cancer as a main focus.

Whether good or bad, life-changing situations often give people the chance to

grow, learn, and appreciate what’s important to them. Many people with cancer

describe their experience as a journey. It’s not necessarily a journey they would

have chosen for themselves. But it sometimes presents the opportunity to look

at things in a different way.

R

eflectio

n

* used with permission
56

Appendix

Financial and Legal Matters 

The financial challenges that people with cancer and their families face are very real.

During an illness, you and your family may have found it hard to find the time or

energy to review your options. Yet it’s important to keep your family financially healthy.

For hospital bills, you may want to talk with a hospital financial counselor. You may be

able to work out a monthly payment plan or even get a reduced rate. You may also want

to stay in touch with your insurance company to make sure costs are covered.

For information about resources that are available, see the Resources section. You can also

get the NCI fact sheet “Financial Assistance for Cancer Care” at www.cancer.gov, search terms

“financial assistance.” Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for it.

Legal Documents

If you haven’t developed an advance directive, you may want to consider it. Advance

directives are legal documents that let a person decide important issues ahead of time,

including how much treatment to receive and who should make decisions if he or she

can’t. Having an advance directive helps ensure that you get the treatment you want.

Understanding your wishes will also make it easier for family members if a time comes

when treatment decisions need to be made.

Advance directives:

■ A living will lets people know what kind of medical care patients want if they

are unable to speak for themselves.

■ A durable power of attorney for health care names a person to make

medical decisions for a patient if he or she can’t make them. This person, chosen

by the patient, is called a health care proxy.

Other legal papers that are not part of the advance directives:

■ A will tells how a person wants to divide money and property among his or her

heirs. (Heirs are usually the surviving family members. Other people may also be

named as heirs in a will.)

■ A trust appoints the person a patient chooses to manage money for him or her.

■ Power of attorney appoints a person to make financial decisions for the

patient when he or she can’t make them.

A lawyer does not always need to be present when you fill out these papers. However, a

notary public may be needed. Each state has its own laws about advance directives.

Check with your lawyer or social worker about the laws in your state. See the Resources

section on page 57 for more information.
Resources

Federal Agencies

National Cancer Institute 

NCI provides current information on cancer prevention, screening, diagnosis, treatment,

genetics, and supportive care. It also lists clinical trials and specific cancer topics in

NCI’s Physician Data Query (PDQ®) database. The following free material may also be

helpful. To order, visit NCI’s Web site or call NCI’s Cancer Information Service (CIS) tollfree. 

■ Facing Forward: Ways You Can Make a Difference in Cancer

■ Facing Forward: When Someone You Love Has Completed Cancer Treatment—

Support for Caregivers

■ Moving Beyond Breast Cancer (DVD or videotape)

Cancer Information Service 

CIS answers questions about cancer, clinical trials, and cancer-related services and helps

users find information on the NCI Web site. It also provides NCI printed materials.

Phone: 1-800-4-CANCER (1-800-422-6237)

TTY: 1-800-332-8615

Web site: www.cancer.gov 

Chat online: www.cancer.gov/help

Administration on Aging 

The Administration on Aging provides information, assistance, individual counseling,

organization of support groups, caregiver training, respite care, and supplemental

services.

Phone: 1-202-619-0724

TTY: 1-800-877-8339

Web site: www.aoa.gov 

Centers for Medicare & Medicaid Services 

The Centers for Medicare & Medicaid Services provides information for consumers about

patient rights, prescription drugs, and health insurance issues, including Medicare and

Medicaid.

Phone: 1-800-MEDICARE (1-800-633-4227)

Web site: www.medicare.gov (for Medicare information) or www.cms.hhs.gov 

(for the free booklet Medicare Basics: A Guide for Caregivers)

Equal Employment Opportunity Commission 

EEOC provides fact sheets about job discrimination, protections under the Americans

With Disabilities Act, and employer responsibilities. It also coordinates investigations of

employment discrimination.

Phone: 1-800-669-4000

TTY: 1-800-669-6820

Web site: www.eeoc.gov

For a Complete List of Resources

See the fact sheet, “National Organizations That Offer Services

to People With Cancer and Their Families,” at www.cancer.gov,

search terms “national organizations.” Or call 1-800-4-CANCER

(1-800-422-6237) to ask for it.

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National Association of Area Agencies on Aging/Eldercare Locator

The Eldercare Locator is a nationwide directory assistance service designed to help older

persons and caregivers find local resources for support. Areas of support include

transportation, meals, home care, housing alternatives, legal issues, and social activities.

Phone: 1-800-677-1116

Web site: www.eldercare.gov

U.S. Department of Labor/Office of Disability Employment Policy 

The U.S. Department of Labor provides fact sheets on a variety of disability issues,

including discrimination, workplace accommodation, and legal rights.

Phone: 1-866-ODEP-DOL (1-866-633-7365)

TTY: 1-877-889-5627

Web site: www.dol.gov/odep 

Nonprofit Organizations

American Cancer Society/National Cancer Information Center

ACS provides cancer information and support to patients, families, and caregivers. It

also supports research, community education, and advocacy and public policy issues.

Phone: 1-800-ACS-2345 (1-800-227-2345)

Web site: www.cancer.org

CancerCare

CancerCare provides free, professional support services to anyone affected by cancer:

people with cancer, caregivers, children, loved ones, and the bereaved. CancerCare

programs—including counseling, education, financial assistance and practical help—

are provided by trained oncology social workers and are free of charge.

Phone: 1-800-813-HOPE (1-800-813-4673)

Web site: www.cancercare.org

Cancer Hope Network

Cancer Hope Network matches patients and families with trained volunteers who have

recovered from a similar cancer experience.

Phone: 1-877-HOPENET (1-877-467-3638)

Web site: www.cancerhopenetwork.org

Family Caregiver Alliance

FCA addresses the needs of families and friends who provide long-term care at home. 

Phone: 1-800-445-8106

Web site: www.caregiver.org

Gilda’s Club, Inc.

Gilda’s Club provides social and emotional support for patients, families, and friends. 

Phone: 1-888-GILDA-4-U (1-888-445-3248) 

Web site: www.gildasclub.org

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59

Lance Armstrong Foundation 

The Lance Armstrong Foundation seeks to inspire and empower people living with,

through, and beyond cancer to live strong. It provides education, advocacy, and public

health and research programs.

Phone: 1-512-236-8820 (general number) 

1-866-235-7205 (LIVESTRONG SurvivorCare program) 

Web site: www.livestrong.org 

National Coalition for Cancer Survivorship

NCCS provides information and resources on cancer support, advocacy, and quality-oflife issues to cancer survivors and their loved ones. 

Phone: 1-877-NCCS-YES (1-877-622-7937)

Web site: www.canceradvocacy.org

National Family Caregivers Association

NFCA provides information, education, support, public awareness, and advocacy for

caregivers.

Phone: 1-800-896-3650

Web site: www.nfcacares.org

NeedyMeds

The NeedyMeds Web site lists medicine assistance programs available from drug

companies. NOTE: Usually, patients cannot apply directly to these programs. Ask a

doctor, nurse, or social worker to contact NeedyMeds on your behalf.

Web site: www.needymeds.com

Patient Advocate Foundation

PAF provides education, legal counseling, and referrals to cancer patients and survivors.

It specializes in matters related to managed care, insurance, financial issues, job

discrimination, and debt crisis.

Phone: 1-800-532-5274 

Web site: www.patientadvocate.org

The Well Spouse Association 

The association provides support to wives, husbands, and partners of chronically ill

and/or disabled persons.

Phone: 1-800-838-0879

Web site: www.wellspouse.org

The Wellness Community 

The Wellness Community is a national organization that provides support groups, stress

reduction and cancer education workshops, nutrition guidance, exercise sessions, and 

social events.

Phone: 1-888-793-WELL (1-888-793-9355) 

Web site: www.wellness-community.org
Learning To Relax

Many people with cancer have found that

practicing deep relaxation has helped relieve

their pain or reduce their stress. The exercises

on the next few pages may not be right for

everyone. Ask your doctor or nurse if these

exercises can help you. Before trying the full

exercise below, first practice steps 1 through 5,

so you can get used to deep breathing and

muscle relaxation.

You may find that your mind wanders. When

you notice yourself thinking of something else,

gently direct your attention back to your

deepening relaxation. Be sure to maintain your

deep breathing. If any of these steps makes you

feel uncomfortable, feel free to leave it out. 

Exercise 1

1. Find a quiet place where you can rest

undisturbed for 20 minutes. Let others

know you need this time for yourself.

2. Make sure the setting is relaxing. For

example, dim the lights if you like, and find a comfortable chair or couch.

3. Get into a comfortable position where you can relax your muscles. Close your eyes

and clear your mind of distractions.

4. Breathe deeply, at a slow and relaxing pace. People usually breathe shallowly, high in

their chests. Concentrate on breathing deeply and slowly, raising your belly, rather

than just your chest, with each breath.

5. Next, go through each of your major muscle groups, tensing (squeezing) them for 

10 seconds and then relaxing. If tensing any particular muscle group is painful, skip

the tensing step and concentrate just on relaxing. Focus completely on releasing all

the tension from your muscles and notice the differences you feel when they are

relaxed. Focus on the pleasant feeling of relaxation. 

In turn, tense, hold, and relax your:

• Right and left arms. Make a fist and bring it up to your shoulder, tightening 

your arm.

• Lips, eyes, and forehead. Scowl, raise your eyebrows, pucker your lips, and 

then grin.

• Jaws and neck. Thrust your lower jaw out, and then relax. Then tilt your chin

down toward your chest.

60

Practicing Relaxation To Relieve

Pain and Stress

Relaxation can help you feel better—

both mentally and physically. For most

of us, though, it is not easy to “just

relax.” Relaxation is a skill, and it

needs to be practiced, just like any

other skill.

Many people wait until they are in a

lot of pain or feel a lot of stress before

they try to relax, when it can be

hardest to succeed. Then they might

try to relax by overeating, smoking, 

or drinking—activities that are not

helpful and might even be harmful.

Take the time to learn helpful

relaxation skills and practice them

often. You can also take a class or buy

a relaxation tape or CD.
61

• Shoulders. Shrug your shoulders upward toward your ears.

• Chest. Push out your chest.

• Stomach. Suck in your stomach.

• Lower back. Stretch your lower back so that it forms a gentle arch, with your stomach

pushed outward. Make sure to do this gently, as these muscles are often tight.

• Buttocks. Squeeze your buttocks together.

• Thighs. Press your thighs together.

• Calves. Point your toes up, toward your knees.

• Feet. Point your toes down, like a ballet dancer’s.

6. Review these parts of your body again and release any tension that remains. Be sure

to maintain your deep breathing.

7. Now that you are relaxed, imagine a calming scene. Choose a spot that is

particularly pleasant to you. It may be a favorite comfortable room, a sandy beach, a

chair in front of a fireplace, or any other relaxing place. Concentrate on the details: 

• What can you see around you? 

• What do you smell? 

• What are the sounds that you hear? For example, if you are on the beach, how

does the sand feel on your feet, how do the waves sound, and how does the air

smell? 

• Can you taste anything? 

• Continue to breathe deeply as you imagine yourself relaxing in your safe,

comfortable place.

8. Some people find it helpful at this point to focus on thoughts that enhance their

relaxation. For example: “My arms and legs are very comfortable. I can just sink into

this chair and focus only on the relaxation.”

9. Spend a few more minutes enjoying the feeling of comfort and relaxation.

10. When you are ready, start gently moving your hands and feet and bringing yourself

back to reality. Open your eyes and spend a few minutes becoming more alert.

Notice how you feel now that you have completed the relaxation exercise, and try to

carry these feelings with you into the rest of your day. 

Exercise 2

1. Sit comfortably. Loosen any tight clothes. Close your eyes. Clear your mind and

relax your muscles using steps 4 and 5 above.

2. Focus your mind on your right arm. Repeat to yourself, “My right arm feels heavy

and warm.” Stick with it until your arm does feel heavy and warm.

3. Repeat with the rest of your muscles until you are fully relaxed.
NIH Publication No. 06-2424

Printed September 2006