Cancer Survivorship Themes: Guilt

Over the past three months we have explored some of the survivorship themes identified by the staff of the Connecticut Challenge Survivorship Clinic at Yale Cancer Center.This month we'll take a brief look at a complex and difficult theme: Guilt.  As with the other themes it is manifested in various ways:

• I must have brought this (cancer) on myself somehow.
• I know my cancer was caused by eating  . . . . (red meat, fast food, dairy, etc.).
• If only I could have had a more positive attitude!
• Being a couch potato sure didn't help.
• I'm grateful to be a survivor, but I feel bad that I did well while some of the people I got to know in the treatment center had a much harder time.
• I can't believe what I put my family through!

Our clinicians address this phenomenon in a hypothetical patient:

APRN:  There is a tendency to find someone to blame when something bad happens to us; too often we turn that blame in on ourselves, a cultural characteristic in the West.  In reality no one can know what "caused" a specific cancer in a specific individual.  Cancer is a very complex process that takes years to develop and requires several metabolic steps to occur in the right sequence.  It's helpful to recognize that specific behaviors and attitudes neither cause nor cure cancer.  Risk factors (which in themselves are not "causes") are identified in studies of large heterogeneous groups.  Many, perhaps most, cases of cancer arise without being able to identify risk factors in an individual.  Providing some self-empathy, acknowledging that this has been a frightening and difficult experience, and giving ourselves credit for having come through it - being a survivor! - is a step toward emotional healing. 

Physical Therapist:  Research shows that regular exercise may decrease one's risk of developing certain cancers.  However, it addresses only one of many variables or risk factors for developing cancer.  Even the most active individuals are still at risk of developing cancer. 

If you did not exercise prior to your cancer diagnosis, then your post-cancer treatment life is a great time to start exercising to help you physically and mentally recover from your treatments.  Many people report that they are actually healthier after cancer because their diagnosis was a 'wake-up call' to make changes in their life (such as exercising).  If you did exercise prior to your cancer diagnosis, this is also a chance for a 'redo.'  People who exercised prior to cancer may have only done one or two types of exercises or done the same machine at the gym every day; now is the opportunity to try new activities, establish new challenges, and exercise with a greater clarity and purpose.  If you used to run on the treadmill 4 or 5 times a week but never did a road race before your cancer diagnosis, this is your chance to try something new.  And exercise makes you feel better!

Social Worker:  We seem to have a "little voice" that whispers in our ear, "you did something to cause the cancer."  There is no evidence to back this up.  Cancer survivors are a diverse group:  all ages, all races and religions, and socio-economic groups.   We are omnivores and vegetarians, alcohol consumers and teetotalers, coach potatoes and fitness buffs, and everyone in between.  (It is also true that some nonsmokers get cancer and some smokers do not.)  That said, good habits serve us well-eating healthy foods, regular exercise, adequate sleep and relaxation, laughter, light alcohol consumption, loving relationships, and having fun-will improve quality of life and assist us in staying healthy.

Nutritionist:  Just as there is no one food that will trigger a recurrence, there is no one food that caused your cancer. As previously explained, there are many variables or risk factors for developing cancer.  Even individuals whose customary diet has been very nutritious are still at risk for developing cancer. But continuing, or putting into place, nutritious eating habits will improve energy levels and boost the immune system.  Let's not forget eating food is fun and delicious!

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