Coping with Cancer Return

One piece of news no cancer patient wants to hear is that the cancer has reoccurred. If a cancer patient you’re working with has just received news of this type, it has probably left the patient with a lot of new questions and concerns. One of the biggest challenges during this time is uncertainty about what’s ahead. It helps for you to first understand what cancer recurrence is and how it is treated, so you can be helpful and effective in ministry.

What is Cancer Recurrence?

When the same cancer resurfaces in the body after a period of time following treatment and remission (in which the cancer could not be detected), it is called a recurrence, or recurrent cancer. While it’s possible to develop a new cancer unrelated to the original one, recurrence is more common.

A recurrence is a regrowth of the original disease. It means a small number of cancer cells may have been left behind after treatment. These may have been too small to be seen in follow-up, but, over time, they have become active and grown into detectable tumors. Cancer cells can return to the same place where the cancer first originated, or they can migrate to other parts of the body.

The following are the different types of cancer recurrence, based on where the cancer returns in the body:

• Local – the cancer returns to the same area as the original cancer or very close to it
• Regional – the cancer returns to the lymph nodes or tissues near the primary site
• Distant – the cancer returns to distant organs or tissues far from the primary site   

Distant recurrence is also called secondary, or metastatic, cancer. It means the original cancer has spread (metastasized) from the primary site to other areas of the body, often by way of the lymphatic system or bloodstream. The liver, lungs, lymph nodes, and bones are common areas of spread or metastasis.

Even when cancer has spread to a new location, it’s still named after the part of the body where it started. For example, a person with breast cancer that has spread to the bones is said to have breast cancer with bone metastases. Metastatic cancer is considered advanced if it has aggressively spread to many places in the body, is affecting vital organs or can’t be removed.

What is the Risk of Recurrence?

The risk of cancer recurrence is different for each individual. The chance that cancer will come back depends on the type and stage of the original cancer, the treatment given, how long it has been since treatment and other factors. Although cancer recurrence is generally unpredictable, aggressive cancers, late-stage cancers, or difficult-to-treat cancers tend to return more often.

When cancer recurs, it doesn't mean that the treatment received was wrong or that the patient did something to cause the recurrence. Cancer can return even if the patient has done everything just right — eating right, exercising, and seeing the doctor for follow-up visits. Thus, it is important that the patient not blame him or herself for cancer recurrence.

What’s the Next Step?

The patient may have heard that cancer is more difficult to treat the second time around. However, a cancer recurrence does not mean the patient is without options and hope. A lot of progress has been made in the field of cancer research, and treatments have likely improved since the person first had cancer. Advanced treatment methods and technologies, as well as clinical trials, can provide new options to help treat recurrent cancer and/or manage its symptoms.

Although local cancer can be easier to treat than regional or distant cancer, there are options for all three. Surgery and radiation therapy are common treatment options for cancer that comes back locally. If the cancer returns to a distant site, treatment may depend on whether the cancer can be removed by surgery. If it can’t be surgically removed, various forms of chemotherapy, radiation therapy, or biological therapy may be used.

Sometimes the goal of treatment is to relieve symptoms. Palliative treatment helps relieve cancer-related symptoms, such as pain, to help improve quality of life. These treatments are much like the treatments used to fight cancer.

There is no right or wrong decision about how to handle cancer recurrence. A patient’s treatment options will depend on cancer type, previous treatments, the length of time between the original diagnosis and recurrence, the location of the recurrence, the extent of spread, age, overall health and personal goals. It’s important for the patient to weigh the potential pros of a new treatment against the possible cons, such as side effects, to decide what will work best.

Adjusting to the News

News of cancer recurrence can be very upsetting for a patient and his/her loved ones. With the return of cancer come the shock, fear and uncertainties that accompanied the first diagnosis. Yet, a second cancer diagnosis can be even more distressing.

The patient may wonder about the future and feel discouraged at the thought of having to undergo treatments again. He or she may still be recovering physically and emotionally from the previous battle with cancer. The patient could be disappointed in his or her healthcare team, or blame him or herself for past treatment decisions or lifestyle choices. The patient may feel anxious, sad, guilty, desperate, or angry. These feelings are all a normal part of cancer recurrence.

When cancer comes back, new questions may surface for the patient, such as the following:

• Why is this happening to me again?
• Haven't I been through enough?
• What is going to happen now?
• What are my treatment options?
• What if I feel that I can't take more treatment?
• How will my family cope with the news?
• What am I going to do about finances?
• Will the cancer go back into remission?

Everyone handles cancer recurrence differently. While it can be difficult to accept the news at first, cancer patients need to know they are not alone. Also, they need to consider all the things they can do for themselves to help cope with the situation. That way they can regain some control and feel more empowered.

Note: When cancer returns, it’s normal to experience strong emotions. It’s important for cancer patients to keep their healthcare team informed about how they’re feeling.

Tips to Share for Dealing Effectively With Cancer Recurrence

As you minister to a cancer patient who is undergoing a cancer recurrence, here are some tips you can share that may be helpful:

• Acceptance. You may wonder if you did anything to make the cancer come back. Although this feeling is normal, you shouldn’t blame yourself. Try not to focus on what could have been. Instead, try to accept the situation and use your inner strength to move forward.
• Do what is right for you. When cancer returns, your treatment goals may change, or they may be the same as with your first diagnosis. Think about what’s important to you now and make thoughtful decisions about your treatment. And, let your cancer team know your goals. Only you can decide what is best for you.
• Set goals. Develop a plan to help you live your life as fully and best as possible. It can help to set both short-term and long-term goals. Set small goals for each day, such as taking a walk, making a phone call, having lunch with a friend, reading a chapter of a book, etc. With places to go and things to do, you’ll feel more productive and fulfilled and will get your mind off cancer.
• Use lessons learned from the past. You’ve already battled cancer before. You’re more experienced and knowledgeable this time around. Use what you learned in the past to deal with your present situation. Remember that as difficult as it was, you got through it. The same coping skills you used during your initial treatment can give you the strength and confidence you need now.
• Manage your symptoms. The symptoms of cancer recurrence can impact your quality of life. It’s essential that you work with your cancer team to manage your symptoms, such as pain, fatigue, difficulty sleeping, etc. Improving physical symptoms can also improve your mood and overall well being.
• Seek emotional support. Feeling angry and upset about a cancer recurrence is completely normal. It’s important to find support so you can express these feelings. Aside from family and friends, it helps to share feelings and concerns with others who are dealing with cancer recurrence and have been where you are now. In addition to support groups, you may also decide to seek private counseling.
• Nurture your spiritual well being. Spirituality can be a source of strength for many people. Cancer recurrence can make you think about your beliefs. You may find comfort by exploring more deeply what is meaningful to you. Prayer, meditation or writing in a journal are just a few of the ways you can nurture your spiritual well being.
• Share with your loved ones. Your loved ones may also need time to adjust to the news, come to terms with their own feelings and adjust to changing family roles. Remind your family and friends that you are still the same person you always were. Let them know that they can support you just by listening and being at ease with you.
• Plan ahead. Even when you’re healthy, it helps to be prepared and make provisions for your family if the worst happens. Although it’s difficult to talk about these issues, if you have not already done so, you may decide to update your affairs through an advance directive or living will. Planning ahead can also help you worry less about the future, take control of the situation, and protect those you love most.
• Be open with your cancer team. Speak openly about your needs and concerns with your cancer team. Take the time to discuss all the available options with your doctors and family members. Even if you’re happy with your current doctor, this might be a good time to get a second opinion to explore all your options. You need to be comfortable with your decisions.
• Do things you enjoy. Try to participate in activities that matter most to you. Creative outlets, such as drawing, painting, music and poetry can help you express yourself and relieve stress. You can also keep a journal, read a book, watch a funny movie, go fishing, make a scrapbook and spend time with family and friends.
• Stay hopeful. When cancer returns, it can change the way you look at life. It's important to stay hopeful. You may have hope for new treatment options, hope for relief from symptoms or hope for good times with family and friends. Hope can motivate you and make you feel empowered.

Note: This information is not intended nor implied to be a substitute for professional medical advice. Cancer patients should always seek the advice of their physician or other qualified health provider prior to making decisions about their treatment.