By: Valentina Ogaryan, PhD
A woman sat across from me, tearful, with a distant look in her eyes, and shared, “I know I should be happy. It’s done and everyone keeps saying it’s time that I get back to my life. I just can’t. What now?”
This was a disclosure filled with so much confusion and complexity. This vulnerable question came from a woman who displayed incredible resilience throughout her treatment but who now appeared more scared and unsure than when she had first received her diagnosis. The prevalence of breast cancer does not diminish or lessen the intensity of the disruption it can have on different areas of a woman’s life. Often, there is surprise at how the disruption can become even more acute as women transition from treatment to survivorship. It is not unusual for women transitioning into survivorship to feel unprepared for the emotions and challenges that wait for them ahead.
The challenges that come with managing a diagnosis of breast cancer may be particularly disruptive for young adult women. Young women face unique developmental changes and as a result, the impact on their identity formation, career trajectories, family and romantic relationships, sexuality, and family planning may be even more pronounced. Multiple layers of emotional distress can impact a young adult’s survivorship, well after she has received the green light of, “no evidence of disease.”
Throughout the cancer experience, the minutes, hours and days for many women are mapped out and filled with medical appointments ranging from oncology consultation visits, to surgery, to radiation and chemotherapy. Subsequently, there is hopefully a rallying and outpouring of love and support from friends, family and colleagues. Once treatment is completed, all of that structure is taken away, thus, the routine that had become the norm, is no longer. The sense of being taken care of their medical team vanishes, and suddenly women report feeling as having the sole responsibility of managing their ongoing health and well being.
A common theme of managing uncertainty, is the fear of the unknown, the lingering feeling of what if, and then what? A significant stressor in survivorship is the uncertainty of how one can go back to normal or redefine what the “new normal” looks like.
It is important to recognize that many women struggle to return to a previous normal, when they have in fact been changed throughout the experience. There are a multitude of changes that become evident in survivorship, including changes from endocrine therapy, to cognitive changes, to physiological changes such as increased fatigue and lower levels of energy. Within the context of these changes, women are also attempting to manage their already existing roles and responsibilities, with the hopes of “doing it all right.”
While the medical treatment for breast cancer requires patients to anticipate and problem-solve their way through a prescribed progression of appointments, consultations, and procedures, the survivorship experience is highly varied and fluctuant; there is no “one-size-fits-all” prescription for readjusting to one’s life after cancer.
For young breast cancer survivors, the question of “what now?” may originate initially from a place of fear and uncertainty; with support and encouragement, however, women can empower themselves by asking the same question from a place of exploration. The question may in part then be answered with choices a woman can make in her life—changes that make her feel more empowered and nourished.
It is important to remember that there is no “one-size-fits-all” approach to enhancing vitality in survivorship. Each woman can and should make changes that fit her individual needs.
Furthermore, while establishing coping skills or healing practices–whether those practices take the form of mindfulness/meditation, yoga, exercise, spirituality and/or changes in diet–it is important not to lose sight of self-compassion and flexibility in the process. New habits and lifestyle changes should not be viewed as unforgiving regimens, which need to be strictly followed, but rather as realistic, attainable choices that can be made and adjusted as needed along the way.
At the Simms/Mann- UCLA Center for Integrative Oncology, many women find benefits in utilizing psychological support through classes such as mindfulness, meditation, Qi Gong and individual support. In a community of other survivors and with the help of knowledgeable psychosocial oncology clinicians, women can become witnesses to each other’s lives, share their unique experiences, and support one another in redefining what healthy survivorship means to each of them.
To read more from the “Pathways to Wellness Newsletter”, click here: UCLA Newsletter Dec2017