Living life to the full while undergoing cancer treatment

After diagnosis it can take time to adjust to the ‘new normal’. For some people it is a chance to reassess their life.  People with cancer used to be called “brave”. For the two million people in the UK living with the disease — for years or even decades — it is simply a matter of fact. More people are surviving longer with cancer because of improving treatments: some will be cured, some will be go through lengthy treatments, some will have incurable cancer controlled for long periods. Today, 1 in 20 people lives with cancer, and Cancer Research UK says that the number is rising by 3 per cent a year.

Mark Travis, a teacher trainer from Cornwall, calls it “the new normal” — echoing the phrase used by the writer Siddhartha Mukherjee in his book urging the world to learn to live with, rather than fight, cancer (The Emperor of All Maladies, Fourth Estate). Travis, whose aggressive prostate cancer was diagnosed two years ago at the early age of 48, has found that life has settled down into a reasonably settled state that, if not perfect, offers some improvements on his “old normal”.

“I concentrate on the things I can do something about, like keeping fit, and keeping working,” says Travis, who is on hormone drugs to control the cancer. “My new normal is to set time aside for the things that matter and not give time to the things you can’t do anything about, like worrying whether I’ll make it to retirement. I might get knocked off my bike on the dual carriageway anyway.”

Other people find adjustment harder. Cordelia Galgut found that she had breast cancer in her late forties and in the six years since she has had surgery on both breasts, radiotherapy and hormone treatment. She is surprised by the way in which having cancer has shaken her world to its core.

“For a while I was so shocked that I was like a rabbit in headlights,” says Galgut, a counselling psychologist who has written a book based on her experience (The Psychological Impact of Breast Cancer, Radcliffe). “I went into cope mode, being cheerful to everyone. Then I got badly burnt in radiotherapy and my treatment stirred up lots of feelings of vulnerability and bad memories. I think it’s now left me feeling more frightened.”

Professor Michael Sharp, Director of Psychological Medicine Research at the University of Edinburgh, says that as cancer has become a long-term condition rather than a death sentence, the vast majority of people seem to adapt to it psychologically. Although research has indicated that nearly half of cancer patients suffer anxiety and depression in their first year after diagnosis, his studies show that fewer than 10 per cent suffer from persistent depression.

One key factor in people’s outlook is whether they can continue working. “Living off benefits can have an effect on how people see themselves,” Sharp says. “Those who become depressed long-term are often experiencing loss of different types. It might be loss of a job, or a family role, or an old life.”

People living with cancer commonly report other changes in their new life: in body image, in their sense of self, or in relationships. These changes invariably seem negative at first, but many people see benefits as time passes.

Kate Crowe, 60, a former teacher in Tower Hamlets, London, who had oesophageal cancer diagnosed in January, has already noticed that the nature of her friendships is changing. “Some people don’t even like to mention that I’ve got cancer, and I’ve got more distant from the people who can’t cope with it. It’s shown me the people who really are friends, who have been sympathetic, and I’ve got much closer to my brother, as he’s cared for me.”

Her cancer was caught early and she was enrolled on a trial at the Barts Cancer Centre. Although treatment can be gruelling, the extra care that Crowe receives because she is part of a trial has helped her to adjust.

Travis says that he used his cancer diagnosis as a means to cut out life’s “chaff”. He continued working as his employers helped him to adapt his role so that he could work from home.

“I have my dark moments, but they’re mostly about not being able to do my job as well as I used to. Working from home has allowed me to reconstruct my life. I walk, cycle and surf — even when I was having radiotherapy. I’ve worked out that the notion of a good life only being a long life is ridiculous. I think: ‘What would I have done in the past two years if I hadn’t received a diagnosis of cancer?’ I’d have been on the treadmill, cheesed off about the cuts, having the odd argument with my wife. Now life has changed. We have a calmer, more reflective household.”

That’s not to say that living with cancer doesn’t bring new, enduring fears. Amanda Ramirez, Professor of Liaison Psychiatry at King’s College London, says that two of the most common are a sense of uncertainty about the future and a fear that the disease will recur. “Keeping the British stiff upper lip is not a good idea,” she says. “Those who move on best from the maelstrom of anxieties that cancer brings seem to be those who talk about what’s happened to them and ventilate their negative experiences. It helps them to make sense of what matters most, and formulate future plans.”

by Simon Crompton, medical writer and author.  This piece was first published in The Times on 9 April 2011

(c) Simon Crompton