The Many, and Healthy, Ways to Live With Cancer

One thing that all cancer patients seem to express is the feeling that no matter how long ago their initial diagnosis, the fear of recurrence is always there -- a fear reawakened for many with the news this month about Edwards, the wife of Democratic presidential candidate John Edwards, and White House press secretary Snow.

"I think you always have it in the back of your mind, and there are times when it moves to the front of your mind," said Becky Krimstein, a 44-year-old breast cancer survivor in North Potomac. "If you have some weird pain you think, 'Is it just a pain or could it be a recurrence? Is it back?' "

For Krimstein, her diagnosis triggered life changes, albeit slowly.

"I have drastically changed my life, but it's been more incremental," said Krimstein, who eventually left her job in local television to start a documentary film company with her husband, Gary. "It wasn't one of those things like, 'Let's sell the house and travel the country.' But looking at where I am now, nine years later, I realize it set in motion a lot of changes."

Among the biggest initial challenges are the practical logistics -- finding information and doctors, dealing with insurance matters or, if the patients are not insured, struggling to figure out how they are going to pay for their care.

But assuming they get optimal care, research shows that the specific changes that cancer patients do or do not make in their lives are probably less important to their odds of survival than their emotional state.

"It depends what's meaningful for the individual. If someone feels their job is stressful and non-supportive, that individual will be well served to find a way out of it," Rowland said. "But someone else will say, 'I love my job and that's meaningful and important to me.' That's very different than someone who says, 'I might as well quit since I'm not going to be here in six months.' "

A strong network of personal support appears to be crucial, helping to make the experience easier and, perhaps, boosting the chances of survival. For some, having strong religious faith helps. For others, having close friends and families is what matters.

While it remains unclear how much of a role emotions play, patients with a positive outlook appear to have stronger immunity, less stress and fewer toxic side effects from treatment, many studies have shown.

"What clearly doesn't work well is a sense of helplessness and hopelessness," Rowland said. "That feeling that 'I'm not going to make it.' These are the people we worry about the most."

Experts and patients are quick to point out, though, that a positive outlook offers no guarantee.

Nevertheless, patients who seem to fare best are those who approach the disease with the mind-set of athletes at a major competition, researchers say. The fear and feelings that accompany a cancer diagnosis are real -- and beyond control. But what patients do with those fears and feelings is far more under their control than many realize, they say.