We cancer survivors are everywhere these days — 4.8 percent of the U.S. population. When I was young, in the late 1960s, cancer seemed to always win. If you heard your friend’s grandma had cancer, you understood your friend’s grandma would be dying, probably soon. But things have changed. Thanks to early detection and more sophisticated medicine, more and more cancer patients enter treatment with the very real possibility that their lives will continue, and will continue well. They will enter the cancer-treatment system as a sick person and come out having earned the “survivor” label.
We survivors are supposed to be happy and grateful, to embrace our second chance at life. Many survivors can point to decidedly good changes in their lives and outlooks since staring down that black tunnel called cancer. But that’s not how the story ends for some of us.
My breast cancer diagnosis led to a lumpectomy and six weeks of radiation, followed by five years of taking tamoxifen, an estrogen-blocking drug which inhibits some types of tumors. Nine years ago, this was the standard treatment for my type of cancer. I didn’t need chemotherapy, and my radiation treatments ended with an excellent prognosis.
For a while, I celebrated that outcome. My husband and I hiked in the splendor of autumn in New Hampshire to mark the occasion. As months passed, though, a moody broodiness draped over my thoughts and actions. I slept a lot. I smiled little. I wept often. My husband raised his concern. I said, “One more week. Give me one more week. I promise I can pull myself out of this.” I was wrong.
It shouldn’t have been a surprise. Many cancer survivors get clinical depression and/or anxiety. Studies as far back as the mid-1990s were reporting depression and anxiety issues in breast cancer survivors. The National Cancer Institute’s Annual Plan and Budget Proposal for 2019 lists the challenges that cancer survivors face, including risk of recurrence, increased risk of second primary cancer, reduced quality of life, economic burden and treatment side effects. But also on the list: “emotional distress (depression, anxiety, uncertainty, altered body image, survivor’s guilt).”
Many survivors experience some form of Post-Traumatic Stress Disorder (PTSD). One study found that nearly 1 in 4 newly diagnosed breast cancer patients experienced PTSD, which includes the possibility of ongoing anxiety and depression. An Australian study in 2011 found higher rates of anxiety and depression among cancer survivors six months after diagnosis than those in the general population, prompting calls to screen patients throughout their cancer treatment. A German study found that 40 percent of survivors aged 25 to 55 at the time of diagnosis had moderate or high levels of anxiety. That same study also noted that survivors in countries without socialized medicine may well have different numbers due to “other stressors.” (“Other stressors” being code for “huge medical bills.”) And yet the image of the cancer survivor continues to be one of cheerful, grateful bliss.
Some cancer survivors, like me, had a propensity for psychological fallout. I’d had depressive tendencies — I’d tried to skip over grief by sharing Bruce Springsteen too loudly while inhaling Miller beers, among other things, at Mt. Holyoke College. I knew that winters and short days affected me. I faithfully used a light box and tried to get outside as much as possible, even in our cold Wisconsin winters. When an autoimmune disorder made me stop working before I wanted to, I was sad and put myself in therapy for a while. It helped, and I moved on.
But those bouts did not compare with the dark curtain that fell in my mind within my first year of survivorhood. Fatigue drowned any desire to move. Energy vanished. My concentration disappeared. Tired, brain-addled, sad, I felt worthless and guilty. How did I have the right to feel sadness? People died of cancer, and I didn’t. What business did I have wasting my life after what I’d lived through?
Survivor’s guilt is real, as the National Cancer Institute acknowledges, and common to soldiers and those of us who live through cancer. In my case, the guilt fed my brewing depression.
And that’s how I found myself crying over egg yolks, one week after I’d promised my husband I could snap out of this. Something was very wrong in my brain. I made an appointment with my internist to get a referral to a psychiatrist.
At my doctor’s office, I started, with tears, to explain my sadness. I should probably see a psychiatrist, I said. He leaned forward, and his dark eyes looked almost angry. I braced myself for an incoming lecture about how lucky I was, how I had no right to my sadness.
Instead, he was kind. “Didn’t anyone tell you how common this is for cancer survivors?” And I breathed easier. He wasn’t angry with me, but with my caregivers. In his mind, someone should have told me to be watchful for depression as a possible after-effect.
Cancer did have positive effects on my life. My diagnosis changed my attitude about my writing. Before, I was afraid to submit my work. I created stories and essays, but couldn’t muster the courage to put them out in the world. I was afraid of rejection. Cancer slapped me in the face — You were afraid of a rejection letter from an editor?! Fear something worth fearing!
Less than a year after finishing treatment, I had started publishing in literary journals. I have my cancer experience to thank for that. Oh, and earrings. Before cancer, when my husband and I would travel, I would often want to buy a pair of earrings. But I would always talk myself out of it. I didn’t get them; they cost too much money. Post-cancer Pam always buys the earrings. Has too many earrings. And loves them. They make me smile.
But sometimes I need help with smiling. Yes, I’m lucky and blessed, and I know it. But the teams and the support systems nearly vanish once you hear, “Your cancer is gone.” Cancer patients need to know that there are treatments and medications to fight cancer. And survivors need to know that there are also treatments and medications to fight depression. There are ways to be as happy as everyone thinks you already are. I’m living proof.