Health

‘Reentry’ after cancer treatment has lessons for post-pandemic life – STAT


An interesting and important period in the life of cancer survivors begins when major treatments, such as surgery and chemotherapy, end. Known as reentry, this phase of cancer recovery offers lessons for Americans as the pandemic ever so slowly — and fitfully — recedes in the U.S.

Consider the experience of physician Elizabeth McKinley, who wrote in the Annals of Internal Medicine about completing cancer treatment: “After my very last radiation treatment for breast cancer, I lay on a cold steel table hairless, half-dressed, and astonished by the tears streaming down my face. I thought I would feel happy about finally reaching the end of treatment, but instead I was sobbing.”

That’s one response to reentry, a phase one of us (T.D.) experienced when her cancer treatment ended and the other (A.L.S.) has investigated as a meaningful period in the trajectories of people with cancer.

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Described as “a new normal” by the National Cancer Institute, the return to life after cancer treatment can be gradual and bumpy. Many individuals deeply desire to get back to life as usual. But the physical, psychological, social, and economic landscape may be slightly or radically different after cancer treatment. The process of acknowledging and accepting that aspects of life have shifted, and of constructing a life after cancer, can last for weeks or months.

Some people who complete cancer therapy celebrate and feel eager to get on with their lives without needing or wanting the support they had after diagnosis. But many do not return to life as usual right after getting out of the chemotherapy chair or off the radiotherapy table. Instead, many adults diagnosed with cancer return gradually to their pre-cancer levels of well-being. It’s likely something similar will happen with Covid-19.

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Here are some myths of reentry for after cancer treatment ends:

  • I should be celebrating.
  • I should feel well.
  • I should be the pre-cancer me (or a vastly improved version of me).
  • I should not need support.

We label these as myths because they are widely held by people after treatment but often don’t match the nature of the experience. Moreover, they can become expectations or demands others convey or people impose on themselves. The expectations get communicated when your well-intended cancer team gives you balloons during your final chemotherapy session and your son asks what’s for dinner that night. They arise when your chair mate during chemotherapy tells you cancer is a blessing and gives you a copy of the book “You Can’t Afford the Luxury of a Negative Thought.” They linger when you feel adrift as appointments with your oncologist dwindle and your friends don’t check in as often.

As the pandemic declines from its peak in the U.S., are similar expectations being communicated to us and do we hold them ourselves? If you don’t quite feel part of the festive parade, maybe so. If you expect yourself to be performing at 100% or 120% now that several constraints are lifted but don’t feel up to it, probably. If others say you should just “get over it,” absolutely.

Lessons learned from cancer survivors offer insight into who is most likely to experience a rocky post-pandemic reentry.

Adults who undergo the most arduous cancer treatments, or who experience important stressors in other life domains during cancer therapy, such as the death of a loved one or relationship problems, are more at risk for becoming or staying distressed during reentry. People who have fewer personal resources, such as low optimism about life in general, or who cope by trying to push away their cancer-related thoughts and feelings, are prone to difficult reentries.

For many Americans, the active threats of the pandemic continue. Once these subside, they may be vulnerable to a difficult reentry. Did you care for others at home, or in your job, or both? Did you lose someone dear to you? Were you a target of racism? Did you attempt to motor through without attending to your own well-being? If so, it’s no wonder you’re tired, grieving, angry, or just not feeling psychologically or physically yourself. Simply reminding yourself that you’re in the same boat as millions of others might help.

What else can anyone who remains tired or troubled do now? As the two of us have found for cancer reentry, actively acknowledging and approaching one’s current experience can be useful: Figure out what pandemic-related concerns are still bothering you, talk to a faithful friend or professional (especially if your troubles are interfering with your ability to get through the day), ask for and accept help, reflect on what brings meaning to your life, and make a plan to approach meaningful goals. So what if you didn’t become a wiser person who has mastered the art of sourdough bread making, grows your own food, and speaks a second language fluently? As Karyn White once sang, and as one of our (T.D.) Facebook live series declares, “I’m not your superwoman.” And it’s OK not to be.

Acknowledge making it through more than a year of being buffeted, whether by strong breezes or by a hurricane-force tempest. Now, or when it’s time for your own reentry, offer yourself some grace.

Annette L. Stanton is professor and chair of the Department of Psychology at the University of California, Los Angeles. Tammie Denyse is a 17-year survivor of cancer and co-founder and president of Carrie’s TOUCH, a nonprofit organization for Black women with breast cancer. Together they are co-principal investigators for Project SOAR (Speaking Our African American Realities), which aims to understand the Strong Black Woman schema in the context of breast cancer.


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