From the Ovacome Magazine winter 2019

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Ringing the bell in the chemo suite may be a celebratory way to mark the end of treatment, but for many it is the start of an unease about going solo without regular medical support. But there are ways to cope even if you do have a recurrence, explains Macmillan clinical psychologist Dr Jo Ashcroft .

'Ending treatment evokes many emotions from relief and elation to anger, frustration, sadness, apprehension, fear and uncertainty. Although it can feel positive to be moving forward, it can also be a confusing and anxiety provoking time. And women coming through a recurrence, or on maintenance treatment could face the same emotions.'

'Worry about recurrence is normal and expected. Fewer appointments and less contact with your team can be nerve wracking. Future scans can cause anxiety and hearing or reading stories about cancer brings up fears. Anniversaries of significant events, such as diagnosis or achieving a period of being cancer-free, can also trigger those ‘what ifs’. And aches and pains become scary, bringing up questions of what is normal and what needs more attention.'

'With time, the intensity of these worries can start to lessen. You can live alongside these feelings by focusing on what is more certain and in your control. These are my 10 top tips to get you to this point:

1. Make a plan
Ask your oncologist or specialist nurse what your risks are, what signs and symptoms to look out for, how to get help and what sensible changes you can make to your lifestyle to help you stay well. This helps you know what to expect and feel more in control. For future scans and appointments build in distractions, take someone with you, write down your questions and plan something nice to do afterwards or find a safe space to reflect and debrief.

2. Manage your thinking
Check in with your thinking. Ask yourself ‘is what I am thinking accurate, is there proof?’, ‘what would I say to a friend who had these thoughts?’, ‘am I getting things out of proportion or jumping to conclusions?’, ‘am I seeing the negatives and forgetting the positives?’. Try to balance thoughts, so instead of thinking ‘the cancer will come back and I won’t be able to cope with more treatment’, try ‘the cancer may come back, but even if it does I’ve already coped with treatment and could probably do it again’. Mindfulness can also help let thoughts go; try apps, books and online resources.

3. Do things you enjoy
Schedule things to look forward to. Cancer does not have to be all that you are. Getting back to doing things may take time and may be scary at first, but the longer you leave it the harder it will be. Ask yourself what and who is important to you and what would you like to get back to. Are there new things you would love to try? What makes you laugh and feel good? Reconnect with your old routines as much as possible to get a sense of control back, especially if you are feeling anxious or overwhelmed.

4. Keep active
Think of fun ways to keep active. You might need to make adjustments depending on your recovery and treatment side effects; go gently and explore what you can do. It is okay to need to do things a bit differently. Pace yourself and set small realistic targets so that you can see your progress. Investigate what local classes and groups there are to help you get started.

5. Relaxation
Relaxation such as deep breathing, imagining somewhere peaceful and letting go of muscle tension can all calm the mind and body. Complementary therapies such as massage and reflexology can also help. Explore what is local to you. Engage in whatever activities you find relaxing and always make time for you.

6. What has helped before?
Cancer is unlikely to be the first tricky thing you have experienced. What has worked for you in the past when
facing challenges? Build up a ‘first aid kit’ of things that soothe you, including things you value, books, films, ideas and maybe put together some notes to your future self with your soundest advice.

7. Be kind to yourself
There is no normal, adjustment takes time. Avoid comparing yourself to others or being self-critical. Find ways to encourage yourself and consider what you would say to someone you cared about if they were in your shoes.

8. Make room for feelings
Feeling positive all the time is unrealistic. Difficult emotions will crop up and while it can feel uncomfortable, they do not always require you to respond or make them go away. Try to ride them out like a wave, passing on their own without taking over. Mindfulness can help keep you grounded as emotions come and go.

9. Connect
Reconnect with old contacts, spend time with others and resist the urge to isolate yourself. It can be hard, but sharing how you feel with others can often help. Consider joining a support or social group to meet up with others who have been through similar experiences. 

10. Get support
Do not get stuck. Some of the larger cancer centres and cancer charities provide individual counselling and psychological therapy for you and your loved ones. Alternatively, there will be local psychology services and cancer charities that can also offer talking therapies. If you think that you would benefit from further support talk to your GP or oncology team to find out what is available.'

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Download Dr Ashcroft's presentation from our Health and Wellbeing Day:

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Download presentation

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