Fifteen ways to thrive after cancer

ONE DAY AT A TIME

It's common for cancer patients to plan the lifestyle changes they're going to make once they get the all-clear. Sometimes they anticipate a renewed vigour and gratitude for life and imagine a life of adventure, trekking the Inca Trail and visiting the Great Wall of China. Sometimes they promise to slow down and unwind. It doesn't always happen that way: the demands of the body and the financial obligations of modern life usually dictate cancer survivors' big plans. Try to postpone planning major lifestyle changes until after the all-clear. It assuages the guilt and self-doubt that can creep in when you don't meet your goals, and it allows you time and space to listen to your body and make plans accordingly.

REACH OUT

It's good to talk, even better to talk to those who have walked in your shoes. There are numerous support groups for cancer survivors and their families across Ireland and they offer a space in which people who understand each other's trauma can relate their experiences and offer each other advice. Support groups are invaluable, agrees cancer support expert and oncology nurse Ursula Courtney, as long as they are used for addressing the emotional aftermath and not the treatment plan. "The challenge we encounter is that people don't understand that everyone's cancer is different and is individual to their genetic make-up. In a support group scenario, you have two different people with two different consultants and often with two different cancers comparing their treatment and wondering why they didn't get this or that." Some prefer one-on-one therapy to group therapy. The Irish Cancer Society offers funded counselling services in support centres across Ireland. See cancer.ie for more.

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WORK YOUR WAY

Many cancer survivors don't return to full-time work immediately. Some return to part-time work, while others arrange to work remotely for a couple of days each week or to start later and leave earlier each day. Talk to your employer about your options and don't be afraid to use it as an opportunity to discuss your overall workload. Courtney recommends visiting the workplace ahead of your official return date: "It's helpful to ease your way back into the workplace by arranging to visit for lunch or coffee in the days leading up to your return. It's a great ice-breaker and it makes the experience much less daunting."

ANTICIPATE CONFUSING EMOTIONS

Yes, you survived cancer, but that doesn't make your experience any less traumatic. "What we find [among cancer survivors] is that the body has had to get ahead of the mind and now the mind is catching up," explains Courtney. It can be a lonely time for survivors who feel compelled to be happy and relieved when really they're still struggling with a minefield of emotions. Depression (studies vary, but generally one-third of survivors will experience it), anxiety, grief and PTSD are very common among cancer survivors. Some suffer from guilt and most live in fear of recurrence. Compounding this is the psychological trauma of facing your mortality and the unanswered questions it posed. Those who thrive post-cancer tend to be the people who know the journey doesn't end on the last day of treatment. They are aware of the long road ahead and they have given themselves permission to explore the uncomfortable emotions that life post-cancer can throw up.

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ACKNOWLEDGE INTIMACY ISSUES

Lack of libido is a common side effect of cancer for both men and women, and it can continue through recovery and beyond. "There is lots of fear around returning to intimacy," explains Courtney. "People wonder if they'll be able to perform, will it be different, will it hurt…?" She advises that couples use it as an opportunity to re-examine their sex lives. What worked then may not work now, but you can establish a deeper level of intimacy by exploring a new approach. If you feel ready to return to intimacy, Courtney recommends talking to your oncology nurse. If persistent problems occur, consider talking to a psychosexual therapist.

VARY YOUR DIET

Dietitian/nutritionist with the Marie Keating Foundation, Orla Walsh, advises optimising the diet to reduce the risk of recurrence and fight fatigue: "We recommend that cancer survivors eat a plant-based diet full of colourful fruits and vegetables, along with some lentils and pulses. Plant foods in their whole state provide a wide range of nutrients and phytochemicals that act protectively in the body." Remember that cancer-related fatigue isn't always caused by chemotherapy per se. "Fatigue can occur because of new or previously experienced medical issues such as problems with thyroid function or anaemia," adds Walsh. "With these commonly experienced issues, the focus dietetically would be to optimise intake of important minerals and vitamins such as iodine, iron, folate and Vitamin B12."

REINTRODUCE EXERCISE

Exercise may seem impossible to those suffering from post-cancer fatigue, and who already feel like they're climbing a small mountain every day. However, Walsh recommends regular exercise after treatment to restore the body and boost mood: "There is evidence to suggest that physical activity reduces recurrence of the disease, fatigue, sleep disturbances and increases survival, fitness, strength and overall quality of life." Start slow and build up. Take the stairs instead of the lift. Get off the bus one stop early. Try some gentle movement upon waking. Your strength will return. The Irish Cancer Society runs free exercise programmes for women and men who have had breast and bowel cancer. See cancer.ie for more. (Talk to your GP or oncology nurse before you return to exercise).

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CREATE A SUPPORT STRUCTURE

Returning to normal life after cancer is like riding a bicycle with stabilisers. Daily routines that were once easy can now seem insurmountable. A support structure is crucial to thrive post-cancer. You need a caretaker, a cheerleader and a confidante/counsellor. Often a spouse or partner will take on all of these roles, but by expanding your support structure you will feel less isolated and will be less likely to feel guilty about casting the emotional burden on just one person. Surround yourself with people that can offer support and don't be afraid to ask for help. Ursula recommends clear communication. "We encourage those in the support structure not to ask 'what can I do?'. It's better to be clear and say 'I have an hour free on Tuesday morning - can I collect your medication for you?'"

REBUILD YOUR SELF-ESTEEM

The physical and emotional toil of cancer often chips away at self-esteem, particularly in women. There is no shame in having superficial concerns after the all-clear - many women find that looking good can help them feel better. The Marie Keating Foundation can provide you with details of wig suppliers and eyebrow tattooing specialists. Rather than dwelling on what you can't change, focus on what you can. Use the all-clear as an opportunity to update other aspects of your look, or rebuild your self-esteem by embarking on an image overhaul, pencilling in everything from make-up masterclasses to cosmetic dentistry consultations.

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SIMPLIFY YOUR LIFE

It takes time to return to your pre-cancer routine. In the meantime, use it as an opportunity to simplify your life and remove time-consuming rituals. Get rid of clutter (particularly in the bedroom where it can impede a good night's sleep); shop online rather than in-store and, if your budget allows, consider hiring a cleaner. Courtney adds that previously exacting standards may have to be lessened. "The house doesn't have to be spotless and meals don't have to be prepared every evening. If you are feeling energetic, consider batch cooking for the times when you haven't the energy to cook from scratch."

BE STILL

Yoga, meditation and other holistic modalities are often difficult during treatment when the mind is racing and aches and pains make it difficult to switch off. However, practicing stillness once you get the all-clear has proven benefits. A recent study published in the Journal of Clinical Oncology found that breast cancer survivors who practised mindfulness had less physical pain, better sleep and an increased sense of calm. You don't need a mediation bench, gong or incense. It is simply a decision to switch off and still the mind for a few minutes each day.

BALANCE ACTIVITY WITH REST

Ursula Courtney likens daily life after cancer to a deposit account. Fatigue is almost inevitable so activity needs to be balanced with adequate rest. "I tell survivors to look at it like this: If I want to go out tonight I'll make sure to have a lie-in today. Likewise, if I have an energetic day, I know that the credit card payment is due tomorrow so I'll make sure to pace myself the following day." Elsewhere, The Cancer Survivor's Companion by Dr Frances Goodhart and Lucy Atkins recommends 'The 3 Ps' coping strategy: prioritise, plan and pace.

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PREPARE FOR ANNIVERSARIES

Certain dates will forever be etched in a cancer survivor's mind, from the day they were diagnosed to the day of their mastectomy or hysterectomy. These dates can throw up all sorts of emotions that Ursula Courtney likens to PTSD flashbacks. Be mindful of these dates and explain to your loved ones that you may not be yourself. Courtney recommends using anniversaries as an opportunity to be kind to yourself: take the day off work, go shopping, book in for a beauty treatment (with a qualified therapeutic massage or cancer-care therapist).

EMBRACE THE 'NEW NORMAL'

Cancer is a life-changing experience and even those who desperately want to return to 'normal' discover that previous routines can be challenging or unfulfilling. "When you consider the side-effects of cancer - everything from depression to hormonal changes - you realise that it changes one's outlook on life," explains Courtney. Acknowledge that your goals, values and priorities will be different and instead of grieving the person you once were, look forward to discovering the person you will become.

LOOK ON THE LIGHT SIDE OF LIFE

A particularly unwelcome side effect of chemotherapy is the unsolicited advice that comes from people who ardently believe that all will be well if you just "stay positive". Ursula recommends a more realistic approach to lifting your spirits after cancer: comedy. Build up a library of funny films, swap your crime novels for something light and frothy and surround yourself with people that make you laugh. Laughter really is the best medicine.

Ursula Courtney is leading the Marie Keating Foundation Survive + Thrive workshop for people recovering from cancer. The workshop will take place over six weeks and includes advice from experts on issues that cancer survivors often face including coping with emotions, managing stress and fatigue and changing nutritional needs. The first course is for women who have survived any type of cancer, and will be held in the Ashling Hotel, Dublin 8, from 7-9pm, every Tuesday between February 3 and March 10, 2015. The course is free to attend but places are limited and registration is essential. For further application details, contact Angela Egan on 01 628 3726 or email info@mariekeating.ie. A course for men who have survived cancer will be held later in 2015 and further courses will be rolled out nationwide during the year.