Mary K. Hughes, MS, RN, CNS, CT
Advanced Practice Nurse
Psychiatry
The University of Texas MD AndersonCancer Center
Good morning. I'm Mary Hughes and this morning we will be talking about coping with the fear of recurrence.
Bertrand Russell said, "To conquer fear is the beginning of wisdom."
What is fear?
You remember, Roosevelt said, "The only thing we have to fear is fear itself."
Fear is an instinctive emotion. You wouldn't go into a fire or touch something hot. That's instinctual because it would hurt you. To be afraid of some expected evil and for many people they see cancer as evil. It's to suspect and to doubt, that's fear.
Sheryl Lee said, "My biggest fear in life is fear."
What is your biggest fear?
[ Pause ]
Your biggest fear may have nothing to do with cancer. But for many people who have survived cancer that is one of their biggest fears that cancer will return.
Fear is also an unpleasant agitation. Sometimes people call it a gut feeling. They think that something terrible is going to happen and sometimes they don't go with that feeling and then they wish they had. It's also a desire to hide or escape. Lerner said fear was an "uninvited guest." No one invites fear into their life because it is very unpleasant and it's unsettling.
Mencken said, "The only permanent emotion of man is fear, fear of the unknown, the complex, the inexplicable." Fear is not about what you know. Fear is about what you don't know and about letting your imagination take you to the dark place.
But fear has a purpose. It's not a negative thing. It does protect you permanently. You wouldn't walk out into the middle of a busy highway. Fear, remember when you were first diagnosed with cancer, you might have been afraid, "Oh no, does this mean I'm going to die?" And so it kind of, you kind of shut down, so it protects you until you can deal with the reality of the situation. Fear may also paralyze you and keep you from doing anything. And like I said awhile ago, it heightens the imagination. People with good imaginations have and when they have fear their imagination always goes to the worst place. They go down the dark path.
Marcus Aurelius said, "It's not death that man should fear, but he should fear never beginning to live." Look what fear does to you. Think about, if you get cancer back in five years and you've worried the whole five years that you were going to have cancer; then you've lost the good time. Fear robbed you of the good time. If you have fear of having cancer back then you're living like you already have cancer.
Fear presents in multiple ways. For some people they're very anxious or irritable or angry; and that's fear. Some other people may be sad and depressed. Fear takes a lot of energy so you may be very tired because you're so fearful all the time. It may present in physical illness. Some people who are afraid distance themselves. They don't want to be around anybody. Other people cry easily and the crying may interfere with their life.
Physically, what happens when you're afraid, you may not be able to sleep because you're lying there worrying about what's going to happen. Or you sleep to protect yourself. You sleep to hide. It's a good hiding place is to sleep. You may notice you have a racing heart. A lot of people if they fear they have muscle tension and usually it's in their shoulders or the back of their head which causes headaches and that's physical changes from fear.
Now, when do your fears increase? It's very normal for people to notice, when they notice a new symptom that they get more afraid. Say you have headaches that you haven't had before or you have backaches that you haven't had before. So you're wondering, "Oh no, is my cancer in my head or is it in my back?" So then you get more afraid. Also, when you're waiting for them to work up these new symptoms. For instance, you're waiting for a scan, you've had a scan and waiting makes you more fearful. Anytime there's a change in your treatment, say you were getting chemotherapy and now your treatment is changed into radiation. There's a fear because you don't know what radiation's going to be like. And, of course, at the end of treatment, what are people afraid of, that nobody's watching me now, I'm not getting any treatment so the cancer has an opportunity to grow. So it's not surprising that fears increase at this time.
Edmund Burke said, "No passion so effectually robs the mind of all its power of acting and reasoning as fear."
Now, another time that fears increase is the anniversary of the diagnosis. Now, there's many of you in here that have no idea when your wedding anniversary or birthdays are, but you can tell me the day you were diagnosed with cancer. So every year at that time you might not be cognitively aware but some level you are, that today, three years ago, I was diagnosed with cancer and you may be a little more anxious. Or when somebody you know or someone famous gets the same kind of cancer that you have or someone dies from that cancer. For instance, when [ pause ] anybody famous dies, Peter Jennings died of lung cancer, Farrah Fawcett died of colon cancer. So when that happens, if you have that particular kind, you may think, "Oh no, look what happened to them. That might happen to me too."
Mark Twain said, "Courage is resistance to fear, mastery of fear, not absence of fear." So it's how you control your fear; how you master it.
Coping is a short term way to handle stress. Coping is not for the long term. It is overt behaviors. It's things that you do. It's things that you talk to yourself and how you manage internally. And it's anything done to reduce the demands of the success—stressful circumstance, such as the end of treatment and wonder if I'm getting—going to get cancer back.
Baldwin said, "Not everything that if faced can be changed. But nothing can be changed until it's faced." So for you to say, "Oh no, I'm not afraid I'm gonna get my cancer back," but you're not sleeping well, you're thinking about cancer all the time, you're wondering if you're going to die from this, you're not facing it. So when you face the fact that you do have fear about this, then it can help you. Then you can deal with the fear and find out what you need to do.
Maya Angelou said, in her typical manner, "If you don't like something, change it. If you can't change it, change your attitude about it. Don't complain." So you can't change the fact that you had cancer, that all of you are cancer survivors. But what you can change is how you feel about surviving cancer and how you're going to live your life as a cancer survivor.
Coping also is, according to Stern, is "behavior that helps you adjust to the environment for the purpose of attaining some goal." So the goal is to cope with your cancer and to not be fearful about it coming back. It's a multifaceted problem-solving behavior. It's intended to bring relief, reward and equilibrium.
Muriel Spark said, "Parents learn a lot from their children about coping with life." Look at children when they fall down and they jump back up and they play—and start playing again. They may have a little fight with a friend but, you know, next five minutes they're pals again. So they don't hold on to the negative things. They just go on.
Coping depends on a lot of different things. One is the type of cancer you have. If you have a particularly aggressive cancer and it's been hard to control, it may be more difficult to cope because it was harder to get rid of the cancer. It depends on the stage of cancer, what kind of treatment you have. If you have surgery and that was it. For the short term you have to cope with healing from surgery. But if you have chemotherapy, that goes on for several months and you're coping along the way. If you have radiation, radiation is pretty intense for a number of weeks. Afterwards you continue to feel fatigue and coping may be particularly difficult during that time. Depending on what symptoms you have, fatigue is a very long lasting symptom from any kind of cancer treatment and it makes it very hard to think of anything else and makes you vulnerable. The clinical course is how your disease progressed, how your disease is responding to cancer and what your prognosis is, what the doctor said you're going to—how they expect you to live. That this cancer usually doesn't come back or it might come back sooner than others, that's the prognosis.
Malcolm Bradbury said, "Culture is a way of coping with the world by defining it." So depending on the culture that you grew up in, that's how you cope with things. Some Germanic people are more stoic. Asian people are more stoic. They don't show their feelings as much. Whereas Hispanic, Italian are more-they are more open with their feelings. And that's what they learn from their culture; that's what they learn growing up.
So coping depends on how you adjusted before. Maybe you've never had many crises in your life and this—you didn't know how to adjust. Other people have had a lot of crises and had lot of tragedy in their life and were able to adjust and this is just another tragedy, cancer is. What kind of personality you have? Also what your coping style is? For some people they want to talk about what they have and that helps them to cope. Other people are very private and they don't want to talk about it, that's their coping style. And prior experience with loss, because as you know, because you've all had cancer, is, cancer is a great loss of health for you. And you grieve and that's a very normal thing to do, to grieve for what you've lost as a result of cancer. Temporarily, you've lost your health. You may have lost choices about things that you can do and that you used to do. And how you coped in the past with loss will predict how you're going to cope with cancer and its losses.
So the thing that makes cancer difficult, one of the many things, is socially, it's a threat to attaining education. If you're 18, 20, you've gone back to school or you're back to school in your 40's, it's a threat to attaining education because for the time being while you're taking treatment you can't get an education. You have to focus on your treatment. It may be a threat to attaining marriage. There are some people in relationships that thought they were going to marry. Once they get cancer they're wondering, "Well, you know, I don't want to strap my partner with this financial burden." Sometimes people who aren't married and don't have a partner, they're wondering, "How do I tell anybody I've had cancer when I start dating again?" It's also a threat to attaining pregnancy. Many women are delaying pregnancy until their late 30's and if they get cancer then, then their pregnant—their fertility is threatened and they might not be able to get pregnant. If they're young mothers or fathers and they have children and they're trying to, you know, raise the children, it takes a lot of energy to raise children. And when you're dealing with side-effects from treatment, that's very difficult. It may be a threat to your career. You may be on the fast track and you have a lot of plans for what you're going to do with your career but that's temporarily on hold when you're dealing with cancer. And then some people when they retire and saved all the money that [they] were going to travel. And now they have cancer, they had to use that money to pay for the cancer treatments and may have to come out of retirement so that they have enough money to live.
Coping has to do with attitude. So I talked about cultural attitudes and spiritual attitudes. What you believe about a higher being. Some people don't believe there is one, but it's a very personal belief, your spiritual is your relationship, vertical relationship with a higher being. Your religious attitude, religion has to do with a horizontal relationship with people that are of like belief, spiritual belief that you have. And if there's people in your life who are emotionally supportive. Or are you by yourself that you don't have anybody who helps, then it's going to be very difficult to cope. And what potential you have for rehabilitation. Temporarily, you might not be able to lift your arm or you might have lost a limb, but there's great potential for rehabilitation. And how you participate in that also helps with you coping.
Lorna Luft said, "I choose not to think of my life as surviving but as coping." As you remember she was Judy Garland—is Judy Garland's daughter.
Now, what are coping tasks? One of the tasks of coping is to integrate the diagnosis. Number one, you have to believe that you had cancer or that you have cancer and that that's part of your life. It doesn't have to be overtaking your life, but it's a part of your life. So if you think of your life as a tapestry and interwoven in that tapestry is cancer because it's part of your life. And once you integrate the diagnosis, then that helps you to cope with what's going on. You're going to have to be able to tolerate stress. There's an unbelievable amount of stress with treatment as most of you know. And stress of other people, sometimes people are not very thoughtful and they'll say, "You know, I had an uncle that had the cancer just like you and he had a horrible death. It was so horrible for him and I'm so sorry you have that kind of cancer." Well, those people are well-meaning but it's still very stressful. To be able to tolerate the stress of your hair falling out. And for most women, it's very traumatic when their hair falls out, and they feel guilty because they think, "Well, my hair will grow back," but it's a very traumatic thing. So there's a lot of stress that goes on with different treatments. Trying to adjust to the healthcare system, trying to figure out what they're telling you because you have to learn a whole new language. And learn how to get to your appointments, where to go, don't forget to go, and making treatment decisions. And you don't know anything about cancer and now you're asked to make a decision. They've given you a couple of choices and you're thinking, "I don't know what to do." And the hard part that many people tell me, it's very hard to communicate the diagnosis and tell other people what they have. For a parent, it's hard to tell their children, it doesn't matter how old their children are. It's hard to tell them, "Well, you know, I just found out I had cancer." And for many people they don't tell their children until, or tell friends, until they have a plan. And what it means, to have to tell somebody what it means. If you have metastatic disease, people don't understand that the treatment is not going to be over. The treatment is going to continue as long as it works. And what people think about is, "Well, they had a cousin that had cancer and she took treatment and she worked the whole time." Well, you know, everybody reacts differently to treatment and it's very important to communicate that.
There's emotion-focused coping. This is something that you do to make you feel better. It's in situations that can't be changed. For instance, you have cancer. The fact you have cancer is not going to be changed. We can't erase it. It's not going to ever go away. It's a chronic illness just like heart disease. If you've had a hard attack then you're always going to have to be checked [to] make sure that you're heart-healthy. And so, here you have something that you didn't ask for. You know, people tell me, "I didn't ask for this." Nobody asked for cancer. But it's something that you have, it's part of your life but it doesn't have to rule your life.
Problem-focused coping, you find out the facts. So you find out what type of cancer you have. There are some people that go to the computer and read all about their cancer and then they're really "bummed-out," as they say, because they found out too much information. So usually your physician gives you information about your disease and treatment options and then you make a plan, what you need to do to get through this. And then find out how other people coped and how they handle this. You know, in the waiting room you talk to other people. "You know when you had nausea, what did you do? What helped?" And you know somebody may say, "Well, gingersnaps help me." And so you find out little tips from other people; how they coped. And problem-focused coping is used when something can be done to improve or at least change a stressful situation. It's usually directed internally.
Now, optimistic coping behavior, this has to do with positive thinking. Now, there's a lot of books out there about thinking positive- and you have to have a positive outlook and then your cancer won't come back. And your cancer will go away if you have a positive outlook. That can help you get through cancer. Sometime people come to see me because they're afraid they have some negative thoughts. And they're afraid their cancer will come back because of those negative thoughts. Your body is not that fragile that a negative thought or crying or being upset about something is going to make your cancer come back. But a positive outlook helps you get through this situation better. Also, it helps people want to be around you. If you're negative and pessimistic, nobody wants to be around you. Also, comparing yourself to others, a lot of times people say, "Well, you know, I don't have it as bad as I've seen other people." and that helps them. That helps them think there's always going to be somebody that doesn't have it as good as you do. And that is optimistic coping.
Also, humor, and I'm sure you found that your humor has changed. That you have darker humor and you laugh about things that you didn't laugh about before. And other people with cancer get it, but sometimes your family doesn't get it. Using distraction, for instance, when you have a negative thought, you're thinking, "Oh no, what about if my cancer comes back." Then, you know, instead of dwelling on that, some people sew, some people read, other people go to movies, watch movies, work in the garden. So they're using distractions so they're not focused on negative things. Social support is very important, your friends or your family or people that you've met while you're getting treatment. Those people become part of your social support. It can look like denial, optimistic coping behavior, but because you are positive and you are focusing on the positive outcome. But it's not denial because you know that you have cancer and you are dealing with it.
Coping activities- making short- and long- range goals. Sometimes for some people their short-term goal is to be able to get up in the morning and put their clothes on. And for some people that's very difficult. So that's that's a goal. You got up, you took a shower, you put your clothes on and that's it. Then you sit in the chair. Well, you have fatigue you can't do anymore. Long-range goals- sometime people plan to go back to school. Maybe they're going to get married. They're going to take a trip but that gives them something to look forward to. Sometimes people have children that are getting married or that are graduating and this gives them long-range goals. Find out what resources you have available. There's resources and find out where you can find them. Identify what strengths and weaknesses you have. Not everybody needs to be in a group. There are some people that if they're in a group and somebody is having troubles and they're crying and their cancer's back, then that bothers the person. They go home and they're upset and they're worried. So maybe, that's not the person that should be in group. Maybe you need to see someone one-on-one. That maybe, that's just a weakness, it just is. Other people, the strength they have is to go to group, to help other people. They also get help from the group. And one of the things that's hard to remember when you have cancer [is] that you have a choice. It doesn't feel like you have a choice because you have cancer and you didn't choose to have cancer. But you can choose how to deal with it. You can choose the treatments and the treatments that you have, and how you get through the treatments. The fact that you may have nausea, that your hair falls out, that happens but you have a choice on how you are going to cope with that.
Seneca said, "Sometimes even to live is an act of courage." And you know when you—just a lot of people tell me, they don't like it when people them, "Oh you're so brave. I can never do that." But you know, you do what you have to do. It doesn't feel brave to go through chemo or to go through radiation or to have surgery. You do that because you want to live. And it doesn't feel like an act of courage but to other people that's what it seems like.
Now what is depression? Depression is the main cause of decreased libido. So if you're not interested in sex, besides all the cancer treatment that can cause that, it may be depression also. It's frequently undiagnosed because some people say, "Well, of course, you have depression. You have cancer." But depression is a treatable condition, like cancer is a treatable condition. And it needs to be treated. 25 —average 25% of cancer survivors have depression. So it's very important to have it treated.
So depression, what are the symptoms? Two weeks, you just don't wake up one morning and go, "I'm depressed, I need something." Two weeks, it's a slow onset. You might not be sleeping. Or you might sleep well until three in the morning and you wake up and can't go back to sleep. You may want to sleep all the time. You may not want to get out of bed. You might not want to get dressed. You don't want to take a shower. You just want to lie around. You might not go out with anybody or not let anybody come to see you.— Not answering the phone. You may be irritable and grouchy. You may have crying spells. You may feel sad.— Alterations in eating. Unfortunately, women like to feed their feelings so they may gain weight when they have depression because they are eating to feel better. Guys don't. Some of these look like side-effects of treatment, but in erectile dysfunction and alibido, which is no interest in sex.
—Difficulty focusing and concentrating. — Feelings of worthlessness. You feel like you are not worth anything. Why would anybody care about you or come to see you? —Racing thoughts, it may be hard to focus and hard to stay on task. You may feel depressed. And these are real red flags. These are real indications of depression.— Hopelessness. You don't have any hope. You're not making any plans for the future. —Anhedonia, you don't enjoy anything. You may go out to eat with your family but you feel like you're watching yourself go through the motions of life. —And suicidal thoughts, of course, are a red flag. And it is very important to treat depression.
Anti-depressants work but they don't work right away. It may take two to three weeks or four weeks for them to work. And some people are so depressed they can't participate in therapy. Once the antidepressants work, then they can be more active in therapy. —Supportive therapy or cognitive behavioral techniques. Learn to do things. It doesn't change what is, but it changes how you see something. Combination is the most effective way to treat depression.
Now Ernest Hemingway said, "Cowardice," and I like to insert the word fear, "as distinguished from panic is almost always simply a lack of ability to suspend the functions of the imagination." So like I said earlier, the more imaginative you are, and if you have fear, then your fear —your imagination feeds into that fear. "What if this headache is my cancer back? And what if they can't find where it is? What if there is no treatment available and then what if I die?" That's all of your imagination. That's not real. A fear is about the future, it is not about right now.
Now anxiety can happen right away; acute onset, that's means right away. You may feel agitated, poor concentration, maybe worry. If you're a worrier, you're probably an anxious person and then when you get cancer your worry is going to go up even more. You're not able to sleep, that's insomnia. Rumination, you keep thinking about the same thing over and over and over. It may be very hard for you to stay on task. Your speech may be rapid and pressured. You just talked very fast and people can't talk very much because you're talking. It may be very difficult to make decisions if you're anxious.
Treatment depends on the cause. Now people that are anxious, they don't live in the present. Anxious people are always thinking about. "What if? What if I can't sleep and then what if I can't sleep tomorrow night too?" Well, you know, people don't usually die from lack of sleep. You miss one night of sleep you will sleep the next night 'cause you will be very tired. "What if my cancer comes back and then what am I going to do?" So, it's all about the future, or "If only... If only I haven't had that divorce then I wouldn't get cancer. If only my children weren't so bad and drug users, then I wouldn't have got cancer. If only." Both the past and the future can't be changed. The only time you have is right now. And if you're one of those people that jump ahead to "what if?", then focus on right now. If you're getting treatment, when you wake up in the morning, you say, "Right now I know, today I know my cancer is being treated." Or if your treatment is over, "Today I know I don't have cancer," and that's true. As far as you know, today you don't have cancer. If it comes back you'll deal with it then. But you don't have to deal with it now 'cause you don't have it. Some people look anxious because they are in pain and they don't have very good pain management. So it's very important for you to let your practitioner know about your pain. Anti-anxiety drugs can help like Ativan® which is Lorazepam or Clonazepam which is Klonopin®. Those are two anti-anxiety drugs that we use a lot and can be very helpful. Antidepressants with same strength. There is a class of antidepressants like Zoloft®, Prozac®, Lexapro®, Paxil®, Celexa®, they're SSRIs. They're also indicated for anxiety. And antihistamines, if you are having a drug reaction, certain types of drugs like Reglan®, Compazine®, or Phenergan® can cause something that makes you look real agitated and anxious when, indeed, you are not. It's a side-effect from the drug. And antihistamines can take that away, and then you stop taking that drug. Supportive psychotherapy can be very helpful, as well as cognitive behavioral techniques. For instance, when you wake up every morning and you tell yourself, "Today I know I don't have cancer."
Now Eileen Donovan, who was an occupational therapist here at MD Anderson, said, "When you worry, you live it three times: once before it happens, when it happens, and then, of course, you have to relive it after it happens."
Now what resources do you have? Self help, you know, you can look on the computer. You can gather information. You can use distraction. You can go to the Place of Wellness here at MD Anderson and learn meditation, use visual imagery. Visual imagery takes you to a place in your mind. And you can be there and it would give you a little break from where you actually are. Learning relaxation exercises can be very helpful.
Build your support team. That's very important to have a support team. Who are your caregivers? Who are the people there for you? In the middle of the night, if you need to go to the emergency room, who could you call? Family, friends, your support groups, your physicians, and your healthcare team: the nurses, the occupational, physical therapists, different—other kinds of therapists, speech therapists. Those are part of your support team. What spiritual support do you have? Sometimes people tell me they're disappointed that their minister didn't come to see them when they were at the hospital or hadn't called but they found spiritual support elsewhere. And psychosocial clinicians like your social workers and people in psychiatry, those are part of your support team.
So who is your support team? [ pause ] Think about it, write it down. But think about who's part of your support team right now. Maybe it's changed. Maybe when you were dealing with active cancer your support team was different. And people that are in remission, don't have cancer right now, their support team is different.
[ Pause ]
Other resources are support systems: CanCare, Cancer Counseling Inc., professional staff from your institution, private counseling in the community, religious organizations. Some of the larger religious organizations provide counseling and that can be very helpful. There's a website you can go to, it's www.apos-society.org and you can find psycho-oncologists, people who specialize in counseling people with cancer in your area.
And why do you need a support team? Well, it makes you feel more secure, that you don't feel like you're out there doing it all alone and thinking, "Well why am I doing this if nobody's there for me and nobody cares." It decreases your sense of isolation. You feel like people are there for you and you're not as vulnerable to depression if you have a support team. It also gives you better information processing and management. When you take someone to your appointments with you and they hear something differently than you hear, they may be taking notes. They may ask questions that you forgot about so that can help you. It gives you physical and logistical support. It can drive you here for your treatments and for your appointments. And having a support team gives you better likelihood of successful coping with your cancer.
John Wayne said, "Courage is being scared to death... and saddling up anyway."
Other resources are the library. Find out what information you can find there if this is a kind of thing that you like to do. Computers, but be very careful about the websites you go to. The National Cancer Institute, which is part of the National Health Institute, has good information. The American Cancer Society, which is cancer.org, has good information. Some of the information is specifically for particular types of cancer. For instance, phoenix.com is for men with prostate cancer. And there are all sorts of websites for women with breast cancer and different kinds of breast cancer. Sarcoma, pancreatic cancer, any kind of cancer that you have, there's a website. And there's also chat rooms you can go to. Now, always remember that sometimes people that go to chat rooms are very negative. And you know, you just kind of watch and see what information you're getting from chat rooms. If it feels negative, maybe that's not anything you want to be a part of.
William Shakespeare said, "Cowards die many times before their deaths; the valiant never taste of death but once." So the fear that you have, of getting cancer back, and of dying, you're dying many times because you're thinking about dying instead of focusing on living. People—I did a group with—for people with metastatic cancer and their focus was on living with cancer, not dying with cancer but living with cancer, living as good as they could.
Lincoln said, "Nothing valuable can be lost by taking time." You know, time is the one thing that we all have the same amount of. It doesn't matter how rich, how poor, where you live, what gender you are, what ethnicity you are, what culture you're from, we all have the same 24 hours in our life. And time can't be saved. We can't regain the time that we've lost. Time is very precious. That's why some people would rather give money to charity than volunteer their time. So time is very precious and you don't want to waste your time worrying about your cancer coming back.
Frost said, "In three words I can sum up everything I learned about life; it goes on." Right? I'm sure you found that since your cancer diagnosis, it doesn't matter what you're going through with your cancer, life goes on. Life goes on all around you. And those of you who are through with treatment, and you don't have active disease, it still goes on. So your challenge is how it goes on.
Eleanor Roosevelt said, "You gain strength, courage and confidence by every experience in which you stop to look fear in the face. You're able to say, "I've lived through this horror, I can take the next thing that comes along." So when you think about your cancer diagnosis, your first diagnosis, you lived through that, you lived through chemotherapy. I've had many people say, "Hey, I've gone through chemotherapy, I can go through anything." Whatever comes along next, you can take it. But you don't have to deal with it until it actually comes along.
You can't choose to have recurrence. But you can choose how to control the fear of it.
Now, Frank Herbert, who wrote Dune, wrote, "I must not fear. Fear is a mind killer. Fear is the little death that brings total obliteration. I will face my fear. I will permit it to pass over me and through me. And when it has gone past me I will turn to see fear's path. Where the fear has gone, there will be nothing. Only I will remain." So it's very important that you face fear and you don't let it rule you. And you don't let it control your mind. And you get rid of it so that you remain, so that you can enjoy your life.
Find happiness where you can. It's not a destination... but it's a way of traveling and a choice. You look around you and you see four people that had cancer. One person is grouchy and negative. The others may be happy. They've chosen to be happy. It's a choice that you make. And it's not like, "When I get through with my cancer then I'm going to do this." It's a matter of how do you attain that goal while you're getting cancer? How do you live while you're dealing with cancer? And more importantly, once your cancer has gone away, don't let the cancer control you. Don't let the fear control you. Live, so that if it does come back, you look back and say, "Oh, I had—I lived, I enjoyed my time."
Bruce Barton said, "Action and reaction, ebb and flow, trial and error, change - this is the rhythm of life. Out of our over- confidence, fear; out of fear, clear vision, fresh hope. And out of hope, progress."
George Herbert said, "He that lives in hope danceth without music." So remember, you don't have to hear the music to have hope. The hope you have is every day, that today you will live the best you can and without cancer. And if your cancer comes back, you still have hope that it will be controlled.
Coping with the Fear of Recurrence video
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