I’m Monica Raznahan, a Licensed Professional Counselor (LPC), specializing in coping when a loved one is living with cancer and finding a life worth living when you are living with cancer

Hi one of my parents is in the late stages and has been given a certain life expectancy . Do you have any advice coping with the looming ominous feeling as the expected time comes closer ?

I'm sorry to hear that. Grieving is never easy or comfortable, but it's something we go through. The more you can be honest with yourself and allow yourself to be in the moment with your feelings right now, the less you will feel the need to struggle with them later. I say that knowing how hard this is...the feelings can be quite intense, but they will ebb and flow. Give yourself permission to ride the wave, knowing that it won't always be like this. Spend time with your parents and enjoy the time you have with them right now, in this moment. Let them know how you feel about them. Share memories. Your willingness to be there with them will hopefully be a meaningful experience for all.

I’m a 24 year old currently undergoing treatment for lymphoma. I think the treatment days are the hardest for me, I feel like a total outlier next to older folks who have gotten the chance to live a full life and have a family. I know you said this isn’t therapy, but do you have any advice for someone in my situation?

I wish you all the best in your cancer journey. It's important to keep engaging in activities that are meaningful to you and connecting with the people you care about the most. So often, there's a tendency to isolate and that can definitely do more harm to your mental and physical health. To the extent that you're able, continue to live you life and enjoy the time you have. Also, be kind and patient with yourself. This journey can be an exhausting one, so try not to beat yourself up if your body isn't responding the way it used to. Take things one day at a time and know that there are many support services available to assist you if needed.

Cancer is something that has affected many people in my family. My father survived kidney cancer but my mother lost her, short, battle with Cutaneous T-Cell Lymphoma (CTCL) in 2017. Little did we know that she was battling this for two years prior to being diagnosed because it was such a rare and difficult lymphoma to diagnose.

CTCL is a blood cancer but it is not hidden as it affects and attacks the skin. My mom would have blisters, open wounds, and inflamed skin all over her body. It started off as a blister on her nose and within a year it spread to her neck and chest. Six months after that it was on her torso and arms.

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Numerous doctor visits, specialists visits, and hospital visits and no one could figure out what it was. Before any of this we were looking forward to the first wedding in our family since my Parents, as my wedding was scheduled for May 2016. A few weeks before my wedding after yet another hospital stay for testing and treatment, unbeknownst to me, my mom begged the doctors to give her something so she could be cleared up for the wedding as she was worried about her appearance and how it would embarrass me.

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Doctors agreed and gave her some cocktail that suppressed it for about 2-3 weeks and allowed her to feel good physically, emotionally, and feel like she looked good. Not going to lie it was a great 2-3 weeks and great to see her happy. However, after it wore off this nasty disease did not just creep back up it came in full force. Within days she was covered head to toe with blisters, skin was completely red, she said it would feel like someone was peeling her skin off of her when she would put her clothes on or even pull back a sheet.

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Back to another hospital stay and more uncertainty from one of the best health systems in the country. One of the doctors recommended transferring her to the burn unit to see if they can mitigate some of the pain and inflammation. Problem is their burn unit was full but we were able to get them to transfer her to another hospital an hour away, the best hospital in the state and one of the best in the world with the best burn unit too.

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The doctors at this burn unit put her in a full body suit, as they would to someone who was burned, and it not only gave her some relief from the pain and discomfort but it helped with the open wounds, scabs, and skin to become smooth again, which was shocking because no other treatment was working. It was then when one of the Burn Unit doctors had did some research and found other cases similar to hers that we were finally able to get an idea of what it was.

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While in the burn unit the head of the oncology department consulted the burn doctor and ordered some tests and requested all of her medical records from the other health system. That was when she was finally diagnosed, in September 2016, with CTCL stage 4.

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She started chemo in pill form and it was not working, and not stopping it from progressing. In December 2016, she started chemo transfusions. Between Jan 2017 and April 2017 she was hospitalized 6 times, with the last time being 6 weeks before she went home with hospice and died on April 9th, which was four days before her 52nd birthday.

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I shared all this because April is an obvious hard month for me and while I have accepted it and continue to grieve for my Mom, I have never been able to shake this feeling of guilt that because she felt like she needed to do that cocktail to be cleared up for my wedding and how that likely made this progress so quickly. Sometimes I can't help but feel like I am the cause of her not being able to beat it because of that.

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I have done therapy and acknowledge the trauma I have experienced and it is not as painful
as it once was. However, how does one ever overcome, cope or accept that it is not their fault
for how f***ed up cancer is?

Cancer is fucked up. I 100% agree. I can tell how painful this experience with your mom has been for you. You did nothing wrong. None of this is your fault. Your mother wanted to be more comfortable at your wedding, and the doctors provided her with medication that temporarily helped her symptoms. That meant that you had a few wonderful weeks enjoying her company and seeing her happy. That's priceless. While I'm not a physician, I have seen how sometimes after a trial of medications to control symptoms, the cancer appears to come back even stronger. That's a disheartening and confusing thing to witness. I'm glad to hear that therapy has been helpful to you in the past. There is not one right answer to how one can overcome, cope or accept...everyone's experience will be different, but therapy can definitely help.

I’ve actually survived cancer, so my question has to do with post living with cancer. Are feelings of survivor guilt something that happens to a lot of people? Every time I hear about people who died who had the same kind of cancer as me I have an external crisis. I don’t understand why I was chosen to live when they died. What if I’m not doing enough with my second life and would they have done better. Is there a place I can go to with these feelings?

I'm glad to hear that you're doing well. Survivor's guilt is a real thing and you are definitely not alone in your experiences. There are many wonderful support groups for cancer survivors all over the country, both in person and virtual, which you may find helpful. Here's a link to some helpful information on the American Cancer society's website, but there are many more resources online to help you find an appropriate group for you. https://www.cancer.org/support-programs-and-services.html

Thanks. I always tell myself I shouldn’t feel that way, but I do. Hopefully I find someone I can talk to.

Also, if you're interested in speaking with a therapist, that may be helpful too! www.psychologytoday.com is a wonderful resource for finding the right provider for you. Be sure to ask for a free consultation session and interview a few therapists to make sure they're the right fit before scheduling a session.

Thanks for doing this AMA. I lost my husband to glioblastoma, both in our 30s. I was his caregiver for 9 months. I feel that I've come to terms with what happened and have found good coping mechanisms. I always like to share my experience with others in the thought that I can use my caregiver and young widow experience for something good. I wondered, do you have any thoughts on how I may be able to support others going through what I went through? Communities or other services?

I'm sorry about your loss. There are many ways to support others going through something similar. Most cancer hospitals have volunteers on site which are wonderful and helpful. You could also check to see if hospices in your local area have volunteer services. You might also check places that offer grief and bereavement services, as they may need people to help run their support groups or other programs. Also, you might want to check some local churches to see if they already have a support group for people living with cancer or for caregivers, and if not perhaps you could start one. I hope this is helpful. Thank you for the comment and for all that you do.

Can a positive or negative attitude of the person with cancer and the ones around them have any effect on their condition?

This is a common question, thanks for asking. I think the question is more about whether stress will have an impact on a person's cancer journey. Am I on the right track? Just want to make sure I understand before going forward.

I was thinking more like optimism vs. pessimism, but that can be a part of it.

Thanks for providing clarification. This is a tough question, because it's really hard to know if there's a right answer. Optimists tend to see the glass half full, and pessimists see the glass half empty. Both are correct, just different perspectives on the world, and it's quite hard to turn a pessimist into an optimist or vice versa. Overall, it's healthy to have a more balanced approach to cancer, if possible. So, not being overly positive and potentially unrealistic about outcome or overly negative and possibly causing yourself more stress and anguish about worst case scenario. I'm not sure if that answers your question, but I hope it's helpful.

it's healthy to have a more balanced approach to cancer

I'd like to add that it's not just about the patient, but also the caretakers need to have a more balanced approach.

I've recently lost my mother to cancer. She was an optimist, fully believing it would just pass with the right therapy, ignoring warning signs of when it was getting worse. I'm more of a depressive realist, I saw the signs and warned her, but it sounded like nagging and just being a pessimist; still managed to make enough of a fuss to get her to a hospital 3 times, right when she was about to die. My father was a scared negationist, scared of taking her to the ER because of all the sick people in there, and diminishing the importance of warning signs, which played right into my mom's playbook of ignoring warning signs completely. Unfortunately, the 4th time, the dynamic broke down; she was getting better, then caught a really nasty cough. I alarmed her that it was a dangerous sign in her condition, she dismissed it as "just an infection", lied to me about having told any doctors about it, while my father didn't want to risk taking her to the ER and would rather wait two weeks for her next specialist appointment. I had no strength left to start another fight, all I managed to do was to alert a doctor friend of hers... and the next day she passed away.

I also know a two times cancer survivor, with a balanced approach, who faced it alone both times, with no caretakers to sway her either way.

I'm really sorry to hear what you went through in trying to care for your mother. It is a really challenging dynamic as parents want to maintain their autonomy and independence despite their health condition, but don't always know how to communicate their desires to their children. It sounds like your mom was not interested in pursuing further treatment and did not want to spend more time in the hospital, which is understandable. As an adult child of a parent with cancer, there can be a profound feeling of powerlessness, as you want so much to help, to give back, to protect your loved one, but often either don't know how or maybe met with resistance from your parent. It sounds like you were there for your mother to give her the love and support she needed, as best you could under the circumstances.

What advice would you give to people who are not licensed therapists but end up assuming that role anyway (bartenders, hair stylists, fortune tellers, church leaders, etc...)?

You are amazing, is what I would say. Please recognize the incredible gift you are offering people just by being there to listen, support, encourage and help. So often, people going through this journey feel isolated, because they no longer can relate to "normal" people around them. It's extremely helpful to have at least one or two people with whom they feel comfortable processing their feelings. It would be great also to refer your friends, loved ones to a support group as well, if they are open to that. The support groups give cancer patients and survivors a place to share with others who are experiencing something similar, so that they don't feel so alone in their experiences. This feeling of community can be very helpful, and it might help them identity other resources or educational things that will benefit them. These wonderful people that you mention, who are acting as therapists for friends and loved ones also need to really stay mindful of their own self care and recognize that they can quickly become depleted if they don't make the time for themselves too.

Do you have therapists that specialize for being therapists for other therapists in your field? How do you deal with compassion fatigue as a therapist?

Absolutely!!! Many therapists have their own therapists whom they see on a regular basis. It's very common and extremely helpful. Compassion fatigue is not specific only to therapists, but it is definitely a real phenomenon and can interfere with functioning both personally and professionally. For me, I really try to be consistent about my self care routine. I find that meditation and mindfulness activities help me tremendously, so I engage in this exercise daily. I also do yoga and other forms of exercise. Sometimes though, even with all of that self care, I still feel depleted. Those are days when I just notice the feelings, give myself permission to have them and be with them, and I show extra kindness towards myself. Sometimes that means going to sleep a little earlier or putting off a chore for another day, or taking some time off from work. Thank you for this question.

A question for me...my father was just diagnosed with pancreatic cancer, already metastasized to his liver. Obviously not a good initial diagnosis/prognosis, but still awaiting biopsy for type and more imagery to see how far it has spread.

I'm aware of the likely outcome, especially for pancreatic cancer due to its difficulty in diagnosing. Oddly though, so far I haven't felt nearly as emotionally affected as I thought I would. I know everyone grieves differently, but how can I assure those around me that I am, so far at least, genuinely accepting/coping? I keep waiting for it all to hit, but to be honest, I'm not sure it will. Unfortunately, I've had a long relationship with death; worked as a crime scene cleanup/mortuary driver, military special operations, and in the healthcare system - so I have come to my own terms with death. I'm just not sure how to have other people realize that and try to inject themselves into my version of coping.

Any advice?

Thank you for this comment. I'm sorry to hear about your father's diagnosis. You are correct about people coping differently and how there is not necessary a right or wrong way to grieve. Most people are quite fearful of death and struggle with their grief, because it's difficult to accept the loss. Given your past experiences, your relationship with death sounds different from that of the average person, so it would make sense that your grief response would also be different. That being said, it sounds like your father was diagnosed fairly recently. So, it's also possible that for you perhaps the emotions will hit a little later on in his cancer journey. However it happens for you, is how it happens for you, and it's okay. Other people may or may not always understand, but it sounds like they are supportive and acting out of concern and love. Just recognize that they are well intentioned in this way, but that your grief journey may be different than theirs.

My mother has brain cancer and can't really understand what's going on anymore. She understands but forgets very fast. She often asks what's going on, when she will be healthy again, but her partner wouldn't tell her because he thinks she couldn't stand it. I'm not sure if it would be better to tell her the truth. I think it's also an ethical question to give her the chance to face her death and decide how to deal with it, even if she can't barely move and talk anymore. Could you give an advice?

Thank. you for this comment. I'm sorry to hear that your mother has brain cancer. I agree that this is an ethical dilemma. Did you mom say anything about her wishes prior to progression of her disease? Based on your knowledge of her, would she have wanted to be aware of her health status so that she can make meaningful decisions on her own behalf? I guess another question would be if she has the capacity to make meaningful decisions at this point in her cancer journey. I would take these answers into consideration when deciding on what action would be in her best interest. It's not an easy decision either way. You may also want to consider if the information would cause her more distress or not. Hopefully you can communicate openly with her partner about your concerns and come to an agreement regarding your mom, together.

For cancers with longer prognoses, how do you help your patients deal with the fact that they still need to do “normal” things, like go to work, when they know they’re going to have less time on earth than most people?

I’ll likely die in my forties, fifties if I’m lucky. I’m currently in my late thirties. I was diagnosed in my late twenties. Stopping work wasn’t an option - I still need to pay for accommodation, food, transport, not to mention trying to have money to enjoy my life.

But I feel like I’m just burning up what little time I have. It feels like some kind of cruel joke that my life will be shorter than most, but that I have to spend what time I get on mundane shit because I’m living longer than most cancer patients.

I’m not trying ti sound ungrateful - my diffuse astrocytoma is way better than a GBM. but this just eats at me. All I want to do is explore the world and travel and spend time with my family. Things I’d normally do after a successful career and retirement. But I won’t be retiring? My life insurance isn’t accessible until two doctors say I’ve only got two years left to live.

Thank you for sharing your experiences. Cancer is hard to navigate emotionally no matter what stage you are in your diagnosis. The reality is always the same in that the future is uncertain. In many ways though, our future is always going to be uncertain, but a chronic health condition like cancer, certainly adds a greater intensity and sense of urgency to the choices we make. Many people recommend trying to maintain a "normal" routine as much as possible, which can be helpful in generally keeping you grounded and in the present moment. However, if what's normal for you is causing too much stress or isn't congruent with your values, then maybe it's time to take a look at what you spend your time doing. Perhaps some changes can be made to allow you to engage more in activities that you enjoy and find meaningful.

What's the best advice you can give for a child has aparent with cancer?

This is such a hard and challenging experience for both parents and children. I have answered this question in one of the previous comments above. Please take a look and if you have additional questions, I'd be happy to answer them.

Thank you.

I am a clinical social worker and I want to expand my knowledge regarding supporting clients with grief and chronic conditions. Are there books/resources you would recommend?

Thank you for the question. Here are a few of the resources I have found helpful in my work with cancer patients:

Counseling Clients Near the End of Life, by James Worth Jr.

On Death and Dying by Kubler Ross

When Things Fall Apart, by Pema Chodron

https://www.cancer.org/?_ga=2.36474088.998909560.1681954355-1931500573.1681954355

https://www.cancersupportcommunity.org/

dougy.org

My mom passed away last year (not of cancer, but a rare neurological disease; though she was also a cancer survivor). Can you share any general advice on how to productively look at a person’s situation where their entire life was full of trauma and hardships, and meanwhile they themselves were the kindest/nicest person—and then they end up with a horrific terminal disease that causes unimaginable suffering? The whole “why do bad things happen to good people?” question. My dad is very pessimistic and raised me to believe “life isn’t fair” so I know “that’s just the way it is” but that doesn’t help me at all. And one of my therapists has a similar but at least more balanced take that “life is full of good and bad things, and that’s just the way it is.” but that also doesn’t really help me. And I’m not religious, so not much comfort there, though I do believe my mom’s “in a better place” now, but it’s still extremely upsetting to have to witness a slow motion train wreck happen to someone, let alone a person who has endured one rough situation after another. 😞 If there’s no general advice you can give, and it’s more of a case by case basis best suited for working out in therapy, I understand! I do talk to a grief counselor and therapists to help with my many, many issues, including mourning my mom, but just wanted to ask in case you have come up with something you’ve found helps folks in situations like this. Thank you for your time! 💜

Hi there. I'm so sorry to hear about your loss. Your mom was a very important person in your life and someone you looked up to and admired. It makes sense that it would be confusing to see someone so wonderful endure so much suffering in her life. I wish that I had something different to say than what you've already heard from other therapists. Grief is really hard, especially in situations where it feels almost wrong and unjust. Sometimes it can help to work on developing more flexibility in the way you see or talk about things. We can get stuck in our own cycles of thinking and a therapist can sometimes help us to pull back to see a different perspective or see things through a different lens. I can't say that there's an easy fix. You're doing a lot of hard work in therapy, and I encourage you to keep taking care of yourself while finding meaningful ways to remember your mother. Imagine how she might answer this question you posed to me. Sometimes this can be enlightening too.

Thank you for taking the time to do this. I’ve been reading through the comments and it’s almost kind of comforting to read so many stories about cancer.

My 8 year old son got diagnosed with a cancerous brain tumour 7 months ago, originally they told us he had 12-14 months to live, and because of the placement of the tumour they couldn’t operate on it. We have since then, had the diagnoses contested as the biopsy results indicated a more rare but treatable/curable cancer.

Of course we are elated that his cancer is treatable, and he has since gone through 6 weeks of radiotherapy, and we are now in stage 4 (of 8) rounds of chemotherapy. I feel incredibly amazed by the Drs, nurses and hospital staff who work so hard to help him, and us, it has been an eye opening time for us as a family.

My questions is, as silly as it might seem, is there a better way of asking “how are you?” Because every single person asks him this, all the time. It’s almost unreal how many times a day we hear this phrase. And he has told me many times how much he hates being asked this repeatedly…and I’ve told family, friends and school but they often forget, or say it automatically.

I wonder if there is a better way for them to ask/or a phrase we can ask them to use instead? Or is it just something we should learn to live with. I know that it’s always meant well from the people who ask, but it’s also accumulative over the course of a day for him and is a constant reminder of his situation every time.

Anyone else feel the same?

Thank you.

Thank you so much for this question. What a brave little guy you have there!! I'm glad to hear that he is doing well with the treatment process overall. It sounds like you're doing a great job trying to keep his day to day life as normal as possible, and staying in contact with teachers and school counselors. From a kid's perspective, I get not wanting the constant reminders with people asking "how are you." Maybe it would be helpful to normalize the checking in by asking the teachers to perhaps make it part of their morning routine and check in with all the kids, so your son doesn't feel singled out. Or maybe ask your son how he would like that conversation to go; maybe he has some ideas to make it more fun and less a reminder of his illness.

What are your thoughts on psilocybin as therapy for terminally ill cancer patients?

Thank you for this question. Unfortunately, I am not experienced in working with terminally ill patients using psilocybin as therapy. I have heard anecdotally that it has been helpful for some, but I am not an expert in this area. If anyone else here has experience with that, please feel free to share.

Family relationship considerations: seeking support as needed for appointments without providing 'helpful advice' which is not based on medical or scientific best practices. What are typical recommendations for having family members providing support understand and accept the scope of what the patient is willing to act on for maximum patient compliance to a physical, mentally and emotionally challenging treatment plan?

That sounds like a complicated and potentially exhausting situation for the patient and caregivers alike!! Setting boundaries is important, even at this stage of life and with this challenging experience. Boundaries both on the part of the caretaker and on the part of the patient. Family has good intentions, but sometimes they don't have a helpful approach. You may need to set aside some time to have a talk with the caretakers about what is and is not needed in this situation. They can't read minds and neither can you. Communication that open and honest will go a long way towards reducing the stressful impact of this experience for everyone involved.

Hi my gf had lymphoma but luckily she's fine now. But since the sickness has regressed I'm in constant anxiety that something like a resurgence of the cancer could be behind the corner. What would be your advice to copy with this anxiety? Especially when we approach the annual check up

That is a very real concern regarding resurgence. There are many things you can do as part of your self care, that can help with anxiety such as exercise, yoga, talking with good friends, meditation, or engaging in other activities you enjoy. The anxiety will still be there, because you care about your gf and you want her to be healthy. If you're already practicing regular self care and your anxiety is beginning to interfere with your functioning at work or in your personal life, then you may want to consider finding a therapist. This website is a wonderful resource for finding the right provider for you. www.psychologytoday.org

With younger adults being diagnosed more and more with cancer, there are school age children to think about. Do you have any advice for the cancer patients of those children or for the young children with parents who have cancer?

That's a really good question and important point. Thankfully, there are a lot of wonderful resources available online, through cancer hospitals as well as books and other materials. You're absolutely right though, it's important to think about how the children are impacted by all of this. While children at different developmental stages will need different things when it comes to understanding, accepting, processing about a parent with cancer, the main point is that it's important to keep them included in the family conversation. Most children of any age have a keen sense when their parents are hiding something or keeping something from them, and this can build feelings of resentment and isolation from caregivers. It's generally best to be open and honest with children about the reality of what's happening with their parent's health condition and then give them the space and permission to have their feelings and share them with you. So, first they need to be included and informed in a way that's developmentally appropriate. Second, it's important to inform their school teachers/counselors to keep an eye on them at school in case they need extra support. After all, they spend 8 hours a day in school, so teachers may see things that we don't. Thirdy, I would keep their routine as regular and normal as possible, but if mom or dad is in the hospital, ask the child if he/she wants to see them and give them that choice. Sometimes there's a tendency to want to protect children from sadness and grief, but this simply is not possible and could potentially cause more pain in the long run. Here's a helpful resource on talking with kids in a developmentally appropriate way for different age groups. https://www.cancer.org/treatment/caregivers.html

https://www.cancer.org/treatment/children-and-cancer.html

I hope you find this helpful.

Hello, and thank you for the work you do. I cannot imagine it’s easy and can often be heartbreaking but can see it’s likely very fulfilling.

I know you probably do work intended for human patients, but last year my cat was diagnosed with cancer that ultimately took her life in November. Do you have any general advice for coping with the grief for more aggressive forms, and particularly for the family members who were more directly involved in treatment? I find myself still wondering if there were anything more I could have done to save her as I was the one administering her daily medicine after diagnosis. As a related note, we’re approaching the one year anniversary of her diagnosis and my own cell phone is being brutal bringing up the picture I had to show around a lot relating to it.

Thank you. The work that I do is indeed both challenging and fulfilling.

The loss of a beloved pet is difficult too! Often our pets are like our little 4-legged fur babies. When it comes time for their passing, it certainly brings on feelings of grief, much like the grief we experience with other losses. It sounds like your kitty had a special place in your life. I know the Facebook memories can stir up a lot of emotions and bring back a lot of memories, but I wonder if you can try giving yourself the space and opportunity to be with your feelings as you remember how sweet she was. You did your best by caring for her during her final days and giving her all the love, cuddles and treats she could handle. That’s probably the best thing you could have done for her. Be kind with yourself. Grieving takes time. Give yourself permission to feel and sit with your feelings, as pushing it down or away only causes those feelings to resurface stronger than before. Remember that there are also other sources of support out there if needed, such as bereavement groups or individual counseling.

How do you cope with the sadness that you see, hear and feel from all the people you work with? It must weigh such a heavy toll on you. My deepest respect and sincerest thank you for what you do!

I really appreciate that. Thank you. Honestly my first few years working with cancer patients was really painful and emotionally exhausting. I felt so powerless. I cried so many times at work, and sometimes with patients too. Over time, and with developing a consistent self care routine and processing with colleagues, I got better at managing my emotions...but there were still times years later, that I would take work home. I learned that it's okay to feel for others and not always be able to hold your emotions at bay; that's part of what makes the human experience a beautiful thing.

In November I was given a few months to live if I didn’t get a surgery in a major city. I luckily got it, and survived. How do I go back to normal, after I was ready to die at 37? I was ready to let go, now I have about 10-20 years left

I'm not sure it's possible to go back to normal...at least not the same normal you had before your cancer. You were ready to let go of life, and now you have many more years ahead of you. That was a life changing experience! I would ask, how did that experience change you, your values or your priorities? Did you have thoughts when you were going through treatment about what you wish you could do again or how you would do things differently? What would that look like for you now? It might be helpful to spend some time doing a little self exploration, perhaps journaling or talking with a therapist to see what a meaningful life would look like for you now.

What sorts of things does working in your profession make you feel about your sense of purpose and your general perception of life?

This is an interesting question. I definitely chose my profession, because I wanted to help others struggling with mental health issues. My passion came from my own personal life experiences and experiences in therapy; that taught me how valuable it is to be heard in a non judgemental space and begin learning and developing practical skills to help build a meaningful life. Ultimately, my love for others and desire to help is what has guided me along this path.

I just survived Stage 4 Hodgkin's lymphoma in January. I had my three-month check up recently and while all looks good, I had the worst weeks leading up to it. Any slight pain on the chest will lead to an anxiety attack, I'll be crying and breathless. The future I want flashes before my eyes at the likelihood of it not happening if I have to go through cancer again.

I have a therapist and will see a psychiatrist soon at the referral of my physician. Any tips to reduce the anxiety of relapse?

I'm glad to hear that you are a survivor! I know it can still be scary each time you go in for follow up scans and feel hypervigilant about what sensations in your body could mean. If you have not already started to do this, try developing a gentle mindfulness practice centered around noticing your breath and body. Even 5 minutes a day can be very helpful in developing your awareness and learning to not only sit with what you're noticing in your mind and body, but also learning to let go. Maybe, if you're interested, ask your therapist about this strategy and see if you two can work together on this. I really like the Insight Timer as an app to help support those who are just getting into mindfulness practice as they offer a lot of free guided practices. I hope this is helpful and I wish you all the best.

My partner's parent has just been diagnosed with lung cancer, so the fact I stumbled across this so early seems to be fate. They've just had a biopsy taken a week ago and yesterday had a PET scan, so we don't know what stage, type, etc we're facing at the moment, but should do soon. Regardless, as it's all so new and fresh, what the best coping mechanisms I can recommend to my partner and their family? What you recommend I do to help other than just "being there"? This is all so new, I'm a bit lost in how I cope and help others cope once we know the next steps.

Hello,

Having gone through this - spouse diagnosed with cancer, and unfortunately she succumbed to the disease...Your just being there and providing moral support is huge - especially for your partner to vent, cry, talk about their fears etc...However, one thing you can do is just take the initiative to be helpful - help take care of meals...Show up with coffee...Offer to stay with the parent so the other family members can get a break...Are there any young children in the family who might need distraction? Any dogs need to be walked? This is assuming your presence isn't best spent just being by your partner's side.

In my experience, a lot of people in our family and friendship circle offered unspecific help "If there's anything I can do." and we really didn't ask anyone for anything...But a few people just jumped in - bringing meals, taking my daughter to the park, being beside my wife so I could take a walk in the park. Those people were amazingly helpful. For other's who did not feel comfortable being so forward - I completely understood.

Thank you so much for sharing this. I'm sorry to hear about your loss, and I appreciate your willingness to talk about it. This is something that I hear very often, that we are often quite concerned about "burdening" others, so are unwilling to ask for the help that is needed. Rather, we feel more comfortable when our friends or loved ones jump in without our asking. Those who jump in almost seem to inherently know what to do or what we need in the moment, which is lovely. Our other friends/family who ask for guidance on how to help, need a little direction, but are still very much interested in being there. What I. have heard a lot from the friends and family of someone with cancer, is not knowing what to do or how to help. In these cases, it is helpful to be specific in your requests as these loved ones also want to be involved and show their support. It sounds like you have a wonderful support system.

I'm sorry to hear about your partner's parent's illness. Let me assure you that "being there" counts for far more than you may realize. At this point, everything is so new that you, your partner and their parents are still processing and have many questions. All of this is completely natural and honestly pretty scary. Having a safe place to talk about those feelings is really important, rather than trying to avoid their emotions. So it's helpful for your partner to know that what he's experiencing emotionally right now is normal and okay, and encourage him to share if you're comfortable being the sounding board. At this point, there are many questions and unknowns which can cause anxiety on a number of levels. Trying to take things just one day at a time is helpful. Focusing on what's happening right now, in this moment rather than thinking too far into the future. Engaging in regular dialogue with your loved ones to offer support and let them know you're available to listen, is invaluable.

Caregiver or primary contact question: when there is little negative prognosis or the care team makes a series of incremental changes to the treatment plan that results in significant efforts that do not seem to result in even little measurable improvement for an extended period, what are the typical helpful mindsets or ways to deal with this?

This is really a hard position to be in. The uncertainty makes it really challenging. In situations like these, it's helpful to stay focused on what IS working and go from there, because sometimes quality of life gets lost in the effort to find the next best treatment.

Thanks for doing this! I would love to know what would you say/do with a client who recently lost a partner to cancer, began mourning, but a few months later started a new relationship. Let's say the client did this to escape the hurt, didn't know wha they wanted and doesn't have a lot of self-awareness of there vulnerabilities. How would you navigate this, or select and apply an appropriate intervention?

Thanks for writing in with your question. It sounds like the client may be trying to distract from or avoid his feelings of grief, by starting up a new relationship. I wonder what the client has to say about what this new relationship means to him and why it was important that he find a new partner right away. In situations where the client does not have a lot of self awareness, it's really hard. Even though you may be seeing concerning behaviors, unless your client also sees it, it will be challenging trying to work in this area. We need to meet our clients where they are, and if they're not where we think they need to be, that's okay. We start from where the client is and let them lead the way by focusing on what's concerning them in the moment or what their goals are. I hope this is helpful. Thank you for doing this challenging work.

Thank you for the work you are doing. As a person with cancer, and a caregiver for a husband with cancer....same cancer...I would like to know how closely you get to work with the providers. My providers were horrible. My onc was like a gogo girl...boots and everything, the second onc didn't even put notes in the system for my weird side effects, the RAD ONC lied about major things and never took me seriously. I suffer immensely from the treatment that caused other issues that i deal with daily. i would rather be dead than deal with some of this, yet I'm told to just be happy. I cannot do that. on the other hand, my husband has had better docs...a horrible surgeon halfway (if not your specialty, don't operate on that) but great care. Communication seems to be off between docs and the main people. Is it normal for those in your position to be able to communicate with all and put it all together and then get back with those docs to provide better patient care...or better care for the next person?

I'm so sorry to hear about all that you and your husband have been through with your illnesses and navigating the medical system. The system can be difficult to navigate and stressful, for sure. Communication can be a problem, both among providers and between patients and their providers. On the other hand, when it's working smoothly and efficiently, it can be wonderful. However, these relationships are not always cohesive and there isn't always a reliable point person who can communicate the details back to the patient. You are definitely not alone in your experiences. That being said, counselors and social workers can work closely with providers and with the patients to provide optimal care, and that is definitely the goal.

What made you decide to take this career path? Were there experiences you had or a calling you felt? Did you go into therapy knowing you would specialize in cancer therapy or did you find it along the way?

Thank you for this question. While I have always had a passion for mental health care, I honestly did not plan on working with cancer patients. The opportunity presented itself several years ago, and I accepted. It turned out to be a significant turning point in both my career and my personal life, as I learned a tremendous amount about people, human suffering and the challenges of the healthcare system. The experience brought my values into much sharper focus and helped me to make important changes. I'm very grateful for the experiences I have had working with this population, as I have learned so much.

What are some of the most common challenges and struggles faced by those living with cancer? What can be done to cope with these challenges?

Thank you for the questions. Some of the most common challenges faced by those living with cancer include: adjusting to the loss of normalcy, experiencing a loss of identity, grieving over the things they used to do or how they used to be, feeling isolated among friends and family, experiencing a role reversal with partner at home (which also impacts identity and normalcy), and grappling with ongoing uncertainty about treatment outcomes, etc... What can be done to cope with these challenges? Try to focus on what the person can still do and maintain as much normalcy as possible. Give them the space to have their feelings and be willing to listen when they need to talk or cry. Help them stay connected with meaningful activities and with people who are significant to them. Allow them to maintain as much independence as is safely possible. It's also helpful to involve a support group or a therapist to assist further, if needed, and many treatment centers will have counselors, social workers, as well as support groups available to patients.

Love to all living with cancer and making a go of it - good on you! I’m old, and while I’m disease free now, odds are increasing that something will happen soon. Is it terribly unfair to others if I decide to just let go? Do doctors allow/enable this? I’m not much of a fighter.

I hear that you're scared to face another round with cancer. It can certainly take a toll on you physically, emotionally and spiritually. I hope that you continue to stay well and don't have to go through it again. However, if this does become a reality, what are your options? It's an important discussion to have with your loved ones and also with your medical providers. Perhaps additional treatment is not the route you want to take, and in that case, you have other options such as palliative care, which addresses your symptom burden, so that you can experience better quality of life. These choices are yours and they are important. I know it's an uncomfortable conversation to have with family, but they will need to know your wishes going forward, and that may give you a greater sense of peace about the future.

Are you Persian? My mother in law from Tehran has AML post breast cancer and if you know any resources for supporting a first generation spouse with this particular type of parent I would love to find help. Thank you.

Hello, yes I am Persian-American or Iranian-American. I'm sorry to hear about your mother in law's health condition. Unfortunately, I'm not aware of any support groups or organizations that offer services specifically to that population, but I will say that all the support groups I have encountered were quite nicely integrated and served a widely diverse group of people. There are more support groups and organizations specific to Persians in Canada and Europe. So, depending on where you live, you might be able to find a good fit for your husband and his mom. Wishing you and your family all the best in your journey together.

What is your opinion about Euthanasia ?

I don't have an easy answer to your question. I have shared some links below, which you may find helpful. Euthanasia is not an option in the U.S., but depending on the state you live in, there is the option to die with dignity, under certain circumstances.

https://www.nytimes.com/2021/04/05/well/live/aid-in-dying.html

https://triagecancer.org/deathwithdignity

specializing in ... finding a life worth living when you are living with cancer

Can you help me find a life worth living when I'm not living with cancer? 😂😭😶

(I feel like an asshole for feeling like this when people, e.g. people living with cancer, have it so much worse than me. But there it is.)

I hear you. Life can be hard when you don't have cancer or a chronic illness, so it's hard to imagine what it might be like for those who do.

It's also important for you to take care of yourself both physically and emotionally. Recognizing that your life is not what you had hoped or that you need extra support, is a step towards change. Perhaps speaking with a therapist would be helpful.