[Linda]

Serious illness can often intensify the strong relationships that already exist within a family. It also may intensify existing family problems. For example, if a child is not doing well in school, his or her grades are not likely to improve when an additional family problem, like cancer, comes up. Likewise, marital or financial problems often get worse when someone in the family develops a serious illness. Substance abuse, including excessive use of alcohol, use of illegal drugs, misuse of prescription drugs, as well as eating disorders, may also become more severe for a family member or the cancer survivor when new problems arise. This can be especially hard these days, since so many families are already stretched by the demands of taking care of both young children and elderly relatives.

Sometimes, existing problems do seem to "self-correct" for a short time as everyone focuses on an immediate cancer crisis. Eventually, however, the increased stress will probably take its toll. If someone in your family has a personal problem or is caught up in destructive behavior, do all you can to get them to seek counseling or go together for family therapy so that your family doesn't get overwhelmed. If a loved one will not seek help, seek counseling without them so you can get help in managing your own responses to the ongoing family problem and to any new crisis.

I always talk with cancer survivors about specific ways to avoid common barriers to family communication. First, keep cancer in perspective. Cancer can be treated, controlled, or managed. Don't let the negative myths and fears about cancer get in the way of family communication. The cancer survivor and his or her family members need accurate and honest information about cancer, its treatment, cancer recovery, as well as long-term survival, including recurrences and possible second cancers.

Second, periodically review the ways in which family roles and activities have changed or may need to change. For example, will you need to delay or cancel a vacation or family event this year? Have finances changed, and, if so, what does that mean for your family? On the other hand, talk about things that have remained the same or don't need to be changed. It's important to remind each other of the love you have for one another, the value of family time, and the need to continue special activities and celebrations that keep you together as a family.

If family roles have changed, are the changes temporary or more permanent? One suggestion I often make is to change assignments or responsibilities among family members, when possible, every few months. This way, nobody becomes too burdened by any one task or responsibility. It usually helps to avoid having all of the personal care tasks fall on only one person. Consider asking teenager in the family and close family friends to share the care. For example, a teenager who drives could take you to doctor's visits or other appointments. This will enable the teenager to learn more about your treatment and progress, and will also provide an opportunity for private and meaningful conversation between the two of you.

If you worked before your cancer diagnosis and treatment, talking with your boss about your employment situation every few weeks or months can be very important. Will your employer need to make changes so you can return to work? Or, will you need to find a different type of work that is better suited to your energy level and recovery process? Keep in mind that you have rights in the workplace.

Some people use their experience with cancer as an opportunity to evaluate many fundamental aspects of their lives. Some will be eager to return to their original jobs and activities, but others will want to explore new options.

A third suggestion for avoiding barriers to communication—think about and plan exactly how you are going to go back to work and other outside activities. Many friends, neighbors, and co-workers will be curious about your illness and prognosis. Most will ask questions because they care about you and want to be supportive. Some people, however, are simply interested in the drama of a serious illness, or they like to gossip. Don't feel like you have to share the details of your health with everyone who asks. You and your family may want to practice answers to difficult questions so that when other people ask, you will have your answers ready.

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