[Narrator]

Section 6—"Living With Hope While Dealing With Uncertainty." 

Ever since you were diagnosed with cancer, you may have found yourself living with the ever-present reminder of how insecure you feel about your future. From that first moment you are told that you have cancer, your immediate future becomes defined, at least in part, by the period of weeks or months between diagnostic tests and checkups. Even though survivors are living longer than ever before, it's not surprising that many feel that their futures are cast in a gray zone of uncertainty. 

But, to a certain extent, living with uncertainty is what all of us do as we go about our daily activities. You don't have to have a diagnosis of cancer or other life-threatening disease to feel uncertain about the future. The terrorist events of September 11, 2001, for example, made many of us feel less secure. Suddenly, we sensed that there's a degree of uncertainty about the future that wasn't there before that tragic day. Some people think of a diagnosis of cancer as its own form of biological terrorism. Like terrorism, cancer is an unexpected and dreadful intruder in the lives of many people. This includes the person who receives a cancer diagnosis, as well as his or her family, friends, and colleagues. These situations can change your life and make you feel uncertain in ways that can be disturbing and confusing. These feelings can make you wonder if there is any satisfactory way to reduce your fear of death or cancer recurrence, or of being stigmatized—that is, being thought of or treated differently by the people in your life—just because of your cancer diagnosis. You may wonder if there is any way to overcome your feelings of sadness or loss. 

[ Linda]

A diagnosis of cancer puts fears about an uncertain future and feelings of our lives being out of control squarely in front of us. Cancer knocks us off balance. One cancer survivor I work with said it this way: Cancer patients crave "feeling normal" and try to work the gray areas of living with uncertainty into daily living. It becomes normal—a "new normal"—to live with the stress of cancer survivorship. 

Cancer does not represent a single crisis in our lives, but a sequence of crises. For many survivors, this sequence begins with the "first-alert" system that our bodies use to tell us that something has gone wrong. It might be a symptom that nags at us and tells us that something is just not right. It may take us a while to admit that there really could be something wrong. And, it may take even longer for us to get around to going to see a doctor about it.

For some people, the diagnosis takes some additional time for tests and more tests, and draws out the uncertainty. For other people, the diagnosis can be made fairly quickly. In any case, actually getting the diagnosis of cancer starts a whole other sequence of crises—the crisis of decision-making about treatment; the crisis of surgery, radiation, and/or chemotherapy; the crisis of dealing with changes in the way your body looks or functions; the crisis of ending treatment and wondering what may happen next; and the crisis of recurrence, if that is our destiny.

With each crisis comes increased anxiety and fear. These fears and anxieties are a very basic part of being human. They are part of cancer survivorship. They can be managed and become the "new normal" that many survivors feel. Let's begin that process together.

Along with the many uncertainties that go with a diagnosis of cancer, there are also many fears. I hear them daily from cancer survivors and their caregivers. The three fears I hear most often are: the fear of death; the fear of cancer recurrence; and, the fear of being stigmatized as being "different" by the people in your life because of your cancer diagnosis.

Although a fear of dying is a very natural part of life for most people, we, as a society, do not deal with it naturally and honestly. Most people who receive a diagnosis of cancer—no matter how good their prognosis may be after treatment—feel the reality of their own mortality, perhaps for the first time. The reality becomes an immediate concern, not just something in the far-off future. We might think of the diagnosis as starting the clock that counts down our remaining days. For these reasons, it is very important to give voice not only to our fears about death and dying, but also to our hopes for what we would wish our process of dying would be if we were given a choice. Cancer survivor and author Arthur Frank captured these feelings well in his book, At the Will of the Body, when he wrote: "The ultimate value of illness is that it teaches us the value of being alive…illness and, ultimately, death remind us of living. Death is no enemy of life…..illness restores the sense of proportion that is lost when we take life for granted. To learn about value and proportion we need to honor illness, and ultimately, to honor death."

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