Introduction
It's hard to image what a young person feels when the doctor says "cancer." Your life is ahead of you and then suddenly, the word, cancer, pushes your whole other world aside.
What are the thoughts a teen thinks? What are the fears a teen has? We've heard from many and we've learned that thoughts and fears cannot be pigeon-holed. There is no one thought or fear. All of your thoughts, fears, worries, anger, or resentment are yours and they are neither good nor bad. They simply are there, inside your head, screaming to be heard or perhaps whispering timidly even as you want to shush them because maybe it's all a mistake. And now, at the end of treatment, you probably have different thoughts and fears.
You may have had to take only a little time out during your treatment and may feel that your diagnosis was a bump in an otherwise smooth road. But you may have lost lots of time. While you sat in your hospital bed, your friends were moving on. Now the time has come for you to go back to the life that cancer interrupted, but it may not be easy. You won't have your old energy back for awhile. You'll have to reconnect with what's happening with your friends and in school. Most teens tell us that the process is gradual, but it happens. You may join a different group of friends. Even if your friends have not moved on, you may have yourself.
Some teens take an active role in their illness and treatment; others put their parents in charge. If you did not take an active role, you may be ready to be more assertive now at the end of treatment. It may take some time for your parents to recognize that you are ready and able to be more independent. It is often hard for parents to give up shielding and protecting their children, especially when the child has survived such a significant threat. You and your parents may need help sorting out your post-cancer roles. If you feel unable to move things along, your doctor, nurse, social worker, school guidance counselor, trusted adult friend, or relative may be able to give you advice about how to broach your concerns with your parents.
Emotional Roller Coaster
Most people have ups and downs, even without cancer. You will also, and though they may have something to do with your cancer experience, often, they'll have more to do with what is happening in your life at that moment. You might even want to blame the cancer when things don't go the way you want them to. As time goes on, the cancer will begin to become a memory rather than a daily reality, and the ups and downs will, once more, be the ups and downs that are common to everyone.
Going Back To School
You may be excited about going back to school, or you may be nervous, especially if your physical appearance has changed. Perhaps your hair is just beginning to grow in. Or perhaps you have a visible scar. Your doctor and nurse will be able to help you with some role-play activities to prepare you for comments and questions. No one can tell you how to behave or how to feel on that first day back. But we can tell you that most teens manage well, even if some kids stare and are curious about what happened while you were sick. Within a short time, your friends and classmates will treat you as another kid, not as a kid with cancer.
Loss
You may find yourself having to deal with new challenges and disappointments after cancer. Some things may be lost for good. You may not be able to play some sports. You may find that your studies seem more difficult than they did before your treatment. Ask your doctor what you might expect, not only immediately, but over several years. If you are told that you can expect some late effects, ask what you might do to minimize them, and who can help you when necessary.
Siblings
Remember the days when you would quarrel with your brothers or sisters? We imagine those days disappeared when you got cancer. They have probably been careful of how they act around you. They are likely to be concerned, attentive, protective, and scared for you. They may also have felt a little jealous and perhaps even resentful of the attention you received and because your parents did not have as much time for them. These are normal feelings and certainly do not mean they love you less. Now that your treatment is over, you will re-establish a more normal relationship with them. It may take some time, especially since you may not feel fully up to par. But your relationships may be stronger for what each of you has gone through.
Dating
If you are or were dating, it might be easy to pick up where you left off because there will be little explaining to do. Your boyfriend or girlfriend will know about your cancer. It becomes harder when you meet new people and they do not know about your cancer. You might wonder if there is a right or wrong time to tell someone. What should you say when you do tell them? There is no one right time or right thing to say. You will have to feel your way and come to solutions that work for you. It would be nice if we could report that these conversations are always successful, that dates are always understanding and supportive and do not shy away or simply withdraw and disappear. Unfortunately, that is not always the case. Our only advice, again gained from the experience of those who have been through it, is that, it hurts when it happens, but it's better to know early on that this is not the person you want to share your life with. And, the kind of person who runs away when confronted with illness might well run away when confronted with other problems. You have come through cancer; you've survived one of life's biggest challenges and will likely face any other challenges knowing you know how to cope.
Ongoing Medical Follow-Up
The goal of this program is to tell you what kind of follow-up medical care you should have so that any late side effects can be taken care of as soon as they occur. Make sure you have complete records of your cancer diagnosis and all of your treatments. If you do not have a record, begin to assemble one now. When you finish treatment, ask your doctor how often you should be seen in follow-up. Also ask what kinds of late effects are commonly seen with the treatment you have had, when they occur, and what can be done about them. Finally, ask if there are things you can do to minimize the chance that you will have these late effects.
Good Health Practices
While it is important for everyone to practice good health measures, it is even more important for people who have already had a serious illness. Do not smoke (don't even think about it!). Pay attention to your diet. Healthy food choices may protect against many types of cancer and certainly help protect against heart disease and diabetes. Regular exercise may go a long way to helping you live a healthy and active life. Do not forget to keep your follow-up doctor's appointments. We hope you never have to say, "If only I had paid attention to the doctor."
Employment
Your cancer history should not be an issue in a job search. Many survivors wonder whether they must disclose their cancer history to a prospective employer. The answer to this question is no. By law, an employer may not even inquire about your medical history. However, some employers may do so. You may answer questions about your health by saying you are healthy or in good health. Should you elect to tell a potential employer about your health history, you have some legal safeguards, but be aware that a company may find other reasons not to hire you.
While you do not have to share your cancer history with a new employer, you must share it with a new insurer. It is fraudulent not to do so and your insurance could be canceled and you might even lose your job. The only legal reason an insurer can share your medical history with your employer is if it impacts your ability to do your job in a functional way. For example, if doing your job could be a health risk for you, the insurer could inform your employer.
More about Insurance
Many survivors wonder if they are "insurable" after treatment for cancer. The answer is, in almost all cases, yes. Exceptions to this are life insurance, and in some cases, long-term care insurance. If you were covered before your illness, you will still be covered. Recent legislation has ensured that patients do not need to face a "pre-existing condition" clause prior to having full coverage, as long as their coverage hasn't lapsed for more than 60 days. A pre-existing condition means that you would not be covered for a recurrence of that condition until a certain amount of time has gone by.
