By Michelle S. Hayes, LCSW, OSW-C 

Coming to the end of treatment for cancer can bring a multitude of feelings including relief and accomplishment. We also know that this period can bring fear, anxiety, and isolation. Many of the clients we work with are so focused on the next appointment, treatment, and side effect that they have little to no time to allow for the space needed to process their emotional response to a cancer diagnosis and the toll the treatments take on their bodies and minds. Entering this phase many call survivorship can be incredibly challenging as uncertainty surrounds next steps, worry peaks as the time before the next scan seems too far away, and clients describe falling off a cliff in terms of their healthcare.  

As providers, it is incredibly important that we follow our client’s lead when determining our support approach. Do they identify as a survivor? Do they feel a sense of relief or increased anxiety? Have they had any time to connect with peers in the cancer community? What do they know about their prognosis? Sometimes the best we can do is hold space for someone to share their story, connect the dots for themselves and acknowledge all they have been through, and validate that, yes, this did happen, is happening, to you. 

In my organizational work with clients who are nearing the end of treatment or are post-treatment, we offer an eight-week, limited series support group to normalize the concerns that may be rising to the surface at this time. Beginning with a week or two of in-depth introductions, followed by weekly deep dives into the concerns they bring, we aim to create a space for each client to share their history alongside current questions, to foster relationship building with peers for ongoing support. Many group members find that the differences in their diagnoses or treatment decisions pale in comparison to the common ground they find as they begin navigating a path forward.  

Among these concerns, we often discuss fear of recurrence, returning to work, ‘what’s normal?’, ‘who really is managing my healthcare now?’ and how to talk to loved ones who think I am ‘all done’. Peers rise to the occasion, offering strategies that have worked for them, and even normalization of the not-knowing and how to manage that uncertainty. We discuss feeling untethered and isolated when treatment ends, fearful that no one has ‘eyes on the situation’ anymore, or at least for three, six, or 12 months.

We work to identify an array of coping skills to include mindfulness meditation, journaling, physical activity, and prioritizing rest. We talk about decision fatigue and discerning where to spend energy, where to say ‘yes’ when late effects and lingering fatigue create barriers. Because we recognize inherent struggles abound, we also identify why even stepping into a group like this may bring its own challenges; why willingly entering or reentering cancer world may not feel useful. And we honor the naming of both individual and collective encounters concerning body image and betrayal, survivor guilt, and how to hold gratitude AND anger, anxiety, and fear. 

For many, there appears to be a great divide between ‘getting back to who I was’ and charting a new path forward, learning to step toward the pieces of self that define us, while giving permission to set down the ones that no longer serve. Recently, a client and current group member described this process as “folding these feelings into who I am now rather than trying to get back.”  

Finally, we spend time walking toward the shores of grieving what has been lost. Much like the COVID-19 pandemic when the loss of prom, graduation, and family holidays was minimized in the face of lives lost, many in this post-treatment space identify feelings of invalidation for naming the struggle when at least they are alive. Creating a space for compassionate understanding rather than justification allows for normalization that, while being cancer-free, or NED (no evidence of disease), is a good outcome, the roads both to and from this village are fraught with pain, uncertainty, emotional and physical discomfort, and change. Our hope is that we can provide our clients with an opportunity for growth when feeling limited, camaraderie in the face of isolation, and a sense of normalcy when nothing about this journey was a part of their plan.