Grief and Loss

Grief is a strong feeling of sadness in response to a loss. Grief and loss are difficult but natural parts of life, and they are often a part of cancer survivorship in some way. Understanding feelings of grief and loss, and finding the support you need, can help you manage the changes you are experiencing and feel more confident about your survivorship.

Detailed Information

Suggestions

Additional Resources

Print this Topic

Email this Topic

Grief and Loss: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources

Loss is when something or someone that is highly valued disappears from your life. Loss is an unavoidable part of life—it happens to all of us. Grief, or bereavement, is the natural human response to loss. It is the intense emotional pain that is felt at the time of loss and for sometime after. At its worst, grief can make it hard to cope or to even take care of day-to-day responsibilities for a time.

Generally, the experience of grief lessens with the passage of time.

This document will explore grief and loss from the cancer survivor’s point-of-view. Loved ones and friends may also experience forms of loss that are similar to those experienced by the person who has cancer. For this reason, much of the information offered here may also be helpful to loved ones and friends.

Do all survivors experience grief and loss?

Not everyone experiences grief in the same way. Even people in the same family – or those who have similar diagnoses and treatments – may respond differently to what has happened. Grief is unique to each situation and each individual. It may differ in how long it lasts, how intense it is, and what it means. How, when, and what people grieve depends on many things such as age or stage in life, previous experience with loss and grief, and the amount of social support that is present.

Most people think about grief and loss in terms of the death of someone who has been close to them. However, people also grieve other kinds of losses such as the loss of physical ability, the end of a friendship, the loss of a valuable possession, and the inability to achieve an important goal.

Some losses are clearly more difficult to bear than others. When a loss is especially important, grief is much more than a brief and simple sadness. It is a process that happens over a long period of time, and it can include a wide range of thoughts and feelings. Even though these feelings and reactions may be painful, it is important to remember that grief is a normal, healthy response to loss. Expressing grief helps with the adjustment to the loss.

Losses can also bring important gains. For some survivors, the gain may be so significant that what has been lost may come to be seen as not so important as it once seemed.  For example, some survivors say that they are grateful for the cancer experience because it taught them new priorities around what is really important in life. However, for others, a loss may be so intense that any gains seem unimportant.

What losses are common for survivors?

Cancer survivors may experience losses in a variety of ways, and some may be easy to see and name. However, other losses can be harder to recognize. A loss may be temporary or permanent, life-altering, or a minor inconvenience. For example, hair loss from treatment can be very important to some, but less important to others. Any type of loss may be an emotional experience. 

The following are types of losses that might be experienced by some survivors:

Physical losses:

• A body function
• Changes in the ability to have sex
• Lessened strength or energy
• An ability or skill to perform certain activities
• Physical comfort
• Fertility
• Bodily changes such as a scar or amputation

Emotional losses:

• Sense of security and predictability such as in health and in the future
• Sense of control or independence
• Self-esteem or sense of identity
• Self-confidence
• Body image
• Goals, hopes or dreams
• Faith or spirituality
• Habits, such as changes in daily routines, or life “the way it used to be”

Social and relationship losses:

• Relationships with friends, family members or co-workers
• Sexual relationships
• Ability to have own biological child
• Loss of certain roles such as providing for the family
• Loss of other cancer survivors

Financial losses:

• Career or job opportunities
• Financial security
• Insurance
• Ability to work

What symptoms come with grief?

The grieving process generally follows a recognizable pattern. It often begins with a brief period of shock that comes after learning about the loss. There may then be a period of denial during which there is a problem believing that there has been or will be a loss. In many cases, the emotions of anger follow the period of denial as one comes to recognize that a loss has occurred. Acceptance happens as one begins to understand and release the feelings of grief and truly accept what has happened. Often the period of coming to acceptance is a challenging one. This is because the denial no longer acts as a temporary shield from the pain of loss. However, this experience is necessary before one is able to move beyond the strong emotions of loss and grief.

Each survivor’s experience with grief and loss is different. A survivor may have all, many, or only a few of the following types of feelings and reactions, and they may be experienced in any order. These types of feelings can be low-key, intense, frequent, or infrequent. Common signs of grief include:

Strong feelings:

• °Sadness, despair
• Emotional numbness
• Anger, general irritation
• Guilt
• Fear
• Anxiety

Bodily reactions:

• Crying
• Lack of energy
• Changes in eating or sleeping patterns
• Feeling generally “under the weather”

Changes in behaviors:

• Withdrawal
• Lessened productivity
• Hyperactivity
• Increased need for reassurance
• Changes in sexual patterns (more or less)
• Attention getting
• Aggressive behavior such as being demanding or physically aggressive

Changes in thinking:

• Avoiding or denying the loss
• Lowered self-esteem
• Not being able to pay attention or concentrate
• Thinking about the loss almost all of the time
• Idealizing the past or future

Knowing that these kinds of grief responses are common can help you understand your situation better. With time, grief responses usually become less intense, last a shorter period of time, and happen less frequently. However, you should talk to your health care team about any physical and long-term emotional symptoms that do not go away.  

The grieving process can bring problems if you begin feeling confused or overwhelmed. If this happens, ask your doctor to refer you to a licensed counselor who has experience helping survivors with the grieving process. The following questions may help you sort out whether or not you could benefit from extra support:

• Can you connect your feelings and reactions to specific losses?
• Do you respond to comfort and support from others?
• Can you directly express difficult feelings such as anger or sadness?
• Can you still find and experience enjoyment in life?
• Are you able to seek and get relief from your physical complaints?
• Are your feelings and reactions becoming less intense and less frequent over time?

If you answered “yes” to these questions, it is likely that you are experiencing normal, healthy grief that will resolve over time. If you answered “no” to some or most of these questions, or if you are uncertain about how you are coping, ask your health care team for help.

When might a survivor experience loss and grief?

Cancer survivors can experience loss and grief during treatment, during recovery from treatment, and months or even years following completion of treatment for reasons such as the following: 

• It can initially be a shocking experience to be diagnosed with cancer.
• During the experience of diagnosis and treatment, time and energy may be directed toward coping with the immediate crisis. This is the time when survivors much choose the health care team, learn about and decide among treatment options, and get through the treatments. This is a time when it is common to put off recognizing and dealing with losses. 
• When treatment has ended, there may be time and energy to focus on emotional responses to the experience of cancer. This is a time when unexpected reactions of grief to losses can surface.

Reminders of the experience with cancer can bring up grief even years after treatment has ended. The following are examples of things that can trigger such emotions:

• Sensory reminders such as certain tastes or odors
• Medical appointments, even those that are routine
• Hearing about someone who has been diagnosed with cancer or who has died from cancer
• Anniversary events such as date of diagnosis or date of going off treatment
• Important events with family or friends such as weddings, graduations, birthdays, and holidays
• Experiencing ongoing losses because of the aftereffects of treatment

Grief is not a single event--it occurs over time. Like waves in the ocean, grief comes and goes as you understand and appreciate various aspects of loss. The amount of time you grieve can vary. Even though survivors might experience grief and loss over time, people who fully experience grief can be happy again and may even feel stronger and more capable than before. However, if grief lasts for a long time, and you feel that you are unable to resolve your grief, talk with your health care team.

Can grief cause a recurrence of cancer?

Grief does not cause cancer, and it cannot make your cancer return. Grieving is often painful, but it is a normal process that occurs as you cope with the losses and changes that come into your life. However, it is important to pay attention to your emotions and how they impact your body. Grief that lasts a long time and is not resolved can lead to negative feelings and stress in your body. Talk to your health care team if you are having a difficult time. They can provide referrals to professional counselors who can help you understand and deal with what you are feeling.

Why is it important to talk with others about the feelings of loss and grief?

Important losses that are not grieved are difficult to resolve. They can rob you of energy and joy and prevent you from moving forward into a full and productive life. Talking with others can help you:

• Recognize your losses
• Express your feelings
• Connect your feelings and reactions to the experience of loss
• Understand your feelings and reactions as normal
• Find ways to cope
• Adjust to your life without what you lost
• Feel stronger and more capable than before

Even though talking with others about your experiences of grief and loss is important, it may be difficult. People around you may not recognize your losses or your grief. They might believe that you should be feeling gratitude, not grief. It can be hard to acknowledge loss and grief when others see you as a winner and someone who should be grateful to be alive, regardless of what has happened.

Grief can also be hard to acknowledge when others listen to or deal with the intense feelings that grief can sometimes bring. If your friends or family members act like they do not want to talk about emotions, it may be that they may not know how to deal with their own emotions. They may really want to help you, but do not know how to be there for you. 

Some people may not be aware of the importance for you to talk about your feelings. You can explain to them that you need someone to listen to you and support you. It might help them to know that you do not expect them to make everything better--you just need them to listen to you. It may not be easy, but it is important to let others know what you need. 

The pain of grief subsides when it is shared. You may be able to find good listeners and support among loved ones, friends, your health care team, licensed counselors, support groups, clergy or members of your faith-based organization.

This doument was produced in collaboration with:

Bebe Guill, M.Div.

Former Director, Quality of Life Programs & Services

The Brain Tumor Center at Duke University Medical Center

Works Cited

Heegaard, Margaret. When Someone Very Special Dies. Minnesota: Woodland Press, 1988.

Keene, Nancy, Wendy Hobbie, and Kathy Ruccione. Childhood Cancer Survivors: A Practical Guide to Your Future. Cambridge: O’Reilly & Associates, 2000.

O’Toole, Donna. Growing Through Grief. Burnsville, NC: Mountain Rainbow Publications, 1989.The American Heritage Dictionary of the English Language. Boston: Houghton Mifflin Company, 1992.

[return to top]

Grief and Loss: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

Give yourself permission to release any feelings of grief you may have.

You have the right to express in safe ways your feelings about the loss of anything important to you without being judged for your appearance or your words. If you are holding your feelings of grief inside, learn to recognize any barriers that may be blocking your grief.

Some barriers to grief may come from within you. These might include:

• Fear that others will judge you as weak
• Fear that you, or others around you, will be overwhelmed by your feelings (“If I start crying, I’m afraid I’ll never stop.”)
• Thinking that some of the feelings and reactions of grief – such as anger or crying – are not appropriate to express
• Thinking that your loss seems trivial

Other barriers to grief may come from others’ comments or actions. Some people may try to comfort you or avoid your feelings of grief by saying:

• “Don’t cry. Everything is going to be just fine.”
• “Look on the bright side. At least you have _________.”
• “You have been a tower of strength. I don’t know how you’ve done it!”

If your grief is blocked, you can remind yourself that:

• Grief is a normal healthy process.
• Holding feelings inside makes them grow stronger and last longer.
• Releasing feelings reduces the fear and pain of grief.
• Feelings are just feelings – they are neither right nor wrong.
• Grief is a sign of the strength you have for living your life fully and well.

Explore a variety of ways to release your feelings.

There are many safe things you can do to release your feelings. You can:

• Tell your story of grief and loss several times to someone you trust, someone who listens to you without judgment. Each time you tell your story of loss, you release the feelings of grief associated with it.
• Express your feelings through a creative outlet you enjoy, such as music or art. Try banging on a piano, drumming or scribbling with crayons.
• Have a good cry or, alternatively, a good, deep belly laugh. Watching a sad or funny movie that you enjoy can help trigger your tears or laughter.
• Find a safe place to yell or scream.
• Find a physical outlet, such as hitting pillows, going to a baseball batting cage or a golf driving range.
• Write down your thoughts and feelings in a journal.

Seek support. 

You do not need to reject people who are trying to comfort you. You can turn to other ways of safely sorting out and releasing your feelings. Comfort and acceptance from others throughout the grief process is important.

Find a support group.

If you are uncomfortable talking about loss and grief with your family or friends, a support group may be an option.

Support groups provide safe environments to share experiences with other survivors, learn new ways to handle difficult situations and talk about emotions. You will see different styles of coping with stress and adjusting to life as a cancer survivor. If you are uncomfortable talking about certain subjects with your family or friends, a support group offers you a place to talk freely about what is important to you.

Cancer support groups exist in most communities. Some ways to find out more about support groups in your area:

• Ask your health care team for suggestions. Some cancer programs offer support groups for cancer survivors and their family members right in the clinic or hospital.
• Call a nearby cancer center or university hospital and ask about support groups.
• Visit LIVESTRONG^TM SurvivorCare at www.livestrong.org/survivorcare , or call 1-866-235-7205 for information on support groups.

Find a counselor/therapist:

If your grief is overwhelming, or if you prefer the privacy of an individual counseling setting, consider talking to a counselor or therapist. Ask a member of your health care team for a referral to a therapist who works with other cancer survivors. Most cancer centers employ oncology social workers who are specially trained to work with cancer survivors and their families. Even if you are not a patient at a cancer center, the oncology social worker may meet with you or refer you to someone else in the community.

It is important to interview the therapist to find out if s/he is the right professional for you. Speak honestly with the therapist and let him or her know your reasons for wanting to work with a therapist.

Examples of questions to ask the therapist:

• What type of education background do you have?
• What type of license do you have?
• What is your experience working with people with cancer?
• What do you understand about the emotional response to this illness?
• Do you take my insurance?
• Do you work with people who are anxious? Depressed?
• Do you know community resources for people with cancer?

Practice good self-care.

Grieving an important loss can be hard work. It can create stress and anxiety that might leave you at risk for accidents, illnesses or misuse of substances such as alcohol or drugs.

Concentrate on helping your body tolerate the feelings of grief by:

• Including rest in the rhythm of your day to help replace the energy that grieving uses
• Trying to eat healthy foods daily
• Exercising in ways you enjoy

Your health care team can help you find foods and exercises that are right for you. You may also want to create a list of things you can do to nurture yourself if you are overwhelmed by your feelings. Your list might include things such as:

• Calling a friend
• Taking a hot bath
• Listening to music
• Going for a walk

You can refer to your list if you are having intense feelings or whenever you think you need a break from thoughts of your loss. As time goes on, you may add or subtract items from your list.

Be patient with yourself.

Grieving an important loss is not a single event; it is a process that happens over time. Allow the process to unfold at a pace that is right for you. You don’t need to follow a particular timetable or reach a particular goal. There is no right or wrong way to grieve. There is only what is right and safe for you.

You may never truly get over your loss. However, with patience, acceptance of your feelings and hope, you may find that you have learned to live with it.

[return to top]

Grief and Loss: Additional Resources

The resources listed below provide more detailed information and support services to help you with grief and loss.  Please read the Detailed Information and Suggestions document for more information and questions to ask.

LIVESTRONG SurvivorCare Program

www.livestrong.org/survivorcare

Email:Send email through the LIVESTRONG website.

Phone: 1-866-673-7205

1-866-927-7205 (Spanish)
Intake Coordinator is available for calls Monday through Friday, 9:00 a.m. to 5:00 p.m. (Central Time). Voicemail is available after hours.

LIVESTRONG SurvivorCare offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about treatment options and matching to clinical trials or treatments in development. Counseling services and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations including CancerCare, Patient Advocate Foundation and EmergingMed.

American Cancer Society (ACS)

www.cancer.org

Email: Submit questions in English or Spanish from the “Contact Us” page.

Phone: 1-800-227-2345

TTY for deaf or hard of hearing callers: 1-866-228-4327

The American Cancer Society (ACS) offers information about many of the challenges of cancer and survivorship. You can search for information by cancer type or by topic. ACS provides a list of support groups in your area. You can join online groups and message boards. Some information on the website is available in Spanish, Chinese, Korean and Vietnamese. ACS specialists can answer questions 24 hours a day by phone or email.

American Psychosocial Oncology Society (APOS)

www.apos-society.org

Phone: 1-866-276-7443

Voicemail is available after hours. Messages will be returned within 24 to 48 hours.

APOS works to ensure that all people with cancer have access to psychosocial services as a part of quality cancer care. They provide mental health care referrals to local counseling and support services throughout the United States. If no services are available in your community, a professionally trained Helpline staff member will provide crisis counseling over the phone. To use this service, call the toll-free number.

Cancer Hope Network
www.cancerhopenetwork.org

Email: info@cancerhopenetwork.org

Phone: 1-877-HOPE NET (1-877-467-3638)

This number is answered Monday-Friday, from 8:00 a.m. to 5:30 p.m. (EST). Voicemail is available after hours.  

Cancer Hope Network is a not-for-profit organization that provides free and confidential one-on-one support to cancer patients and their families.  They offer support by matching cancer patients or family members with trained volunteers who have already undergone and recovered from a similar cancer experience. You can submit your request by phone or by email. A volunteer will try to contact you within 24 hours.

National Register of Health Service Providers in Psychology
www.findapsychologist.org

Email: search@findapsychologist.org

Phone: 1-202-783-7663 

The National Register of Health Service Providers in Psychology sponsors this free psychologist referral website to promote consumer access to more than 12,000 professionally screened psychologists in the United States and Canada. This site also contains frequently asked questions about getting help, web links and resources on behavioral health care issues for consumers.

U.S. Institutes of Health - National Cancer Institute (NCI)

www.cancer.gov

Online:  Online assistance is available in English or Spanish through the LiveHelp instant messaging system. This service is available Monday-Friday, 9:00 a.m. to 11:00 p.m. (EST)

Email: Send an email through the “Need Help?” section of the website

Phone: 1-800-422-6237

TTY for deaf and hard of hearing callers: 1-800-332-8615

 Information specialists answer calls Monday-Friday, 9:00 a.m. to 4:30 p.m. local time.

The National Cancer Institute’s website provides accurate information about the challenges cancer can bring. You can search for information by cancer type or topic. You can find information about treatment, financial and insurance matters. You can also learn how treatments in development work and search for a clinical trial in your area. This site also has a good dictionary of cancer terms, drug information and other publications. The knowledgeable and caring specialists have access to comprehensive, accurate information on a range of cancer topics, including the most recent advances in cancer treatment. The service is confidential, and information specialists spend as much time as needed for thorough and personalized responses.

[return to top]

Grief and Loss

Grief is a strong feeling of sadness in response to a loss. Grief and loss are difficult but natural parts of life, and they are often a part of cancer survivorship in some way. Understanding feelings of grief and loss, and finding the support you need, can help you manage the changes you are experiencing and feel more confident about your survivorship.

Detailed Information

Suggestions

Additional Resources

Print this Topic

Email this Topic

Grief and Loss: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources

Loss is when something or someone that is highly valued disappears from your life. Loss is an unavoidable part of life—it happens to all of us. Grief, or bereavement, is the natural human response to loss. It is the intense emotional pain that is felt at the time of loss and for sometime after. At its worst, grief can make it hard to cope or to even take care of day-to-day responsibilities for a time.

Generally, the experience of grief lessens with the passage of time.

This document will explore grief and loss from the cancer survivor’s point-of-view. Loved ones and friends may also experience forms of loss that are similar to those experienced by the person who has cancer. For this reason, much of the information offered here may also be helpful to loved ones and friends.

Do all survivors experience grief and loss?

Not everyone experiences grief in the same way. Even people in the same family – or those who have similar diagnoses and treatments – may respond differently to what has happened. Grief is unique to each situation and each individual. It may differ in how long it lasts, how intense it is, and what it means. How, when, and what people grieve depends on many things such as age or stage in life, previous experience with loss and grief, and the amount of social support that is present.

Most people think about grief and loss in terms of the death of someone who has been close to them. However, people also grieve other kinds of losses such as the loss of physical ability, the end of a friendship, the loss of a valuable possession, and the inability to achieve an important goal.

Some losses are clearly more difficult to bear than others. When a loss is especially important, grief is much more than a brief and simple sadness. It is a process that happens over a long period of time, and it can include a wide range of thoughts and feelings. Even though these feelings and reactions may be painful, it is important to remember that grief is a normal, healthy response to loss. Expressing grief helps with the adjustment to the loss.

Losses can also bring important gains. For some survivors, the gain may be so significant that what has been lost may come to be seen as not so important as it once seemed.  For example, some survivors say that they are grateful for the cancer experience because it taught them new priorities around what is really important in life. However, for others, a loss may be so intense that any gains seem unimportant.

What losses are common for survivors?

Cancer survivors may experience losses in a variety of ways, and some may be easy to see and name. However, other losses can be harder to recognize. A loss may be temporary or permanent, life-altering, or a minor inconvenience. For example, hair loss from treatment can be very important to some, but less important to others. Any type of loss may be an emotional experience. 

The following are types of losses that might be experienced by some survivors:

Physical losses:

• A body function
• Changes in the ability to have sex
• Lessened strength or energy
• An ability or skill to perform certain activities
• Physical comfort
• Fertility
• Bodily changes such as a scar or amputation

Emotional losses:

• Sense of security and predictability such as in health and in the future
• Sense of control or independence
• Self-esteem or sense of identity
• Self-confidence
• Body image
• Goals, hopes or dreams
• Faith or spirituality
• Habits, such as changes in daily routines, or life “the way it used to be”

Social and relationship losses:

• Relationships with friends, family members or co-workers
• Sexual relationships
• Ability to have own biological child
• Loss of certain roles such as providing for the family
• Loss of other cancer survivors

Financial losses:

• Career or job opportunities
• Financial security
• Insurance
• Ability to work

What symptoms come with grief?

The grieving process generally follows a recognizable pattern. It often begins with a brief period of shock that comes after learning about the loss. There may then be a period of denial during which there is a problem believing that there has been or will be a loss. In many cases, the emotions of anger follow the period of denial as one comes to recognize that a loss has occurred. Acceptance happens as one begins to understand and release the feelings of grief and truly accept what has happened. Often the period of coming to acceptance is a challenging one. This is because the denial no longer acts as a temporary shield from the pain of loss. However, this experience is necessary before one is able to move beyond the strong emotions of loss and grief.

Each survivor’s experience with grief and loss is different. A survivor may have all, many, or only a few of the following types of feelings and reactions, and they may be experienced in any order. These types of feelings can be low-key, intense, frequent, or infrequent. Common signs of grief include:

Strong feelings:

• °Sadness, despair
• Emotional numbness
• Anger, general irritation
• Guilt
• Fear
• Anxiety

Bodily reactions:

• Crying
• Lack of energy
• Changes in eating or sleeping patterns
• Feeling generally “under the weather”

Changes in behaviors:

• Withdrawal
• Lessened productivity
• Hyperactivity
• Increased need for reassurance
• Changes in sexual patterns (more or less)
• Attention getting
• Aggressive behavior such as being demanding or physically aggressive

Changes in thinking:

• Avoiding or denying the loss
• Lowered self-esteem
• Not being able to pay attention or concentrate
• Thinking about the loss almost all of the time
• Idealizing the past or future

Knowing that these kinds of grief responses are common can help you understand your situation better. With time, grief responses usually become less intense, last a shorter period of time, and happen less frequently. However, you should talk to your health care team about any physical and long-term emotional symptoms that do not go away.  

The grieving process can bring problems if you begin feeling confused or overwhelmed. If this happens, ask your doctor to refer you to a licensed counselor who has experience helping survivors with the grieving process. The following questions may help you sort out whether or not you could benefit from extra support:

• Can you connect your feelings and reactions to specific losses?
• Do you respond to comfort and support from others?
• Can you directly express difficult feelings such as anger or sadness?
• Can you still find and experience enjoyment in life?
• Are you able to seek and get relief from your physical complaints?
• Are your feelings and reactions becoming less intense and less frequent over time?

If you answered “yes” to these questions, it is likely that you are experiencing normal, healthy grief that will resolve over time. If you answered “no” to some or most of these questions, or if you are uncertain about how you are coping, ask your health care team for help.

When might a survivor experience loss and grief?

Cancer survivors can experience loss and grief during treatment, during recovery from treatment, and months or even years following completion of treatment for reasons such as the following: 

• It can initially be a shocking experience to be diagnosed with cancer.
• During the experience of diagnosis and treatment, time and energy may be directed toward coping with the immediate crisis. This is the time when survivors much choose the health care team, learn about and decide among treatment options, and get through the treatments. This is a time when it is common to put off recognizing and dealing with losses. 
• When treatment has ended, there may be time and energy to focus on emotional responses to the experience of cancer. This is a time when unexpected reactions of grief to losses can surface.

Reminders of the experience with cancer can bring up grief even years after treatment has ended. The following are examples of things that can trigger such emotions:

• Sensory reminders such as certain tastes or odors
• Medical appointments, even those that are routine
• Hearing about someone who has been diagnosed with cancer or who has died from cancer
• Anniversary events such as date of diagnosis or date of going off treatment
• Important events with family or friends such as weddings, graduations, birthdays, and holidays
• Experiencing ongoing losses because of the aftereffects of treatment

Grief is not a single event--it occurs over time. Like waves in the ocean, grief comes and goes as you understand and appreciate various aspects of loss. The amount of time you grieve can vary. Even though survivors might experience grief and loss over time, people who fully experience grief can be happy again and may even feel stronger and more capable than before. However, if grief lasts for a long time, and you feel that you are unable to resolve your grief, talk with your health care team.

Can grief cause a recurrence of cancer?

Grief does not cause cancer, and it cannot make your cancer return. Grieving is often painful, but it is a normal process that occurs as you cope with the losses and changes that come into your life. However, it is important to pay attention to your emotions and how they impact your body. Grief that lasts a long time and is not resolved can lead to negative feelings and stress in your body. Talk to your health care team if you are having a difficult time. They can provide referrals to professional counselors who can help you understand and deal with what you are feeling.

Why is it important to talk with others about the feelings of loss and grief?

Important losses that are not grieved are difficult to resolve. They can rob you of energy and joy and prevent you from moving forward into a full and productive life. Talking with others can help you:

• Recognize your losses
• Express your feelings
• Connect your feelings and reactions to the experience of loss
• Understand your feelings and reactions as normal
• Find ways to cope
• Adjust to your life without what you lost
• Feel stronger and more capable than before

Even though talking with others about your experiences of grief and loss is important, it may be difficult. People around you may not recognize your losses or your grief. They might believe that you should be feeling gratitude, not grief. It can be hard to acknowledge loss and grief when others see you as a winner and someone who should be grateful to be alive, regardless of what has happened.

Grief can also be hard to acknowledge when others listen to or deal with the intense feelings that grief can sometimes bring. If your friends or family members act like they do not want to talk about emotions, it may be that they may not know how to deal with their own emotions. They may really want to help you, but do not know how to be there for you. 

Some people may not be aware of the importance for you to talk about your feelings. You can explain to them that you need someone to listen to you and support you. It might help them to know that you do not expect them to make everything better--you just need them to listen to you. It may not be easy, but it is important to let others know what you need. 

The pain of grief subsides when it is shared. You may be able to find good listeners and support among loved ones, friends, your health care team, licensed counselors, support groups, clergy or members of your faith-based organization.

This document was produced in collaboration with:

Bebe Guill, M.Div.

Former Director, Quality of Life Programs & Services

The Brain Tumor Center at Duke University Medical Center

Works Cited

Heegaard, Margaret. When Someone Very Special Dies. Minnesota: Woodland Press, 1988.

Keene, Nancy, Wendy Hobbie, and Kathy Ruccione. Childhood Cancer Survivors: A Practical Guide to Your Future. Cambridge: O’Reilly & Associates, 2000.

O’Toole, Donna. Growing Through Grief. Burnsville, NC: Mountain Rainbow Publications, 1989.

The American Heritage Dictionary of the English Language. Boston: Houghton Mifflin Company, 1992.

[return to top]

Grief and Loss: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

Give yourself permission to release any feelings of grief you may have.

You have the right to express in safe ways your feelings about the loss of anything important to you without being judged for your appearance or your words. If you are holding your feelings of grief inside, learn to recognize any barriers that may be blocking your grief.

Some barriers to grief may come from within you. These might include:

• Fear that others will judge you as weak
• Fear that you, or others around you, will be overwhelmed by your feelings (“If I start crying, I’m afraid I’ll never stop.”)
• Thinking that some of the feelings and reactions of grief – such as anger or crying – are not appropriate to express
• Thinking that your loss seems trivial

Other barriers to grief may come from others’ comments or actions. Some people may try to comfort you or avoid your feelings of grief by saying:

• “Don’t cry. Everything is going to be just fine.”
• “Look on the bright side. At least you have _________.”
• “You have been a tower of strength. I don’t know how you’ve done it!”

If your grief is blocked, you can remind yourself that:

• Grief is a normal healthy process.
• Holding feelings inside makes them grow stronger and last longer.
• Releasing feelings reduces the fear and pain of grief.
• Feelings are just feelings – they are neither right nor wrong.
• Grief is a sign of the strength you have for living your life fully and well.

Explore a variety of ways to release your feelings.

There are many safe things you can do to release your feelings. You can:

• Tell your story of grief and loss several times to someone you trust, someone who listens to you without judgment. Each time you tell your story of loss, you release the feelings of grief associated with it.
• Express your feelings through a creative outlet you enjoy, such as music or art. Try banging on a piano, drumming or scribbling with crayons.
• Have a good cry or, alternatively, a good, deep belly laugh. Watching a sad or funny movie that you enjoy can help trigger your tears or laughter.
• Find a safe place to yell or scream.
• Find a physical outlet, such as hitting pillows, going to a baseball batting cage or a golf driving range.
• Write down your thoughts and feelings in a journal.

Seek support. 

You do not need to reject people who are trying to comfort you. You can turn to other ways of safely sorting out and releasing your feelings. Comfort and acceptance from others throughout the grief process is important.

Find a support group.

If you are uncomfortable talking about loss and grief with your family or friends, a support group may be an option.

Support groups provide safe environments to share experiences with other survivors, learn new ways to handle difficult situations and talk about emotions. You will see different styles of coping with stress and adjusting to life as a cancer survivor. If you are uncomfortable talking about certain subjects with your family or friends, a support group offers you a place to talk freely about what is important to you.

Cancer support groups exist in most communities. Some ways to find out more about support groups in your area:

• Ask your health care team for suggestions. Some cancer programs offer support groups for cancer survivors and their family members right in the clinic or hospital.
• Call a nearby cancer center or university hospital and ask about support groups.
• Visit LIVESTRONG^TM SurvivorCare at www.livestrong.org/survivorcare , or call 1-866-235-7205 for information on support groups.

Find a counselor/therapist:

If your grief is overwhelming, or if you prefer the privacy of an individual counseling setting, consider talking to a counselor or therapist. Ask a member of your health care team for a referral to a therapist who works with other cancer survivors. Most cancer centers employ oncology social workers who are specially trained to work with cancer survivors and their families. Even if you are not a patient at a cancer center, the oncology social worker may meet with you or refer you to someone else in the community.

It is important to interview the therapist to find out if s/he is the right professional for you. Speak honestly with the therapist and let him or her know your reasons for wanting to work with a therapist.

Examples of questions to ask the therapist:

• What type of education background do you have?
• What type of license do you have?
• What is your experience working with people with cancer?
• What do you understand about the emotional response to this illness?
• Do you take my insurance?
• Do you work with people who are anxious? Depressed?
• Do you know community resources for people with cancer?

Practice good self-care.

Grieving an important loss can be hard work. It can create stress and anxiety that might leave you at risk for accidents, illnesses or misuse of substances such as alcohol or drugs.

Concentrate on helping your body tolerate the feelings of grief by:

• Including rest in the rhythm of your day to help replace the energy that grieving uses
• Trying to eat healthy foods daily
• Exercising in ways you enjoy

Your health care team can help you find foods and exercises that are right for you. You may also want to create a list of things you can do to nurture yourself if you are overwhelmed by your feelings. Your list might include things such as:

• Calling a friend
• Taking a hot bath
• Listening to music
• Going for a walk

You can refer to your list if you are having intense feelings or whenever you think you need a break from thoughts of your loss. As time goes on, you may add or subtract items from your list.

Be patient with yourself.

Grieving an important loss is not a single event; it is a process that happens over time. Allow the process to unfold at a pace that is right for you. You don’t need to follow a particular timetable or reach a particular goal. There is no right or wrong way to grieve. There is only what is right and safe for you.

You may never truly get over your loss. However, with patience, acceptance of your feelings and hope, you may find that you have learned to live with it.

[return to top]

Grief and Loss: Additional Resources

The resources listed below provide more detailed information and support services to help you with grief and loss.  Please read the Detailed Information and Suggestions document for more information and questions to ask.

LIVESTRONG SurvivorCare Program

www.livestrong.org/survivorcare

Email:Send email through the LIVESTRONG website.

Phone: 1-866-673-7205

1-866-927-7205 (Spanish)
Intake Coordinator is available for calls Monday through Friday, 9:00 a.m. to 5:00 p.m. (Central Time). Voicemail is available after hours.

LIVESTRONG SurvivorCare offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about treatment options and matching to clinical trials or treatments in development. Counseling services and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations including CancerCare, Patient Advocate Foundation and EmergingMed.

American Cancer Society (ACS)

www.cancer.org

Email: Submit questions in English or Spanish from the “Contact Us” page.

Phone: 1-800-227-2345

TTY for deaf or hard of hearing callers: 1-866-228-4327

The American Cancer Society (ACS) offers information about many of the challenges of cancer and survivorship. You can search for information by cancer type or by topic. ACS provides a list of support groups in your area. You can join online groups and message boards. Some information on the website is available in Spanish, Chinese, Korean and Vietnamese. ACS specialists can answer questions 24 hours a day by phone or email.

American Psychosocial Oncology Society (APOS)

www.apos-society.org

Phone: 1-866-276-7443

Voicemail is available after hours. Messages will be returned within 24 to 48 hours.

APOS works to ensure that all people with cancer have access to psychosocial services as a part of quality cancer care. They provide mental health care referrals to local counseling and support services throughout the United States. If no services are available in your community, a professionally trained Helpline staff member will provide crisis counseling over the phone. To use this service, call the toll-free number.

Cancer Hope Network
www.cancerhopenetwork.org

Email: info@cancerhopenetwork.org

Phone: 1-877-HOPE NET (1-877-467-3638)

This number is answered Monday-Friday, from 8:00 a.m. to 5:30 p.m. (EST). Voicemail is available after hours.  

Cancer Hope Network is a not-for-profit organization that provides free and confidential one-on-one support to cancer patients and their families.  They offer support by matching cancer patients or family members with trained volunteers who have already undergone and recovered from a similar cancer experience. You can submit your request by phone or by email. A volunteer will try to contact you within 24 hours.

National Register of Health Service Providers in Psychology
www.findapsychologist.org

Email: search@findapsychologist.org

Phone: 1-202-783-7663 

The National Register of Health Service Providers in Psychology sponsors this free psychologist referral website to promote consumer access to more than 12,000 professionally screened psychologists in the United States and Canada. This site also contains frequently asked questions about getting help, web links and resources on behavioral health care issues for consumers.

U.S. Institutes of Health - National Cancer Institute (NCI)

www.cancer.gov

Online:  Online assistance is available in English or Spanish through the LiveHelp instant messaging system. This service is available Monday-Friday, 9:00 a.m. to 11:00 p.m. (EST)

Email: Send an email through the “Need Help?” section of the website

Phone: 1-800-422-6237

TTY for deaf and hard of hearing callers: 1-800-332-8615

 Information specialists answer calls Monday-Friday, 9:00 a.m. to 4:30 p.m. local time.

The National Cancer Institute’s website provides accurate information about the challenges cancer can bring. You can search for information by cancer type or topic. You can find information about treatment, financial and insurance matters. You can also learn how treatments in development work and search for a clinical trial in your area. This site also has a good dictionary of cancer terms, drug information and other publications. The knowledgeable and caring specialists have access to comprehensive, accurate information on a range of cancer topics, including the most recent advances in cancer treatment. The service is confidential, and information specialists spend as much time as needed for thorough and personalized responses.

[return to top]

Grief and Loss

Grief is a strong feeling of sadness in response to a loss. Grief and loss are difficult but natural parts of life, and they are often a part of cancer survivorship in some way. Understanding feelings of grief and loss, and finding the support you need, can help you manage the changes you are experiencing and feel more confident about your survivorship.

Detailed Information

Suggestions

Additional Resources

Print this Topic

Email this Topic

Grief and Loss: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources

Loss is when something or someone that is highly valued disappears from your life. Loss is an unavoidable part of life—it happens to all of us. Grief, or bereavement, is the natural human response to loss. It is the intense emotional pain that is felt at the time of loss and for sometime after. At its worst, grief can make it hard to cope or to even take care of day-to-day responsibilities for a time.

Generally, the experience of grief lessens with the passage of time.

This document will explore grief and loss from the cancer survivor’s point-of-view. Loved ones and friends may also experience forms of loss that are similar to those experienced by the person who has cancer. For this reason, much of the information offered here may also be helpful to loved ones and friends.

Do all survivors experience grief and loss?

Not everyone experiences grief in the same way. Even people in the same family – or those who have similar diagnoses and treatments – may respond differently to what has happened. Grief is unique to each situation and each individual. It may differ in how long it lasts, how intense it is, and what it means. How, when, and what people grieve depends on many things such as age or stage in life, previous experience with loss and grief, and the amount of social support that is present.

Most people think about grief and loss in terms of the death of someone who has been close to them. However, people also grieve other kinds of losses such as the loss of physical ability, the end of a friendship, the loss of a valuable possession, and the inability to achieve an important goal.

Some losses are clearly more difficult to bear than others. When a loss is especially important, grief is much more than a brief and simple sadness. It is a process that happens over a long period of time, and it can include a wide range of thoughts and feelings. Even though these feelings and reactions may be painful, it is important to remember that grief is a normal, healthy response to loss. Expressing grief helps with the adjustment to the loss.

Losses can also bring important gains. For some survivors, the gain may be so significant that what has been lost may come to be seen as not so important as it once seemed.  For example, some survivors say that they are grateful for the cancer experience because it taught them new priorities around what is really important in life. However, for others, a loss may be so intense that any gains seem unimportant.

What losses are common for survivors?

Cancer survivors may experience losses in a variety of ways, and some may be easy to see and name. However, other losses can be harder to recognize. A loss may be temporary or permanent, life-altering, or a minor inconvenience. For example, hair loss from treatment can be very important to some, but less important to others. Any type of loss may be an emotional experience. 

The following are types of losses that might be experienced by some survivors:

Physical losses:

• A body function
• Changes in the ability to have sex
• Lessened strength or energy
• An ability or skill to perform certain activities
• Physical comfort
• Fertility
• Bodily changes such as a scar or amputation

Emotional losses:

• Sense of security and predictability such as in health and in the future
• Sense of control or independence
• Self-esteem or sense of identity
• Self-confidence
• Body image
• Goals, hopes or dreams
• Faith or spirituality
• Habits, such as changes in daily routines, or life “the way it used to be”

Social and relationship losses:

• Relationships with friends, family members or co-workers
• Sexual relationships
• Ability to have own biological child
• Loss of certain roles such as providing for the family
• Loss of other cancer survivors

Financial losses:

• Career or job opportunities
• Financial security
• Insurance
• Ability to work

What symptoms come with grief?

The grieving process generally follows a recognizable pattern. It often begins with a brief period of shock that comes after learning about the loss. There may then be a period of denial during which there is a problem believing that there has been or will be a loss. In many cases, the emotions of anger follow the period of denial as one comes to recognize that a loss has occurred. Acceptance happens as one begins to understand and release the feelings of grief and truly accept what has happened. Often the period of coming to acceptance is a challenging one. This is because the denial no longer acts as a temporary shield from the pain of loss. However, this experience is necessary before one is able to move beyond the strong emotions of loss and grief.

Each survivor’s experience with grief and loss is different. A survivor may have all, many, or only a few of the following types of feelings and reactions, and they may be experienced in any order. These types of feelings can be low-key, intense, frequent, or infrequent. Common signs of grief include:

Strong feelings:

• °Sadness, despair
• Emotional numbness
• Anger, general irritation
• Guilt
• Fear
• Anxiety

Bodily reactions:

• Crying
• Lack of energy
• Changes in eating or sleeping patterns
• Feeling generally “under the weather”

Changes in behaviors:

• Withdrawal
• Lessened productivity
• Hyperactivity
• Increased need for reassurance
• Changes in sexual patterns (more or less)
• Attention getting
• Aggressive behavior such as being demanding or physically aggressive

Changes in thinking:

• Avoiding or denying the loss
• Lowered self-esteem
• Not being able to pay attention or concentrate
• Thinking about the loss almost all of the time
• Idealizing the past or future

Knowing that these kinds of grief responses are common can help you understand your situation better. With time, grief responses usually become less intense, last a shorter period of time, and happen less frequently. However, you should talk to your health care team about any physical and long-term emotional symptoms that do not go away.  

The grieving process can bring problems if you begin feeling confused or overwhelmed. If this happens, ask your doctor to refer you to a licensed counselor who has experience helping survivors with the grieving process. The following questions may help you sort out whether or not you could benefit from extra support:

• Can you connect your feelings and reactions to specific losses?
• Do you respond to comfort and support from others?
• Can you directly express difficult feelings such as anger or sadness?
• Can you still find and experience enjoyment in life?
• Are you able to seek and get relief from your physical complaints?
• Are your feelings and reactions becoming less intense and less frequent over time?

If you answered “yes” to these questions, it is likely that you are experiencing normal, healthy grief that will resolve over time. If you answered “no” to some or most of these questions, or if you are uncertain about how you are coping, ask your health care team for help.

When might a survivor experience loss and grief?

Cancer survivors can experience loss and grief during treatment, during recovery from treatment, and months or even years following completion of treatment for reasons such as the following: 

• It can initially be a shocking experience to be diagnosed with cancer.
• During the experience of diagnosis and treatment, time and energy may be directed toward coping with the immediate crisis. This is the time when survivors much choose the health care team, learn about and decide among treatment options, and get through the treatments. This is a time when it is common to put off recognizing and dealing with losses. 
• When treatment has ended, there may be time and energy to focus on emotional responses to the experience of cancer. This is a time when unexpected reactions of grief to losses can surface.

Reminders of the experience with cancer can bring up grief even years after treatment has ended. The following are examples of things that can trigger such emotions:

• Sensory reminders such as certain tastes or odors
• Medical appointments, even those that are routine
• Hearing about someone who has been diagnosed with cancer or who has died from cancer
• Anniversary events such as date of diagnosis or date of going off treatment
• Important events with family or friends such as weddings, graduations, birthdays, and holidays
• Experiencing ongoing losses because of the aftereffects of treatment

Grief is not a single event--it occurs over time. Like waves in the ocean, grief comes and goes as you understand and appreciate various aspects of loss. The amount of time you grieve can vary. Even though survivors might experience grief and loss over time, people who fully experience grief can be happy again and may even feel stronger and more capable than before. However, if grief lasts for a long time, and you feel that you are unable to resolve your grief, talk with your health care team.

Can grief cause a recurrence of cancer?

Grief does not cause cancer, and it cannot make your cancer return. Grieving is often painful, but it is a normal process that occurs as you cope with the losses and changes that come into your life. However, it is important to pay attention to your emotions and how they impact your body. Grief that lasts a long time and is not resolved can lead to negative feelings and stress in your body. Talk to your health care team if you are having a difficult time. They can provide referrals to professional counselors who can help you understand and deal with what you are feeling.

Why is it important to talk with others about the feelings of loss and grief?

Important losses that are not grieved are difficult to resolve. They can rob you of energy and joy and prevent you from moving forward into a full and productive life. Talking with others can help you:

• Recognize your losses
• Express your feelings
• Connect your feelings and reactions to the experience of loss
• Understand your feelings and reactions as normal
• Find ways to cope
• Adjust to your life without what you lost
• Feel stronger and more capable than before

Even though talking with others about your experiences of grief and loss is important, it may be difficult. People around you may not recognize your losses or your grief. They might believe that you should be feeling gratitude, not grief. It can be hard to acknowledge loss and grief when others see you as a winner and someone who should be grateful to be alive, regardless of what has happened.

Grief can also be hard to acknowledge when others listen to or deal with the intense feelings that grief can sometimes bring. If your friends or family members act like they do not want to talk about emotions, it may be that they may not know how to deal with their own emotions. They may really want to help you, but do not know how to be there for you. 

Some people may not be aware of the importance for you to talk about your feelings. You can explain to them that you need someone to listen to you and support you. It might help them to know that you do not expect them to make everything better--you just need them to listen to you. It may not be easy, but it is important to let others know what you need. 

The pain of grief subsides when it is shared. You may be able to find good listeners and support among loved ones, friends, your health care team, licensed counselors, support groups, clergy or members of your faith-based organization.

This document was produced in collaboration with:

Bebe Guill, M.Div.

Former Director, Quality of Life Programs & Services

The Brain Tumor Center at Duke University Medical Center

Works Cited

Heegaard, Margaret. When Someone Very Special Dies. Minnesota: Woodland Press, 1988.

Keene, Nancy, Wendy Hobbie, and Kathy Ruccione. Childhood Cancer Survivors: A Practical Guide to Your Future. Cambridge: O’Reilly & Associates, 2000.

O’Toole, Donna. Growing Through Grief. Burnsville, NC: Mountain Rainbow Publications, 1989.

The American Heritage Dictionary of the English Language. Boston: Houghton Mifflin Company, 1992.

[return to top]

Grief and Loss: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

Give yourself permission to release any feelings of grief you may have.

You have the right to express in safe ways your feelings about the loss of anything important to you without being judged for your appearance or your words. If you are holding your feelings of grief inside, learn to recognize any barriers that may be blocking your grief.

Some barriers to grief may come from within you. These might include:

• Fear that others will judge you as weak
• Fear that you, or others around you, will be overwhelmed by your feelings (“If I start crying, I’m afraid I’ll never stop.”)
• Thinking that some of the feelings and reactions of grief – such as anger or crying – are not appropriate to express
• Thinking that your loss seems trivial

Other barriers to grief may come from others’ comments or actions. Some people may try to comfort you or avoid your feelings of grief by saying:

• “Don’t cry. Everything is going to be just fine.”
• “Look on the bright side. At least you have _________.”
• “You have been a tower of strength. I don’t know how you’ve done it!”

If your grief is blocked, you can remind yourself that:

• Grief is a normal healthy process.
• Holding feelings inside makes them grow stronger and last longer.
• Releasing feelings reduces the fear and pain of grief.
• Feelings are just feelings – they are neither right nor wrong.
• Grief is a sign of the strength you have for living your life fully and well.

Explore a variety of ways to release your feelings.

There are many safe things you can do to release your feelings. You can:

• Tell your story of grief and loss several times to someone you trust, someone who listens to you without judgment. Each time you tell your story of loss, you release the feelings of grief associated with it.
• Express your feelings through a creative outlet you enjoy, such as music or art. Try banging on a piano, drumming or scribbling with crayons.
• Have a good cry or, alternatively, a good, deep belly laugh. Watching a sad or funny movie that you enjoy can help trigger your tears or laughter.
• Find a safe place to yell or scream.
• Find a physical outlet, such as hitting pillows, going to a baseball batting cage or a golf driving range.
• Write down your thoughts and feelings in a journal.

Seek support. 

You do not need to reject people who are trying to comfort you. You can turn to other ways of safely sorting out and releasing your feelings. Comfort and acceptance from others throughout the grief process is important.

Find a support group.

If you are uncomfortable talking about loss and grief with your family or friends, a support group may be an option.

Support groups provide safe environments to share experiences with other survivors, learn new ways to handle difficult situations and talk about emotions. You will see different styles of coping with stress and adjusting to life as a cancer survivor. If you are uncomfortable talking about certain subjects with your family or friends, a support group offers you a place to talk freely about what is important to you.

Cancer support groups exist in most communities. Some ways to find out more about support groups in your area:

• Ask your health care team for suggestions. Some cancer programs offer support groups for cancer survivors and their family members right in the clinic or hospital.
• Call a nearby cancer center or university hospital and ask about support groups.
• Visit LIVESTRONG^TM SurvivorCare at www.livestrong.org/survivorcare , or call 1-866-235-7205 for information on support groups.

Find a counselor/therapist:

If your grief is overwhelming, or if you prefer the privacy of an individual counseling setting, consider talking to a counselor or therapist. Ask a member of your health care team for a referral to a therapist who works with other cancer survivors. Most cancer centers employ oncology social workers who are specially trained to work with cancer survivors and their families. Even if you are not a patient at a cancer center, the oncology social worker may meet with you or refer you to someone else in the community.

It is important to interview the therapist to find out if s/he is the right professional for you. Speak honestly with the therapist and let him or her know your reasons for wanting to work with a therapist.

Examples of questions to ask the therapist:

• What type of education background do you have?
• What type of license do you have?
• What is your experience working with people with cancer?
• What do you understand about the emotional response to this illness?
• Do you take my insurance?
• Do you work with people who are anxious? Depressed?
• Do you know community resources for people with cancer?

Practice good self-care.

Grieving an important loss can be hard work. It can create stress and anxiety that might leave you at risk for accidents, illnesses or misuse of substances such as alcohol or drugs.

Concentrate on helping your body tolerate the feelings of grief by:

• Including rest in the rhythm of your day to help replace the energy that grieving uses
• Trying to eat healthy foods daily
• Exercising in ways you enjoy

Your health care team can help you find foods and exercises that are right for you. You may also want to create a list of things you can do to nurture yourself if you are overwhelmed by your feelings. Your list might include things such as:

• Calling a friend
• Taking a hot bath
• Listening to music
• Going for a walk

You can refer to your list if you are having intense feelings or whenever you think you need a break from thoughts of your loss. As time goes on, you may add or subtract items from your list.

Be patient with yourself.

Grieving an important loss is not a single event; it is a process that happens over time. Allow the process to unfold at a pace that is right for you. You don’t need to follow a particular timetable or reach a particular goal. There is no right or wrong way to grieve. There is only what is right and safe for you.

You may never truly get over your loss. However, with patience, acceptance of your feelings and hope, you may find that you have learned to live with it.

[return to top]

Grief and Loss: Additional Resources

The resources listed below provide more detailed information and support services to help you with grief and loss.  Please read the Detailed Information and Suggestions document for more information and questions to ask.

LIVESTRONG SurvivorCare Program

www.livestrong.org/survivorcare

Email:Send email through the LIVESTRONG website.

Phone: 1-866-673-7205

1-866-927-7205 (Spanish)
Intake Coordinator is available for calls Monday through Friday, 9:00 a.m. to 5:00 p.m. (Central Time). Voicemail is available after hours.

LIVESTRONG SurvivorCare offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about treatment options and matching to clinical trials or treatments in development. Counseling services and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations including CancerCare, Patient Advocate Foundation and EmergingMed.

American Cancer Society (ACS)

www.cancer.org

Email: Submit questions in English or Spanish from the “Contact Us” page.

Phone: 1-800-227-2345

TTY for deaf or hard of hearing callers: 1-866-228-4327

The American Cancer Society (ACS) offers information about many of the challenges of cancer and survivorship. You can search for information by cancer type or by topic. ACS provides a list of support groups in your area. You can join online groups and message boards. Some information on the website is available in Spanish, Chinese, Korean and Vietnamese. ACS specialists can answer questions 24 hours a day by phone or email.

American Psychosocial Oncology Society (APOS)

www.apos-society.org

Phone: 1-866-276-7443

Voicemail is available after hours. Messages will be returned within 24 to 48 hours.

APOS works to ensure that all people with cancer have access to psychosocial services as a part of quality cancer care. They provide mental health care referrals to local counseling and support services throughout the United States. If no services are available in your community, a professionally trained Helpline staff member will provide crisis counseling over the phone. To use this service, call the toll-free number.

Cancer Hope Network
www.cancerhopenetwork.org

Email: info@cancerhopenetwork.org

Phone: 1-877-HOPE NET (1-877-467-3638)

This number is answered Monday-Friday, from 8:00 a.m. to 5:30 p.m. (EST). Voicemail is available after hours.  

Cancer Hope Network is a not-for-profit organization that provides free and confidential one-on-one support to cancer patients and their families.  They offer support by matching cancer patients or family members with trained volunteers who have already undergone and recovered from a similar cancer experience. You can submit your request by phone or by email. A volunteer will try to contact you within 24 hours.

National Register of Health Service Providers in Psychology
www.findapsychologist.org

Email: search@findapsychologist.org

Phone: 1-202-783-7663 

The National Register of Health Service Providers in Psychology sponsors this free psychologist referral website to promote consumer access to more than 12,000 professionally screened psychologists in the United States and Canada. This site also contains frequently asked questions about getting help, web links and resources on behavioral health care issues for consumers.

U.S. Institutes of Health - National Cancer Institute (NCI)

www.cancer.gov

Online:  Online assistance is available in English or Spanish through the LiveHelp instant messaging system. This service is available Monday-Friday, 9:00 a.m. to 11:00 p.m. (EST)

Email: Send an email through the “Need Help?” section of the website

Phone: 1-800-422-6237

TTY for deaf and hard of hearing callers: 1-800-332-8615

 Information specialists answer calls Monday-Friday, 9:00 a.m. to 4:30 p.m. local time.

The National Cancer Institute’s website provides accurate information about the challenges cancer can bring. You can search for information by cancer type or topic. You can find information about treatment, financial and insurance matters. You can also learn how treatments in development work and search for a clinical trial in your area. This site also has a good dictionary of cancer terms, drug information and other publications. The knowledgeable and caring specialists have access to comprehensive, accurate information on a range of cancer topics, including the most recent advances in cancer treatment. The service is confidential, and information specialists spend as much time as needed for thorough and personalized responses.

[return to top]

Grief and Loss

Grief is a strong feeling of sadness in response to a loss. Grief and loss are difficult but natural parts of life, and they are often a part of cancer survivorship in some way. Understanding feelings of grief and loss, and finding the support you need, can help you manage the changes you are experiencing and feel more confident about your survivorship.

Detailed Information

Suggestions

Additional Resources

Print this Topic

Email this Topic

Grief and Loss: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources

Loss is when something or someone that is highly valued disappears from your life. Loss is an unavoidable part of life—it happens to all of us. Grief, or bereavement, is the natural human response to loss. It is the intense emotional pain that is felt at the time of loss and for sometime after. At its worst, grief can make it hard to cope or to even take care of day-to-day responsibilities for a time.

Generally, the experience of grief lessens with the passage of time.

This document will explore grief and loss from the cancer survivor’s point-of-view. Loved ones and friends may also experience forms of loss that are similar to those experienced by the person who has cancer. For this reason, much of the information offered here may also be helpful to loved ones and friends.

Do all survivors experience grief and loss?

Not everyone experiences grief in the same way. Even people in the same family – or those who have similar diagnoses and treatments – may respond differently to what has happened. Grief is unique to each situation and each individual. It may differ in how long it lasts, how intense it is, and what it means. How, when, and what people grieve depends on many things such as age or stage in life, previous experience with loss and grief, and the amount of social support that is present.

Most people think about grief and loss in terms of the death of someone who has been close to them. However, people also grieve other kinds of losses such as the loss of physical ability, the end of a friendship, the loss of a valuable possession, and the inability to achieve an important goal.

Some losses are clearly more difficult to bear than others. When a loss is especially important, grief is much more than a brief and simple sadness. It is a process that happens over a long period of time, and it can include a wide range of thoughts and feelings. Even though these feelings and reactions may be painful, it is important to remember that grief is a normal, healthy response to loss. Expressing grief helps with the adjustment to the loss.

Losses can also bring important gains. For some survivors, the gain may be so significant that what has been lost may come to be seen as not so important as it once seemed.  For example, some survivors say that they are grateful for the cancer experience because it taught them new priorities around what is really important in life. However, for others, a loss may be so intense that any gains seem unimportant.

What losses are common for survivors?

Cancer survivors may experience losses in a variety of ways, and some may be easy to see and name. However, other losses can be harder to recognize. A loss may be temporary or permanent, life-altering, or a minor inconvenience. For example, hair loss from treatment can be very important to some, but less important to others. Any type of loss may be an emotional experience. 

The following are types of losses that might be experienced by some survivors:

Physical losses:

• A body function
• Changes in the ability to have sex
• Lessened strength or energy
• An ability or skill to perform certain activities
• Physical comfort
• Fertility
• Bodily changes such as a scar or amputation

Emotional losses:

• Sense of security and predictability such as in health and in the future
• Sense of control or independence
• Self-esteem or sense of identity
• Self-confidence
• Body image
• Goals, hopes or dreams
• Faith or spirituality
• Habits, such as changes in daily routines, or life “the way it used to be”

Social and relationship losses:

• Relationships with friends, family members or co-workers
• Sexual relationships
• Ability to have own biological child
• Loss of certain roles such as providing for the family
• Loss of other cancer survivors

Financial losses:

• Career or job opportunities
• Financial security
• Insurance
• Ability to work

What symptoms come with grief?

The grieving process generally follows a recognizable pattern. It often begins with a brief period of shock that comes after learning about the loss. There may then be a period of denial during which there is a problem believing that there has been or will be a loss. In many cases, the emotions of anger follow the period of denial as one comes to recognize that a loss has occurred. Acceptance happens as one begins to understand and release the feelings of grief and truly accept what has happened. Often the period of coming to acceptance is a challenging one. This is because the denial no longer acts as a temporary shield from the pain of loss. However, this experience is necessary before one is able to move beyond the strong emotions of loss and grief.

Each survivor’s experience with grief and loss is different. A survivor may have all, many, or only a few of the following types of feelings and reactions, and they may be experienced in any order. These types of feelings can be low-key, intense, frequent, or infrequent. Common signs of grief include:

Strong feelings:

• °Sadness, despair
• Emotional numbness
• Anger, general irritation
• Guilt
• Fear
• Anxiety

Bodily reactions:

• Crying
• Lack of energy
• Changes in eating or sleeping patterns
• Feeling generally “under the weather”

Changes in behaviors:

• Withdrawal
• Lessened productivity
• Hyperactivity
• Increased need for reassurance
• Changes in sexual patterns (more or less)
• Attention getting
• Aggressive behavior such as being demanding or physically aggressive

Changes in thinking:

• Avoiding or denying the loss
• Lowered self-esteem
• Not being able to pay attention or concentrate
• Thinking about the loss almost all of the time
• Idealizing the past or future

Knowing that these kinds of grief responses are common can help you understand your situation better. With time, grief responses usually become less intense, last a shorter period of time, and happen less frequently. However, you should talk to your health care team about any physical and long-term emotional symptoms that do not go away.  

The grieving process can bring problems if you begin feeling confused or overwhelmed. If this happens, ask your doctor to refer you to a licensed counselor who has experience helping survivors with the grieving process. The following questions may help you sort out whether or not you could benefit from extra support:

• Can you connect your feelings and reactions to specific losses?
• Do you respond to comfort and support from others?
• Can you directly express difficult feelings such as anger or sadness?
• Can you still find and experience enjoyment in life?
• Are you able to seek and get relief from your physical complaints?
• Are your feelings and reactions becoming less intense and less frequent over time?

If you answered “yes” to these questions, it is likely that you are experiencing normal, healthy grief that will resolve over time. If you answered “no” to some or most of these questions, or if you are uncertain about how you are coping, ask your health care team for help.

When might a survivor experience loss and grief?

Cancer survivors can experience loss and grief during treatment, during recovery from treatment, and months or even years following completion of treatment for reasons such as the following: 

• It can initially be a shocking experience to be diagnosed with cancer.
• During the experience of diagnosis and treatment, time and energy may be directed toward coping with the immediate crisis. This is the time when survivors much choose the health care team, learn about and decide among treatment options, and get through the treatments. This is a time when it is common to put off recognizing and dealing with losses. 
• When treatment has ended, there may be time and energy to focus on emotional responses to the experience of cancer. This is a time when unexpected reactions of grief to losses can surface.

Reminders of the experience with cancer can bring up grief even years after treatment has ended. The following are examples of things that can trigger such emotions:

• Sensory reminders such as certain tastes or odors
• Medical appointments, even those that are routine
• Hearing about someone who has been diagnosed with cancer or who has died from cancer
• Anniversary events such as date of diagnosis or date of going off treatment
• Important events with family or friends such as weddings, graduations, birthdays, and holidays
• Experiencing ongoing losses because of the aftereffects of treatment

Grief is not a single event--it occurs over time. Like waves in the ocean, grief comes and goes as you understand and appreciate various aspects of loss. The amount of time you grieve can vary. Even though survivors might experience grief and loss over time, people who fully experience grief can be happy again and may even feel stronger and more capable than before. However, if grief lasts for a long time, and you feel that you are unable to resolve your grief, talk with your health care team.

Can grief cause a recurrence of cancer?

Grief does not cause cancer, and it cannot make your cancer return. Grieving is often painful, but it is a normal process that occurs as you cope with the losses and changes that come into your life. However, it is important to pay attention to your emotions and how they impact your body. Grief that lasts a long time and is not resolved can lead to negative feelings and stress in your body. Talk to your health care team if you are having a difficult time. They can provide referrals to professional counselors who can help you understand and deal with what you are feeling.

Why is it important to talk with others about the feelings of loss and grief?

Important losses that are not grieved are difficult to resolve. They can rob you of energy and joy and prevent you from moving forward into a full and productive life. Talking with others can help you:

• Recognize your losses
• Express your feelings
• Connect your feelings and reactions to the experience of loss
• Understand your feelings and reactions as normal
• Find ways to cope
• Adjust to your life without what you lost
• Feel stronger and more capable than before

Even though talking with others about your experiences of grief and loss is important, it may be difficult. People around you may not recognize your losses or your grief. They might believe that you should be feeling gratitude, not grief. It can be hard to acknowledge loss and grief when others see you as a winner and someone who should be grateful to be alive, regardless of what has happened.

Grief can also be hard to acknowledge when others listen to or deal with the intense feelings that grief can sometimes bring. If your friends or family members act like they do not want to talk about emotions, it may be that they may not know how to deal with their own emotions. They may really want to help you, but do not know how to be there for you. 

Some people may not be aware of the importance for you to talk about your feelings. You can explain to them that you need someone to listen to you and support you. It might help them to know that you do not expect them to make everything better--you just need them to listen to you. It may not be easy, but it is important to let others know what you need. 

The pain of grief subsides when it is shared. You may be able to find good listeners and support among loved ones, friends, your health care team, licensed counselors, support groups, clergy or members of your faith-based organization.

This document was produced in collaboration with:

Bebe Guill, M.Div.

Former Director, Quality of Life Programs & Services

The Brain Tumor Center at Duke University Medical Center

Works Cited

Heegaard, Margaret. When Someone Very Special Dies. Minnesota: Woodland Press, 1988.

Keene, Nancy, Wendy Hobbie, and Kathy Ruccione. Childhood Cancer Survivors: A Practical Guide to Your Future. Cambridge: O’Reilly & Associates, 2000.

O’Toole, Donna. Growing Through Grief. Burnsville, NC: Mountain Rainbow Publications, 1989.

The American Heritage Dictionary of the English Language. Boston: Houghton Mifflin Company, 1992.

[return to top]

Grief and Loss: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

Give yourself permission to release any feelings of grief you may have.

You have the right to express in safe ways your feelings about the loss of anything important to you without being judged for your appearance or your words. If you are holding your feelings of grief inside, learn to recognize any barriers that may be blocking your grief.

Some barriers to grief may come from within you. These might include:

• Fear that others will judge you as weak
• Fear that you, or others around you, will be overwhelmed by your feelings (“If I start crying, I’m afraid I’ll never stop.”)
• Thinking that some of the feelings and reactions of grief – such as anger or crying – are not appropriate to express
• Thinking that your loss seems trivial

Other barriers to grief may come from others’ comments or actions. Some people may try to comfort you or avoid your feelings of grief by saying:

• “Don’t cry. Everything is going to be just fine.”
• “Look on the bright side. At least you have _________.”
• “You have been a tower of strength. I don’t know how you’ve done it!”

If your grief is blocked, you can remind yourself that:

• Grief is a normal healthy process.
• Holding feelings inside makes them grow stronger and last longer.
• Releasing feelings reduces the fear and pain of grief.
• Feelings are just feelings – they are neither right nor wrong.
• Grief is a sign of the strength you have for living your life fully and well.

Explore a variety of ways to release your feelings.

There are many safe things you can do to release your feelings. You can:

• Tell your story of grief and loss several times to someone you trust, someone who listens to you without judgment. Each time you tell your story of loss, you release the feelings of grief associated with it.
• Express your feelings through a creative outlet you enjoy, such as music or art. Try banging on a piano, drumming or scribbling with crayons.
• Have a good cry or, alternatively, a good, deep belly laugh. Watching a sad or funny movie that you enjoy can help trigger your tears or laughter.
• Find a safe place to yell or scream.
• Find a physical outlet, such as hitting pillows, going to a baseball batting cage or a golf driving range.
• Write down your thoughts and feelings in a journal.

Seek support. 

You do not need to reject people who are trying to comfort you. You can turn to other ways of safely sorting out and releasing your feelings. Comfort and acceptance from others throughout the grief process is important.

Find a support group.

If you are uncomfortable talking about loss and grief with your family or friends, a support group may be an option.

Support groups provide safe environments to share experiences with other survivors, learn new ways to handle difficult situations and talk about emotions. You will see different styles of coping with stress and adjusting to life as a cancer survivor. If you are uncomfortable talking about certain subjects with your family or friends, a support group offers you a place to talk freely about what is important to you.

Cancer support groups exist in most communities. Some ways to find out more about support groups in your area:

• Ask your health care team for suggestions. Some cancer programs offer support groups for cancer survivors and their family members right in the clinic or hospital.
• Call a nearby cancer center or university hospital and ask about support groups.
• Visit LIVESTRONG^TM SurvivorCare at www.livestrong.org/survivorcare , or call 1-866-235-7205 for information on support groups.

Find a counselor/therapist:

If your grief is overwhelming, or if you prefer the privacy of an individual counseling setting, consider talking to a counselor or therapist. Ask a member of your health care team for a referral to a therapist who works with other cancer survivors. Most cancer centers employ oncology social workers who are specially trained to work with cancer survivors and their families. Even if you are not a patient at a cancer center, the oncology social worker may meet with you or refer you to someone else in the community.

It is important to interview the therapist to find out if s/he is the right professional for you. Speak honestly with the therapist and let him or her know your reasons for wanting to work with a therapist.

Examples of questions to ask the therapist:

• What type of education background do you have?
• What type of license do you have?
• What is your experience working with people with cancer?
• What do you understand about the emotional response to this illness?
• Do you take my insurance?
• Do you work with people who are anxious? Depressed?
• Do you know community resources for people with cancer?

Practice good self-care.

Grieving an important loss can be hard work. It can create stress and anxiety that might leave you at risk for accidents, illnesses or misuse of substances such as alcohol or drugs.

Concentrate on helping your body tolerate the feelings of grief by:

• Including rest in the rhythm of your day to help replace the energy that grieving uses
• Trying to eat healthy foods daily
• Exercising in ways you enjoy

Your health care team can help you find foods and exercises that are right for you. You may also want to create a list of things you can do to nurture yourself if you are overwhelmed by your feelings. Your list might include things such as:

• Calling a friend
• Taking a hot bath
• Listening to music
• Going for a walk

You can refer to your list if you are having intense feelings or whenever you think you need a break from thoughts of your loss. As time goes on, you may add or subtract items from your list.

Be patient with yourself.

Grieving an important loss is not a single event; it is a process that happens over time. Allow the process to unfold at a pace that is right for you. You don’t need to follow a particular timetable or reach a particular goal. There is no right or wrong way to grieve. There is only what is right and safe for you.

You may never truly get over your loss. However, with patience, acceptance of your feelings and hope, you may find that you have learned to live with it.

[return to top]

Grief and Loss: Additional Resources

The resources listed below provide more detailed information and support services to help you with grief and loss.  Please read the Detailed Information and Suggestions document for more information and questions to ask.

LIVESTRONG SurvivorCare Program

www.livestrong.org/survivorcare

Email:Send email through the LIVESTRONG website.

Phone: 1-866-673-7205

1-866-927-7205 (Spanish)
Intake Coordinator is available for calls Monday through Friday, 9:00 a.m. to 5:00 p.m. (Central Time). Voicemail is available after hours.

LIVESTRONG SurvivorCare offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about treatment options and matching to clinical trials or treatments in development. Counseling services and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations including CancerCare, Patient Advocate Foundation and EmergingMed.

American Cancer Society (ACS)

www.cancer.org

Email: Submit questions in English or Spanish from the “Contact Us” page.

Phone: 1-800-227-2345

TTY for deaf or hard of hearing callers: 1-866-228-4327

The American Cancer Society (ACS) offers information about many of the challenges of cancer and survivorship. You can search for information by cancer type or by topic. ACS provides a list of support groups in your area. You can join online groups and message boards. Some information on the website is available in Spanish, Chinese, Korean and Vietnamese. ACS specialists can answer questions 24 hours a day by phone or email.

American Psychosocial Oncology Society (APOS)

www.apos-society.org

Phone: 1-866-276-7443

Voicemail is available after hours. Messages will be returned within 24 to 48 hours.

APOS works to ensure that all people with cancer have access to psychosocial services as a part of quality cancer care. They provide mental health care referrals to local counseling and support services throughout the United States. If no services are available in your community, a professionally trained Helpline staff member will provide crisis counseling over the phone. To use this service, call the toll-free number.

Cancer Hope Network
www.cancerhopenetwork.org

Email: info@cancerhopenetwork.org

Phone: 1-877-HOPE NET (1-877-467-3638)

This number is answered Monday-Friday, from 8:00 a.m. to 5:30 p.m. (EST). Voicemail is available after hours.  

Cancer Hope Network is a not-for-profit organization that provides free and confidential one-on-one support to cancer patients and their families.  They offer support by matching cancer patients or family members with trained volunteers who have already undergone and recovered from a similar cancer experience. You can submit your request by phone or by email. A volunteer will try to contact you within 24 hours.

National Register of Health Service Providers in Psychology
www.findapsychologist.org

Email: search@findapsychologist.org

Phone: 1-202-783-7663 

The National Register of Health Service Providers in Psychology sponsors this free psychologist referral website to promote consumer access to more than 12,000 professionally screened psychologists in the United States and Canada. This site also contains frequently asked questions about getting help, web links and resources on behavioral health care issues for consumers.

U.S. Institutes of Health - National Cancer Institute (NCI)

www.cancer.gov

Online:  Online assistance is available in English or Spanish through the LiveHelp instant messaging system. This service is available Monday-Friday, 9:00 a.m. to 11:00 p.m. (EST)

Email: Send an email through the “Need Help?” section of the website

Phone: 1-800-422-6237

TTY for deaf and hard of hearing callers: 1-800-332-8615

 Information specialists answer calls Monday-Friday, 9:00 a.m. to 4:30 p.m. local time.

The National Cancer Institute’s website provides accurate information about the challenges cancer can bring. You can search for information by cancer type or topic. You can find information about treatment, financial and insurance matters. You can also learn how treatments in development work and search for a clinical trial in your area. This site also has a good dictionary of cancer terms, drug information and other publications. The knowledgeable and caring specialists have access to comprehensive, accurate information on a range of cancer topics, including the most recent advances in cancer treatment. The service is confidential, and information specialists spend as much time as needed for thorough and personalized responses.

[return to top]

Grief and Loss

Grief is a strong feeling of sadness in response to a loss. Grief and loss are difficult but natural parts of life, and they are often a part of cancer survivorship in some way. Understanding feelings of grief and loss, and finding the support you need, can help you manage the changes you are experiencing and feel more confident about your survivorship.

Detailed Information

Suggestions

Additional Resources

Print this Topic

Email this Topic

Grief and Loss: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources

Loss is when something or someone that is highly valued disappears from your life. Loss is an unavoidable part of life—it happens to all of us. Grief, or bereavement, is the natural human response to loss. It is the intense emotional pain that is felt at the time of loss and for sometime after. At its worst, grief can make it hard to cope or to even take care of day-to-day responsibilities for a time.

Generally, the experience of grief lessens with the passage of time.

This document will explore grief and loss from the cancer survivor’s point-of-view. Loved ones and friends may also experience forms of loss that are similar to those experienced by the person who has cancer. For this reason, much of the information offered here may also be helpful to loved ones and friends.

Do all survivors experience grief and loss?

Not everyone experiences grief in the same way. Even people in the same family – or those who have similar diagnoses and treatments – may respond differently to what has happened. Grief is unique to each situation and each individual. It may differ in how long it lasts, how intense it is, and what it means. How, when, and what people grieve depends on many things such as age or stage in life, previous experience with loss and grief, and the amount of social support that is present.

Most people think about grief and loss in terms of the death of someone who has been close to them. However, people also grieve other kinds of losses such as the loss of physical ability, the end of a friendship, the loss of a valuable possession, and the inability to achieve an important goal.

Some losses are clearly more difficult to bear than others. When a loss is especially important, grief is much more than a brief and simple sadness. It is a process that happens over a long period of time, and it can include a wide range of thoughts and feelings. Even though these feelings and reactions may be painful, it is important to remember that grief is a normal, healthy response to loss. Expressing grief helps with the adjustment to the loss.

Losses can also bring important gains. For some survivors, the gain may be so significant that what has been lost may come to be seen as not so important as it once seemed.  For example, some survivors say that they are grateful for the cancer experience because it taught them new priorities around what is really important in life. However, for others, a loss may be so intense that any gains seem unimportant.

What losses are common for survivors?

Cancer survivors may experience losses in a variety of ways, and some may be easy to see and name. However, other losses can be harder to recognize. A loss may be temporary or permanent, life-altering, or a minor inconvenience. For example, hair loss from treatment can be very important to some, but less important to others. Any type of loss may be an emotional experience. 

The following are types of losses that might be experienced by some survivors:

Physical losses:

• A body function
• Changes in the ability to have sex
• Lessened strength or energy
• An ability or skill to perform certain activities
• Physical comfort
• Fertility
• Bodily changes such as a scar or amputation

Emotional losses:

• Sense of security and predictability such as in health and in the future
• Sense of control or independence
• Self-esteem or sense of identity
• Self-confidence
• Body image
• Goals, hopes or dreams
• Faith or spirituality
• Habits, such as changes in daily routines, or life “the way it used to be”

Social and relationship losses:

• Relationships with friends, family members or co-workers
• Sexual relationships
• Ability to have own biological child
• Loss of certain roles such as providing for the family
• Loss of other cancer survivors

Financial losses:

• Career or job opportunities
• Financial security
• Insurance
• Ability to work

What symptoms come with grief?

The grieving process generally follows a recognizable pattern. It often begins with a brief period of shock that comes after learning about the loss. There may then be a period of denial during which there is a problem believing that there has been or will be a loss. In many cases, the emotions of anger follow the period of denial as one comes to recognize that a loss has occurred. Acceptance happens as one begins to understand and release the feelings of grief and truly accept what has happened. Often the period of coming to acceptance is a challenging one. This is because the denial no longer acts as a temporary shield from the pain of loss. However, this experience is necessary before one is able to move beyond the strong emotions of loss and grief.

Each survivor’s experience with grief and loss is different. A survivor may have all, many, or only a few of the following types of feelings and reactions, and they may be experienced in any order. These types of feelings can be low-key, intense, frequent, or infrequent. Common signs of grief include:

Strong feelings:

• °Sadness, despair
• Emotional numbness
• Anger, general irritation
• Guilt
• Fear
• Anxiety

Bodily reactions:

• Crying
• Lack of energy
• Changes in eating or sleeping patterns
• Feeling generally “under the weather”

Changes in behaviors:

• Withdrawal
• Lessened productivity
• Hyperactivity
• Increased need for reassurance
• Changes in sexual patterns (more or less)
• Attention getting
• Aggressive behavior such as being demanding or physically aggressive

Changes in thinking:

• Avoiding or denying the loss
• Lowered self-esteem
• Not being able to pay attention or concentrate
• Thinking about the loss almost all of the time
• Idealizing the past or future

Knowing that these kinds of grief responses are common can help you understand your situation better. With time, grief responses usually become less intense, last a shorter period of time, and happen less frequently. However, you should talk to your health care team about any physical and long-term emotional symptoms that do not go away.  

The grieving process can bring problems if you begin feeling confused or overwhelmed. If this happens, ask your doctor to refer you to a licensed counselor who has experience helping survivors with the grieving process. The following questions may help you sort out whether or not you could benefit from extra support:

• Can you connect your feelings and reactions to specific losses?
• Do you respond to comfort and support from others?
• Can you directly express difficult feelings such as anger or sadness?
• Can you still find and experience enjoyment in life?
• Are you able to seek and get relief from your physical complaints?
• Are your feelings and reactions becoming less intense and less frequent over time?

If you answered “yes” to these questions, it is likely that you are experiencing normal, healthy grief that will resolve over time. If you answered “no” to some or most of these questions, or if you are uncertain about how you are coping, ask your health care team for help.

When might a survivor experience loss and grief?

Cancer survivors can experience loss and grief during treatment, during recovery from treatment, and months or even years following completion of treatment for reasons such as the following: 

• It can initially be a shocking experience to be diagnosed with cancer.
• During the experience of diagnosis and treatment, time and energy may be directed toward coping with the immediate crisis. This is the time when survivors much choose the health care team, learn about and decide among treatment options, and get through the treatments. This is a time when it is common to put off recognizing and dealing with losses. 
• When treatment has ended, there may be time and energy to focus on emotional responses to the experience of cancer. This is a time when unexpected reactions of grief to losses can surface.

Reminders of the experience with cancer can bring up grief even years after treatment has ended. The following are examples of things that can trigger such emotions:

• Sensory reminders such as certain tastes or odors
• Medical appointments, even those that are routine
• Hearing about someone who has been diagnosed with cancer or who has died from cancer
• Anniversary events such as date of diagnosis or date of going off treatment
• Important events with family or friends such as weddings, graduations, birthdays, and holidays
• Experiencing ongoing losses because of the aftereffects of treatment

Grief is not a single event--it occurs over time. Like waves in the ocean, grief comes and goes as you understand and appreciate various aspects of loss. The amount of time you grieve can vary. Even though survivors might experience grief and loss over time, people who fully experience grief can be happy again and may even feel stronger and more capable than before. However, if grief lasts for a long time, and you feel that you are unable to resolve your grief, talk with your health care team.

Can grief cause a recurrence of cancer?

Grief does not cause cancer, and it cannot make your cancer return. Grieving is often painful, but it is a normal process that occurs as you cope with the losses and changes that come into your life. However, it is important to pay attention to your emotions and how they impact your body. Grief that lasts a long time and is not resolved can lead to negative feelings and stress in your body. Talk to your health care team if you are having a difficult time. They can provide referrals to professional counselors who can help you understand and deal with what you are feeling.

Why is it important to talk with others about the feelings of loss and grief?

Important losses that are not grieved are difficult to resolve. They can rob you of energy and joy and prevent you from moving forward into a full and productive life. Talking with others can help you:

• Recognize your losses
• Express your feelings
• Connect your feelings and reactions to the experience of loss
• Understand your feelings and reactions as normal
• Find ways to cope
• Adjust to your life without what you lost
• Feel stronger and more capable than before

Even though talking with others about your experiences of grief and loss is important, it may be difficult. People around you may not recognize your losses or your grief. They might believe that you should be feeling gratitude, not grief. It can be hard to acknowledge loss and grief when others see you as a winner and someone who should be grateful to be alive, regardless of what has happened.

Grief can also be hard to acknowledge when others listen to or deal with the intense feelings that grief can sometimes bring. If your friends or family members act like they do not want to talk about emotions, it may be that they may not know how to deal with their own emotions. They may really want to help you, but do not know how to be there for you. 

Some people may not be aware of the importance for you to talk about your feelings. You can explain to them that you need someone to listen to you and support you. It might help them to know that you do not expect them to make everything better--you just need them to listen to you. It may not be easy, but it is important to let others know what you need. 

The pain of grief subsides when it is shared. You may be able to find good listeners and support among loved ones, friends, your health care team, licensed counselors, support groups, clergy or members of your faith-based organization.

This document was produced in collaboration with:

Bebe Guill, M.Div.

Former Director, Quality of Life Programs & Services

The Brain Tumor Center at Duke University Medical Center

Works Cited

Heegaard, Margaret. When Someone Very Special Dies. Minnesota: Woodland Press, 1988.

Keene, Nancy, Wendy Hobbie, and Kathy Ruccione. Childhood Cancer Survivors: A Practical Guide to Your Future. Cambridge: O’Reilly & Associates, 2000.

O’Toole, Donna. Growing Through Grief. Burnsville, NC: Mountain Rainbow Publications, 1989.

The American Heritage Dictionary of the English Language. Boston: Houghton Mifflin Company, 1992.

[return to top]

Grief and Loss: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

Give yourself permission to release any feelings of grief you may have.

You have the right to express in safe ways your feelings about the loss of anything important to you without being judged for your appearance or your words. If you are holding your feelings of grief inside, learn to recognize any barriers that may be blocking your grief.

Some barriers to grief may come from within you. These might include:

• Fear that others will judge you as weak
• Fear that you, or others around you, will be overwhelmed by your feelings (“If I start crying, I’m afraid I’ll never stop.”)
• Thinking that some of the feelings and reactions of grief – such as anger or crying – are not appropriate to express
• Thinking that your loss seems trivial

Other barriers to grief may come from others’ comments or actions. Some people may try to comfort you or avoid your feelings of grief by saying:

• “Don’t cry. Everything is going to be just fine.”
• “Look on the bright side. At least you have _________.”
• “You have been a tower of strength. I don’t know how you’ve done it!”

If your grief is blocked, you can remind yourself that:

• Grief is a normal healthy process.
• Holding feelings inside makes them grow stronger and last longer.
• Releasing feelings reduces the fear and pain of grief.
• Feelings are just feelings – they are neither right nor wrong.
• Grief is a sign of the strength you have for living your life fully and well.

Explore a variety of ways to release your feelings.

There are many safe things you can do to release your feelings. You can:

• Tell your story of grief and loss several times to someone you trust, someone who listens to you without judgment. Each time you tell your story of loss, you release the feelings of grief associated with it.
• Express your feelings through a creative outlet you enjoy, such as music or art. Try banging on a piano, drumming or scribbling with crayons.
• Have a good cry or, alternatively, a good, deep belly laugh. Watching a sad or funny movie that you enjoy can help trigger your tears or laughter.
• Find a safe place to yell or scream.
• Find a physical outlet, such as hitting pillows, going to a baseball batting cage or a golf driving range.
• Write down your thoughts and feelings in a journal.

Seek support. 

You do not need to reject people who are trying to comfort you. You can turn to other ways of safely sorting out and releasing your feelings. Comfort and acceptance from others throughout the grief process is important.

Find a support group.

If you are uncomfortable talking about loss and grief with your family or friends, a support group may be an option.

Support groups provide safe environments to share experiences with other survivors, learn new ways to handle difficult situations and talk about emotions. You will see different styles of coping with stress and adjusting to life as a cancer survivor. If you are uncomfortable talking about certain subjects with your family or friends, a support group offers you a place to talk freely about what is important to you.

Cancer support groups exist in most communities. Some ways to find out more about support groups in your area:

• Ask your health care team for suggestions. Some cancer programs offer support groups for cancer survivors and their family members right in the clinic or hospital.
• Call a nearby cancer center or university hospital and ask about support groups.
• Visit LIVESTRONG^TM SurvivorCare at www.livestrong.org/survivorcare , or call 1-866-235-7205 for information on support groups.

Find a counselor/therapist:

If your grief is overwhelming, or if you prefer the privacy of an individual counseling setting, consider talking to a counselor or therapist. Ask a member of your health care team for a referral to a therapist who works with other cancer survivors. Most cancer centers employ oncology social workers who are specially trained to work with cancer survivors and their families. Even if you are not a patient at a cancer center, the oncology social worker may meet with you or refer you to someone else in the community.

It is important to interview the therapist to find out if s/he is the right professional for you. Speak honestly with the therapist and let him or her know your reasons for wanting to work with a therapist.

Examples of questions to ask the therapist:

• What type of education background do you have?
• What type of license do you have?
• What is your experience working with people with cancer?
• What do you understand about the emotional response to this illness?
• Do you take my insurance?
• Do you work with people who are anxious? Depressed?
• Do you know community resources for people with cancer?

Practice good self-care.

Grieving an important loss can be hard work. It can create stress and anxiety that might leave you at risk for accidents, illnesses or misuse of substances such as alcohol or drugs.

Concentrate on helping your body tolerate the feelings of grief by:

• Including rest in the rhythm of your day to help replace the energy that grieving uses
• Trying to eat healthy foods daily
• Exercising in ways you enjoy

Your health care team can help you find foods and exercises that are right for you. You may also want to create a list of things you can do to nurture yourself if you are overwhelmed by your feelings. Your list might include things such as:

• Calling a friend
• Taking a hot bath
• Listening to music
• Going for a walk

You can refer to your list if you are having intense feelings or whenever you think you need a break from thoughts of your loss. As time goes on, you may add or subtract items from your list.

Be patient with yourself.

Grieving an important loss is not a single event; it is a process that happens over time. Allow the process to unfold at a pace that is right for you. You don’t need to follow a particular timetable or reach a particular goal. There is no right or wrong way to grieve. There is only what is right and safe for you.

You may never truly get over your loss. However, with patience, acceptance of your feelings and hope, you may find that you have learned to live with it.

[return to top]

Grief and Loss: Additional Resources

The resources listed below provide more detailed information and support services to help you with grief and loss.  Please read the Detailed Information and Suggestions document for more information and questions to ask.

LIVESTRONG SurvivorCare Program

www.livestrong.org/survivorcare

Email:Send email through the LIVESTRONG website.

Phone: 1-866-673-7205

1-866-927-7205 (Spanish)
Intake Coordinator is available for calls Monday through Friday, 9:00 a.m. to 5:00 p.m. (Central Time). Voicemail is available after hours.

LIVESTRONG SurvivorCare offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about treatment options and matching to clinical trials or treatments in development. Counseling services and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations including CancerCare, Patient Advocate Foundation and EmergingMed.

American Cancer Society (ACS)

www.cancer.org

Email: Submit questions in English or Spanish from the “Contact Us” page.

Phone: 1-800-227-2345

TTY for deaf or hard of hearing callers: 1-866-228-4327

The American Cancer Society (ACS) offers information about many of the challenges of cancer and survivorship. You can search for information by cancer type or by topic. ACS provides a list of support groups in your area. You can join online groups and message boards. Some information on the website is available in Spanish, Chinese, Korean and Vietnamese. ACS specialists can answer questions 24 hours a day by phone or email.

American Psychosocial Oncology Society (APOS)

www.apos-society.org

Phone: 1-866-276-7443

Voicemail is available after hours. Messages will be returned within 24 to 48 hours.

APOS works to ensure that all people with cancer have access to psychosocial services as a part of quality cancer care. They provide mental health care referrals to local counseling and support services throughout the United States. If no services are available in your community, a professionally trained Helpline staff member will provide crisis counseling over the phone. To use this service, call the toll-free number.

Cancer Hope Network
www.cancerhopenetwork.org

Email: info@cancerhopenetwork.org

Phone: 1-877-HOPE NET (1-877-467-3638)

This number is answered Monday-Friday, from 8:00 a.m. to 5:30 p.m. (EST). Voicemail is available after hours.  

Cancer Hope Network is a not-for-profit organization that provides free and confidential one-on-one support to cancer patients and their families.  They offer support by matching cancer patients or family members with trained volunteers who have already undergone and recovered from a similar cancer experience. You can submit your request by phone or by email. A volunteer will try to contact you within 24 hours.

National Register of Health Service Providers in Psychology
www.findapsychologist.org

Email: search@findapsychologist.org

Phone: 1-202-783-7663 

The National Register of Health Service Providers in Psychology sponsors this free psychologist referral website to promote consumer access to more than 12,000 professionally screened psychologists in the United States and Canada. This site also contains frequently asked questions about getting help, web links and resources on behavioral health care issues for consumers.

U.S. Institutes of Health - National Cancer Institute (NCI)

www.cancer.gov

Online:  Online assistance is available in English or Spanish through the LiveHelp instant messaging system. This service is available Monday-Friday, 9:00 a.m. to 11:00 p.m. (EST)

Email: Send an email through the “Need Help?” section of the website

Phone: 1-800-422-6237

TTY for deaf and hard of hearing callers: 1-800-332-8615

 Information specialists answer calls Monday-Friday, 9:00 a.m. to 4:30 p.m. local time.

The National Cancer Institute’s website provides accurate information about the challenges cancer can bring. You can search for information by cancer type or topic. You can find information about treatment, financial and insurance matters. You can also learn how treatments in development work and search for a clinical trial in your area. This site also has a good dictionary of cancer terms, drug information and other publications. The knowledgeable and caring specialists have access to comprehensive, accurate information on a range of cancer topics, including the most recent advances in cancer treatment. The service is confidential, and information specialists spend as much time as needed for thorough and personalized responses.

[return to top]

Grief and Loss

Grief is a strong feeling of sadness in response to a loss. Grief and loss are difficult but natural parts of life, and they are often a part of cancer survivorship in some way. Understanding feelings of grief and loss, and finding the support you need, can help you manage the changes you are experiencing and feel more confident about your survivorship.

Detailed Information

Suggestions

Additional Resources

Print this Topic

Email this Topic

Grief and Loss: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources

Loss is when something or someone that is highly valued disappears from your life. Loss is an unavoidable part of life—it happens to all of us. Grief, or bereavement, is the natural human response to loss. It is the intense emotional pain that is felt at the time of loss and for sometime after. At its worst, grief can make it hard to cope or to even take care of day-to-day responsibilities for a time.

Generally, the experience of grief lessens with the passage of time.

This document will explore grief and loss from the cancer survivor’s point-of-view. Loved ones and friends may also experience forms of loss that are similar to those experienced by the person who has cancer. For this reason, much of the information offered here may also be helpful to loved ones and friends.

Do all survivors experience grief and loss?

Not everyone experiences grief in the same way. Even people in the same family – or those who have similar diagnoses and treatments – may respond differently to what has happened. Grief is unique to each situation and each individual. It may differ in how long it lasts, how intense it is, and what it means. How, when, and what people grieve depends on many things such as age or stage in life, previous experience with loss and grief, and the amount of social support that is present.

Most people think about grief and loss in terms of the death of someone who has been close to them. However, people also grieve other kinds of losses such as the loss of physical ability, the end of a friendship, the loss of a valuable possession, and the inability to achieve an important goal.

Some losses are clearly more difficult to bear than others. When a loss is especially important, grief is much more than a brief and simple sadness. It is a process that happens over a long period of time, and it can include a wide range of thoughts and feelings. Even though these feelings and reactions may be painful, it is important to remember that grief is a normal, healthy response to loss. Expressing grief helps with the adjustment to the loss.

Losses can also bring important gains. For some survivors, the gain may be so significant that what has been lost may come to be seen as not so important as it once seemed.  For example, some survivors say that they are grateful for the cancer experience because it taught them new priorities around what is really important in life. However, for others, a loss may be so intense that any gains seem unimportant.

What losses are common for survivors?

Cancer survivors may experience losses in a variety of ways, and some may be easy to see and name. However, other losses can be harder to recognize. A loss may be temporary or permanent, life-altering, or a minor inconvenience. For example, hair loss from treatment can be very important to some, but less important to others. Any type of loss may be an emotional experience. 

The following are types of losses that might be experienced by some survivors:

Physical losses:

• A body function
• Changes in the ability to have sex
• Lessened strength or energy
• An ability or skill to perform certain activities
• Physical comfort
• Fertility
• Bodily changes such as a scar or amputation

Emotional losses:

• Sense of security and predictability such as in health and in the future
• Sense of control or independence
• Self-esteem or sense of identity
• Self-confidence
• Body image
• Goals, hopes or dreams
• Faith or spirituality
• Habits, such as changes in daily routines, or life “the way it used to be”

Social and relationship losses:

• Relationships with friends, family members or co-workers
• Sexual relationships
• Ability to have own biological child
• Loss of certain roles such as providing for the family
• Loss of other cancer survivors

Financial losses:

• Career or job opportunities
• Financial security
• Insurance
• Ability to work

What symptoms come with grief?

The grieving process generally follows a recognizable pattern. It often begins with a brief period of shock that comes after learning about the loss. There may then be a period of denial during which there is a problem believing that there has been or will be a loss. In many cases, the emotions of anger follow the period of denial as one comes to recognize that a loss has occurred. Acceptance happens as one begins to understand and release the feelings of grief and truly accept what has happened. Often the period of coming to acceptance is a challenging one. This is because the denial no longer acts as a temporary shield from the pain of loss. However, this experience is necessary before one is able to move beyond the strong emotions of loss and grief.

Each survivor’s experience with grief and loss is different. A survivor may have all, many, or only a few of the following types of feelings and reactions, and they may be experienced in any order. These types of feelings can be low-key, intense, frequent, or infrequent. Common signs of grief include:

Strong feelings:

• °Sadness, despair
• Emotional numbness
• Anger, general irritation
• Guilt
• Fear
• Anxiety

Bodily reactions:

• Crying
• Lack of energy
• Changes in eating or sleeping patterns
• Feeling generally “under the weather”

Changes in behaviors:

• Withdrawal
• Lessened productivity
• Hyperactivity
• Increased need for reassurance
• Changes in sexual patterns (more or less)
• Attention getting
• Aggressive behavior such as being demanding or physically aggressive

Changes in thinking:

• Avoiding or denying the loss
• Lowered self-esteem
• Not being able to pay attention or concentrate
• Thinking about the loss almost all of the time
• Idealizing the past or future

Knowing that these kinds of grief responses are common can help you understand your situation better. With time, grief responses usually become less intense, last a shorter period of time, and happen less frequently. However, you should talk to your health care team about any physical and long-term emotional symptoms that do not go away.  

The grieving process can bring problems if you begin feeling confused or overwhelmed. If this happens, ask your doctor to refer you to a licensed counselor who has experience helping survivors with the grieving process. The following questions may help you sort out whether or not you could benefit from extra support:

• Can you connect your feelings and reactions to specific losses?
• Do you respond to comfort and support from others?
• Can you directly express difficult feelings such as anger or sadness?
• Can you still find and experience enjoyment in life?
• Are you able to seek and get relief from your physical complaints?
• Are your feelings and reactions becoming less intense and less frequent over time?

If you answered “yes” to these questions, it is likely that you are experiencing normal, healthy grief that will resolve over time. If you answered “no” to some or most of these questions, or if you are uncertain about how you are coping, ask your health care team for help.

When might a survivor experience loss and grief?

Cancer survivors can experience loss and grief during treatment, during recovery from treatment, and months or even years following completion of treatment for reasons such as the following: 

• It can initially be a shocking experience to be diagnosed with cancer.
• During the experience of diagnosis and treatment, time and energy may be directed toward coping with the immediate crisis. This is the time when survivors much choose the health care team, learn about and decide among treatment options, and get through the treatments. This is a time when it is common to put off recognizing and dealing with losses. 
• When treatment has ended, there may be time and energy to focus on emotional responses to the experience of cancer. This is a time when unexpected reactions of grief to losses can surface.

Reminders of the experience with cancer can bring up grief even years after treatment has ended. The following are examples of things that can trigger such emotions:

• Sensory reminders such as certain tastes or odors
• Medical appointments, even those that are routine
• Hearing about someone who has been diagnosed with cancer or who has died from cancer
• Anniversary events such as date of diagnosis or date of going off treatment
• Important events with family or friends such as weddings, graduations, birthdays, and holidays
• Experiencing ongoing losses because of the aftereffects of treatment

Grief is not a single event--it occurs over time. Like waves in the ocean, grief comes and goes as you understand and appreciate various aspects of loss. The amount of time you grieve can vary. Even though survivors might experience grief and loss over time, people who fully experience grief can be happy again and may even feel stronger and more capable than before. However, if grief lasts for a long time, and you feel that you are unable to resolve your grief, talk with your health care team.

Can grief cause a recurrence of cancer?

Grief does not cause cancer, and it cannot make your cancer return. Grieving is often painful, but it is a normal process that occurs as you cope with the losses and changes that come into your life. However, it is important to pay attention to your emotions and how they impact your body. Grief that lasts a long time and is not resolved can lead to negative feelings and stress in your body. Talk to your health care team if you are having a difficult time. They can provide referrals to professional counselors who can help you understand and deal with what you are feeling.

Why is it important to talk with others about the feelings of loss and grief?

Important losses that are not grieved are difficult to resolve. They can rob you of energy and joy and prevent you from moving forward into a full and productive life. Talking with others can help you:

• Recognize your losses
• Express your feelings
• Connect your feelings and reactions to the experience of loss
• Understand your feelings and reactions as normal
• Find ways to cope
• Adjust to your life without what you lost
• Feel stronger and more capable than before

Even though talking with others about your experiences of grief and loss is important, it may be difficult. People around you may not recognize your losses or your grief. They might believe that you should be feeling gratitude, not grief. It can be hard to acknowledge loss and grief when others see you as a winner and someone who should be grateful to be alive, regardless of what has happened.

Grief can also be hard to acknowledge when others listen to or deal with the intense feelings that grief can sometimes bring. If your friends or family members act like they do not want to talk about emotions, it may be that they may not know how to deal with their own emotions. They may really want to help you, but do not know how to be there for you. 

Some people may not be aware of the importance for you to talk about your feelings. You can explain to them that you need someone to listen to you and support you. It might help them to know that you do not expect them to make everything better--you just need them to listen to you. It may not be easy, but it is important to let others know what you need. 

The pain of grief subsides when it is shared. You may be able to find good listeners and support among loved ones, friends, your health care team, licensed counselors, support groups, clergy or members of your faith-based organization.

This document was produced in collaboration with:

Bebe Guill, M.Div.

Former Director, Quality of Life Programs & Services

The Brain Tumor Center at Duke University Medical Center

Works Cited

Heegaard, Margaret. When Someone Very Special Dies. Minnesota: Woodland Press, 1988.

Keene, Nancy, Wendy Hobbie, and Kathy Ruccione. Childhood Cancer Survivors: A Practical Guide to Your Future. Cambridge: O’Reilly & Associates, 2000.

O’Toole, Donna. Growing Through Grief. Burnsville, NC: Mountain Rainbow Publications, 1989.

The American Heritage Dictionary of the English Language. Boston: Houghton Mifflin Company, 1992.

[return to top]

Grief and Loss: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

Give yourself permission to release any feelings of grief you may have.

You have the right to express in safe ways your feelings about the loss of anything important to you without being judged for your appearance or your words. If you are holding your feelings of grief inside, learn to recognize any barriers that may be blocking your grief.

Some barriers to grief may come from within you. These might include:

• Fear that others will judge you as weak
• Fear that you, or others around you, will be overwhelmed by your feelings (“If I start crying, I’m afraid I’ll never stop.”)
• Thinking that some of the feelings and reactions of grief – such as anger or crying – are not appropriate to express
• Thinking that your loss seems trivial

Other barriers to grief may come from others’ comments or actions. Some people may try to comfort you or avoid your feelings of grief by saying:

• “Don’t cry. Everything is going to be just fine.”
• “Look on the bright side. At least you have _________.”
• “You have been a tower of strength. I don’t know how you’ve done it!”

If your grief is blocked, you can remind yourself that:

• Grief is a normal healthy process.
• Holding feelings inside makes them grow stronger and last longer.
• Releasing feelings reduces the fear and pain of grief.
• Feelings are just feelings – they are neither right nor wrong.
• Grief is a sign of the strength you have for living your life fully and well.

Explore a variety of ways to release your feelings.

There are many safe things you can do to release your feelings. You can:

• Tell your story of grief and loss several times to someone you trust, someone who listens to you without judgment. Each time you tell your story of loss, you release the feelings of grief associated with it.
• Express your feelings through a creative outlet you enjoy, such as music or art. Try banging on a piano, drumming or scribbling with crayons.
• Have a good cry or, alternatively, a good, deep belly laugh. Watching a sad or funny movie that you enjoy can help trigger your tears or laughter.
• Find a safe place to yell or scream.
• Find a physical outlet, such as hitting pillows, going to a baseball batting cage or a golf driving range.
• Write down your thoughts and feelings in a journal.

Seek support. 

You do not need to reject people who are trying to comfort you. You can turn to other ways of safely sorting out and releasing your feelings. Comfort and acceptance from others throughout the grief process is important.

Find a support group.

If you are uncomfortable talking about loss and grief with your family or friends, a support group may be an option.

Support groups provide safe environments to share experiences with other survivors, learn new ways to handle difficult situations and talk about emotions. You will see different styles of coping with stress and adjusting to life as a cancer survivor. If you are uncomfortable talking about certain subjects with your family or friends, a support group offers you a place to talk freely about what is important to you.

Cancer support groups exist in most communities. Some ways to find out more about support groups in your area:

• Ask your health care team for suggestions. Some cancer programs offer support groups for cancer survivors and their family members right in the clinic or hospital.
• Call a nearby cancer center or university hospital and ask about support groups.
• Visit LIVESTRONG^TM SurvivorCare at www.livestrong.org/survivorcare , or call 1-866-235-7205 for information on support groups.

Find a counselor/therapist:

If your grief is overwhelming, or if you prefer the privacy of an individual counseling setting, consider talking to a counselor or therapist. Ask a member of your health care team for a referral to a therapist who works with other cancer survivors. Most cancer centers employ oncology social workers who are specially trained to work with cancer survivors and their families. Even if you are not a patient at a cancer center, the oncology social worker may meet with you or refer you to someone else in the community.

It is important to interview the therapist to find out if s/he is the right professional for you. Speak honestly with the therapist and let him or her know your reasons for wanting to work with a therapist.

Examples of questions to ask the therapist:

• What type of education background do you have?
• What type of license do you have?
• What is your experience working with people with cancer?
• What do you understand about the emotional response to this illness?
• Do you take my insurance?
• Do you work with people who are anxious? Depressed?
• Do you know community resources for people with cancer?

Practice good self-care.

Grieving an important loss can be hard work. It can create stress and anxiety that might leave you at risk for accidents, illnesses or misuse of substances such as alcohol or drugs.

Concentrate on helping your body tolerate the feelings of grief by:

• Including rest in the rhythm of your day to help replace the energy that grieving uses
• Trying to eat healthy foods daily
• Exercising in ways you enjoy

Your health care team can help you find foods and exercises that are right for you. You may also want to create a list of things you can do to nurture yourself if you are overwhelmed by your feelings. Your list might include things such as:

• Calling a friend
• Taking a hot bath
• Listening to music
• Going for a walk

You can refer to your list if you are having intense feelings or whenever you think you need a break from thoughts of your loss. As time goes on, you may add or subtract items from your list.

Be patient with yourself.

Grieving an important loss is not a single event; it is a process that happens over time. Allow the process to unfold at a pace that is right for you. You don’t need to follow a particular timetable or reach a particular goal. There is no right or wrong way to grieve. There is only what is right and safe for you.

You may never truly get over your loss. However, with patience, acceptance of your feelings and hope, you may find that you have learned to live with it.

[return to top]

Grief and Loss: Additional Resources

The resources listed below provide more detailed information and support services to help you with grief and loss.  Please read the Detailed Information and Suggestions document for more information and questions to ask.

LIVESTRONG SurvivorCare Program

www.livestrong.org/survivorcare

Email:Send email through the LIVESTRONG website.

Phone: 1-866-673-7205

1-866-927-7205 (Spanish)
Intake Coordinator is available for calls Monday through Friday, 9:00 a.m. to 5:00 p.m. (Central Time). Voicemail is available after hours.

LIVESTRONG SurvivorCare offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about treatment options and matching to clinical trials or treatments in development. Counseling services and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations including CancerCare, Patient Advocate Foundation and EmergingMed.

American Cancer Society (ACS)

www.cancer.org

Email: Submit questions in English or Spanish from the “Contact Us” page.

Phone: 1-800-227-2345

TTY for deaf or hard of hearing callers: 1-866-228-4327

The American Cancer Society (ACS) offers information about many of the challenges of cancer and survivorship. You can search for information by cancer type or by topic. ACS provides a list of support groups in your area. You can join online groups and message boards. Some information on the website is available in Spanish, Chinese, Korean and Vietnamese. ACS specialists can answer questions 24 hours a day by phone or email.

American Psychosocial Oncology Society (APOS)

www.apos-society.org

Phone: 1-866-276-7443

Voicemail is available after hours. Messages will be returned within 24 to 48 hours.

APOS works to ensure that all people with cancer have access to psychosocial services as a part of quality cancer care. They provide mental health care referrals to local counseling and support services throughout the United States. If no services are available in your community, a professionally trained Helpline staff member will provide crisis counseling over the phone. To use this service, call the toll-free number.

Cancer Hope Network
www.cancerhopenetwork.org

Email: info@cancerhopenetwork.org

Phone: 1-877-HOPE NET (1-877-467-3638)

This number is answered Monday-Friday, from 8:00 a.m. to 5:30 p.m. (EST). Voicemail is available after hours.  

Cancer Hope Network is a not-for-profit organization that provides free and confidential one-on-one support to cancer patients and their families.  They offer support by matching cancer patients or family members with trained volunteers who have already undergone and recovered from a similar cancer experience. You can submit your request by phone or by email. A volunteer will try to contact you within 24 hours.

National Register of Health Service Providers in Psychology
www.findapsychologist.org

Email: search@findapsychologist.org

Phone: 1-202-783-7663 

The National Register of Health Service Providers in Psychology sponsors this free psychologist referral website to promote consumer access to more than 12,000 professionally screened psychologists in the United States and Canada. This site also contains frequently asked questions about getting help, web links and resources on behavioral health care issues for consumers.

U.S. Institutes of Health - National Cancer Institute (NCI)

www.cancer.gov

Online:  Online assistance is available in English or Spanish through the LiveHelp instant messaging system. This service is available Monday-Friday, 9:00 a.m. to 11:00 p.m. (EST)

Email: Send an email through the “Need Help?” section of the website

Phone: 1-800-422-6237

TTY for deaf and hard of hearing callers: 1-800-332-8615

 Information specialists answer calls Monday-Friday, 9:00 a.m. to 4:30 p.m. local time.

The National Cancer Institute’s website provides accurate information about the challenges cancer can bring. You can search for information by cancer type or topic. You can find information about treatment, financial and insurance matters. You can also learn how treatments in development work and search for a clinical trial in your area. This site also has a good dictionary of cancer terms, drug information and other publications. The knowledgeable and caring specialists have access to comprehensive, accurate information on a range of cancer topics, including the most recent advances in cancer treatment. The service is confidential, and information specialists spend as much time as needed for thorough and personalized responses.

[return to top]

Grief and Loss: Detailed Information This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources. What is grief and loss? Loss is when you are unable to be with or have someone or something that is important to you. Even though not always welcome, loss is a natural part of life. Grief is the natural human response to loss. It is the pain of being without something or someone you wanted or valued. Most people think about grief and loss when someone dies. People grieve after the death of someone who was important to them. But people also grieve other kinds of losses. For example, you may have experienced grief when you lost a valuable possession, when a friendship ended, or if you were not able to achieve an important goal. Some losses are more difficult to bear than others. When a loss is especially important, grief is more than simple sadness. It is a process that happens over a long period of time and can include a wide range of thoughts and feelings. Even though these feelings and reactions can be painful, it is important to remember that grief is a normal, healthy response to loss. Expressing your grief helps you adjust to the loss. Anyone who is involved with the cancer survivor can experience loss and grief. Family members and friends of cancer survivors may experience similar forms of loss as the cancer survivor, or their experiences may be very different. This document will explore grief and loss from the cancer survivor’s point-of-view. However, much of the information and the suggestions can be helpful to family members and friends. Do all survivors experience grief and loss? No one is immune to grief and loss. As a natural part of life, grief and loss come to everyone and in many different ways. However, no two people experience a loss in the same way. What can be a significant loss for one person may not be as important to another person. For example, hair loss from treatment can be very important to some, but less important to others. Losses can also have gains. For some survivors, the gain may be so strong that what has been lost seems unimportant. (“I’m grateful for the cancer experience. It has taught me to see what is really important in life.”) For others, the loss may be so intense that any gains may seem unimportant. (“Cancer has taken away everything that was important to me.”) Also, not everyone experiences grief in the same way. Grief is unique to each individual in how long it lasts, how intense it is and what it means. How, when and what people grieve depends on many things. These can include your age or stage in life, your previous experience with loss and grief and the amount of social support you have. Even two people in the same family – or two people who have similar diagnoses and treatments – may respond differently to what has happened. What losses do survivors experience? Cancer survivors can experience many different types of losses. Some may be easy to see and name. Others may be harder to recognize. The loss may be temporary or permanent, life-altering or a minor inconvenience. The following lists provide a few examples. Even though there is a category called emotional losses below, any kind of loss can be a very emotional experience. Physical losses: A part of your body or a body function Changes in your ability to have sex Energy An ability or skill to perform certain activities Physical comfort Fertility Emotional losses: Sense of security (in your health, in your future) Sense of control or independence Self-esteem or sense of identity Self-confidence Goals, hopes or dreams Faith or spirituality Your sense of life as safe and predictable Habits, such as changes in daily routines, or life “the way it used to be” Social/relationship losses: Relationships with friends, family members or co-workers Sexual relationships Your ability to have your own biological child Loss of certain roles (For example, you can no longer earn money for your family, or you can no longer prepare all of the family meals.) Loss of other cancer survivors Financial losses: Job or job opportunities Financial security Insurance Ability to work How can survivors tell they are experiencing grief? Generally, the grief process follows a recognizable pattern. It often begins with a period of not wanting to believe that you have experienced a loss (sometimes called denial). Sometimes anger follows the denial. As you begin to understand and release the feelings that you are experiencing, a time usually comes when you accept what has happened and move on. Signs of grief include: Strong feelings, such as: Emotional numbness Sadness, despair Anger, general irritation Guilt Fear Anxiety Reactions in your body, such as: Crying Lack of energy Changes in eating or sleeping patterns Feeling generally “under the weather” Changes in the way you behave, such as: Withdrawal/less productivity Hyperactivity Increased need for reassurance Changes in sexual patterns (more or less) Attention getting Aggressive behavior (hitting, demanding) Changes in the way you think, such as: Avoiding or denying the loss Lowered self-esteem Not being able to pay attention or concentrate Thinking about your loss almost all of the time Idealizing the past or future You may have all, many or only a few of these feelings and reactions. And you may experience them in any order. Every survivor’s experience with grief and loss is different. Having some of these feelings and reactions some of the time is a natural way to react to being without something you wanted or valued. At first, the periods of grief can be intense and frequent. Gradually, though, grief responses usually become less intense, last a shorter period of time, and happen less frequently. Knowing that these grief responses are common and sometimes expected can help you understand your situation better. However, you should talk to your health care team about any physical and mental health symptoms that do not go away. A normal grief process can have its problems. Your feelings and reactions may be mixed and intense, causing you to feel confused or overwhelmed. The following questions may help you sort out whether or not you could benefit from extra support: Can you connect your feelings and reactions to particular losses you have experienced? Do you respond to comfort and support from others? Can you directly express difficult feelings, such as anger or sadness? Can you experience enjoyment in life? Are you able to seek and get relief from any physical complaints you may have? Are your feelings and reactions becoming less intense and less frequent over time? If you answered “yes” to these questions, it is likely that you are experiencing normal, healthy grief that will resolve over time. If you answered “no” to these questions or if you are uncertain about how you are coping, ask your health care team for help. Can a survivor experience grief and loss during, immediately after, and/or years after treatment? Cancer survivors can experience grief and loss during treatment, during recovery from treatment, or months or years following completion of treatment. This is true for several reasons. Being diagnosed and treated for cancer can be a traumatic event. At first, your energy may be directed toward coping with the immediate crisis – choosing your health care team, deciding among treatment options, and getting through the treatments. You may have been forced to put off acknowledging important losses. Later, when treatment has ended, you may find energy to focus on your emotional response to the cancer experience. You may also have unexpected reactions of grief to different losses. Reminders of your experience with cancer can bring up grief years after treatment has ended. Examples include: Sensory reminders, such as a taste or smell Routine medical appointments Hearing about another person who has been diagnosed with cancer or who has died from cancer Anniversary events (such as date of diagnosis, date of going off treatment) Important events with family or friends (graduations, birthdays, holidays) Experiencing ongoing losses because of adverse aftereffects of treatment Grief is not a single event. Instead, it occurs over time. Like waves in the ocean, grief comes and goes as you understand and appreciate various aspects of a loss. The amount of time you grieve can vary. There is no particular timetable that you must follow. However, if you experience grief for a long time and are unable to resolve your grief, you should talk to a counselor or therapist. Even though survivors might experience grief and loss over time, people who fully experience grief can be happy again and may even feel stronger and more capable than before. Will grief make my cancer come back? Grief does not cause cancer and cannot make your cancer come back. Grief can be painful, but it is a normal process that can help you cope with losses and changes that have come into your life as a result of cancer. However, pay attention to your emotions and how they impact your body. Grief that lasts a long time and is not resolved can lead to negative feelings and stress in your body. Talk to your health care team if you are unable to understand your grief. They can provide referrals to professional counselors who can help you understand what you are feeling. Why should survivors talk to others about what they are feeling? Important losses that are not grieved are difficult to resolve. They can rob you of energy and joy and prevent you from moving forward into a full and productive life. Sometimes survivors come to understand their grief on their own. However, talking with others can help you: Recognize your losses Express your feelings Connect your feelings and reactions to the experience of loss Understand your feelings and reactions as normal Find ways to cope Adjust to your life without what you lost Feel stronger and more capable than before Even though talking with others about your experiences of grief and loss is important, it may be difficult. People around you may not recognize your losses or your grief. They may believe you should be feeling gratitude, not grief. It can be hard to acknowledge grief and loss when others see you as a winner, someone who should be grateful to be alive, regardless of what has happened. Grief can also be hard to acknowledge when others cannot manage to listen to the intense feelings that grief can sometimes bring. If your friends or family members act like they don’t want to talk to you about your feelings, remember that they may not be used to talking about grief. They may really want to help you, but don’t know how. They may not be aware of how important it is for you to talk about your feelings. You can explain to them that you need someone to listen to you and support you. It might help them to know that you don’t expect them to make everything better, that you just need them to listen to you. It may not be easy, but it is important to let others know what you need. The pain of grief subsides when it is shared. Good listeners can include not only family or friends, but also your health care team, mental health professionals, support groups and faith-based support. This document was produced in collaboration with: Bebe Guill, M.Div. Director, Quality of Life Programs & Services The Brain Tumor Center at Duke University Medical Center Works Cited Heegaard, Margaret. When Someone Very Special Dies. Minnesota: Woodland Press, 1988. Keene, Nancy, Wendy Hobbie, and Kathy Ruccione. Childhood Cancer Survivors: A Practical Guide to Your Future. Cambridge: O’Reilly & Associates, 2000. O’Toole, Donna. Growing Through Grief. Burnsville, NC: Mountain Rainbow Publications, 1989. The American Heritage Dictionary of the English Language. Boston: Houghton Mifflin Company, 1992. Print this Topic Email this story

Grief and Loss: Suggestions The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources. Give yourself permission to release any feelings of grief you may have. You have the right to express in safe ways your feelings about the loss of anything important to you without being judged for your appearance or your words. If you are holding your feelings of grief inside, learn to recognize any barriers that may be blocking your grief. Some barriers to grief may come from within you. These might include: Fear that others will judge you as weak Fear that you, or others around you, will be overwhelmed by your feelings (“If I start crying, I’m afraid I’ll never stop.”) Thinking that some of the feelings and reactions of grief – such as anger or crying – are not appropriate to express Thinking that your loss seems trivial Other barriers to grief may come from others’ comments or actions. Some people may try to comfort you or avoid your feelings of grief by saying: “Don’t cry. Everything is going to be just fine.” “Look on the bright side. At least you have _________.” “You have been a tower of strength. I don’t know how you’ve done it!” If your grief is blocked, you can remind yourself that: Grief is a normal healthy process. Holding feelings inside makes them grow stronger and last longer. Releasing feelings reduces the fear and pain of grief. Feelings are just feelings – they are neither right nor wrong. Grief is a sign of the strength you have for living your life fully and well. You do not need to reject people who are trying to comfort you. You can turn to other ways of safely sorting out and releasing your feelings. Explore a variety of ways to release your feelings. There are many safe things you can do to release your feelings. You can: Tell your story of grief and loss several times to someone you trust, someone who listens to you without judgment. Each time you tell your story of loss, you release the feelings of grief associated with it. Express your feelings through a creative outlet you enjoy, such as music or art. Try banging on a piano, drumming or scribbling with crayons. Have a good cry or, alternatively, a good, deep belly laugh. Watching a sad or funny movie that you enjoy can help trigger your tears or laughter. Find a safe place to yell or scream. Find a physical outlet, such as hitting pillows, going to a baseball batting cage or a golf driving range. Write down your thoughts and feelings in a journal. Seek support. Comfort and acceptance from others throughout the grief process is important. Find a support group. If you are uncomfortable talking about loss and grief with your family or friends, a support group may be an option. Support groups provide safe environments to share experiences with other survivors, learn new ways to handle difficult situations and talk about emotions. You will see different styles of coping with stress and adjusting to life as a cancer survivor. If you are uncomfortable talking about certain subjects with your family or friends, a support group offers you a place to talk freely about what is important to you. Cancer support groups exist in most communities. Some ways to find out more about support groups in your area: Ask your health care team for suggestions. Some cancer programs offer support groups for cancer survivors and their family members right in the clinic or hospital. Call a nearby cancer center or university hospital and ask about support groups. Call the American Cancer Society at 1-800-ACS-2345 (1-800-227-2345) and request a list of support groups and cancer centers in your area. Visit LIVESTRONG SurvivorCare at www.livestrong.org/survivorcare, or call 1-866-235-7205 for information on support groups. Find a counselor/therapist: If your grief is overwhelming or if you prefer the privacy of an individual counseling setting, consider talking to a counselor or therapist. Ask a member of your health care team for a referral to a therapist who works with other cancer survivors. Most cancer centers employ oncology social workers who are specially trained to work with cancer survivors and their families. Even if you are not a patient at a cancer center, the oncology social worker may meet with you or refer you to someone else in the community. It is important to interview the therapist to find out if s/he is the right professional for you. Speak honestly with the therapist and let him or her know your reasons for wanting to work with a therapist. Examples of questions to ask the therapist: What type of education background do you have? What license do you have? What is your experience working with people with cancer? What do you understand about the emotional response to this illness? Do you take my insurance? Do you work with people who are anxious? Depressed? Do you know community resources for people with cancer? Practice good self-care. Grieving an important loss can be hard work. It can create stress and anxiety that might leave you at risk for accidents, illnesses or misuse of substances (such as alcohol or drugs). Concentrate on helping your body tolerate the feelings of grief by: Including rest in the rhythm of your day to help replace the energy that grieving uses Trying to eat healthy foods daily Exercising in ways you enjoy Your health care team can help you find foods and exercises that are right for you. You may also want to create a list of things you can do to nurture yourself if you are overwhelmed by your feelings. Your list may include things like: Calling a friend Taking a hot bath Listening to music Going for a walk You can refer to your list if you are having intense feelings or whenever you think you need a break from thoughts of your loss. As time goes on, you may add or subtract items from your list. Be patient with yourself. Grieving an important loss is not a single event; it is a process that happens over time. Allow the process to unfold at a pace that is right for you. You don’t need to follow a particular timetable or reach a particular goal. There is no right or wrong way to grieve. There is only what is right and safe for you. You may never truly “get over” your loss. However, with patience, acceptance of your feelings and hope, you may find that you have learned to live with it. Print this Topic Email this story

Grief and Loss: Additional Resources

The resources listed below provide more detailed information and support services to help you with grief and loss.  Please read the Detailed Information and Suggestions document for more information and questions to ask.

Click a resource for more information:

• AMC Cancer Information and Counseling Line
• LIVESTRONG SurvivorCare Program
• Cancer Hope Network
• National Register of Health Service Providers in Psychology
• American Psychosocial Oncology Society (APOS)
• National Cancer Institute (NCI)
• American Cancer Society

AMC Cancer Information and Counseling Line
www.uccc.info

This counseling line is staffed by trained professional counselors who can talk to you about your concerns. In addition, they provide medical information, resource referrals and emotional support through short-term counseling at no charge. Services are available to survivors, caregivers, family members, or anyone with questions about cancer.  This service is operated by the AMC Cancer Research Center, affiliated with the University of Colorado Cancer Center. The Web site has additional information about a variety of cancer topics, as well as links to other cancer sites.

 Return to top

LIVESTRONG SurvivorCare Program
www.livestrong.org/survivorcare

LIVESTRONG SurvivorCare offers assistance to all cancer survivors, including the person diagnosed, caregivers, family and friends. The program provides education, information about treatment options and new treatments in development, counseling services and assistance with financial, employment or insurance issues. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations, including CancerCare, Patient Advocate Foundation and EmergingMed.

The LIVESTRONG Survivorship Notebook is a tool that can help you organize and guide your cancer experience. The portable, three-ring binder contains a variety of information covering a full range of physical, emotional and practical survivorship topics. You may order a free LIVESTRONG Survivorship Notebook at www.livestrong.org/notebook. Shipping and handling charges will apply.

 Return to top

Cancer Hope Network
www.cancerhopenetwork.org

Cancer Hope Network provides free and confidential one-on-one support for adult survivors and their families. Survivors or family members are matched with a trained volunteer who has gone through and recovered from a similar cancer experience. Volunteers provide emotional support, and they give helpful information about their experiences with managing the physical, emotional and practical challenges of cancer. Whether you submit your request by phone or by email, a volunteer will try to contact you within 24 hours.

 Return to top

National Register of Health Service Providers in Psychology
www.findapsychologist.org

 Return to top

American Psychosocial Oncology Society (APOS)
www.apos-society.org

The American Psychosocial Oncology Society is dedicated to advancing the science and practice of psychosocial care for people with cancer while striving to ensure that all people with cancer have access to psychosocial services as a part of quality cancer care.  APOS provides mental health care referrals to survivors, caregivers and advocates. You can obtain referrals for local counseling and support services throughout the United States. If no services are available in your community, a professionally trained Helpline staff member will provide crisis counseling over the phone. To access this service, call the toll-free number. If you leave a message after hours, include your name, phone number, survivor's cancer diagnosis and survivor's city and state of residence. You should receive a call from an APOS member within two business days. The site also has links to other organizations and a list of suggested books.

 Return to top

National Cancer Institute (NCI)
www.cancer.gov

Cancer.gov, the National Cancer Institute Web site, provides accurate, up-to-date information on many types of cancer and the challenges cancer can bring. You can also use the site to search for information by cancer type or topic, and you can access information about treatment-related issues. Information about financial and insurance matters is also included. You can learn how clinical trials work and search for a clinical trial in your area. This site has a detailed dictionary of cancer terms. Web site information and publications are available in Spanish.

 Return to top

American Cancer Society
www.cancer.org

The American Cancer Society Web site contains information about many of the challenges of cancer and survivorship. You can search for information by cancer type or by topic. ACS provides a list of support groups in your area, or you can join online groups and message boards. Some information on the Web site is available in Spanish, Chinese, Korean and Vietnamese. Information specialists can answer questions 24 hours a day by phone or email.

 Return to top

Print this Topic

Email this story