Survivor’s Guilt in Cancer Patients

Survival after cancer treatment has been discussed and researched extensively.  Fears about recurrence, panic and anxiety that peaks just before the 3-month, then 6-month, then annual exams, are experiences every cancer patient has and talks about. What is LESS talked about is the guilt that many cancer survivors feel for “surviving” – when so many others they knew intimately, or are just aware of, do not. “Survivor’s Guilt” is a phenomenon that one does to oneself and there are different degrees of it; from feeling bad for not suffering enough; to being healthy and alive after cancer treatment is completed when others have not been as fortunate.

There is another type of Survivor’s Guilt that one does to someone else, “Cancer One Ups-Manship.” This is when a cancer survivor minimizes another’s cancer if it wasn’t as severe as theirs. This may or may not cause the person who had the less severe cancer diagnosis to feel guilty and minimize their experiences and feelings.  In this case, the Guilt is about not having been as sick as the other person, and therefore, not really having “earned” the same level of distinction as the other one. This is complicated and less common, although many of you have possibly met people like this. These people are often competitive in their assessment of how much they have suffered, how severe their condition and treatment were, as compared to others.  This is often accompanied by tremendous rage which is being vented on you – for not having suffered as much as they have, and so not as “deserving” of attention or celebration as they are either.

Interestingly, the “Why Me?” question that arises when one is first diagnosed with cancer and others are not, becomes the “Why Me?” question when that same person survives cancer treatment and others do not.  This latter question can then be complicated with the additional guilt that “Since I have survived, I should be doing something very meaningful and purposeful with my life to justify my survival,” and/or “There must be a deeper meaning for my survival and I am obligated to figure that out and do the right things to prove to the world that I am deserving of my survival.” What enormous, heavy burdens these thoughts present to the cancer survivor.

Survivor guilt occurs in all age groups and around many issues. Typically, when it persists, it often brings on obsessional self-blame and depression.  Similarly, when a cancer survivor discovers they carry an identifiable oncogene, they feel guilty about the risks they have passed down to their children, whether those children have had their own cancer diagnosis or not, and whether they may someday have cancer.  Survivor guilt can  also take the form of self-blame when a cancer survivor feels they aren’t “doing it right;” like a Lance Armstrong or someone less public who is able to live life in a way they believe to be “better,” or “more optimistically,” or “more energetically” than they can.

Survivor Guilt can manifest differently. In adolescents, it can look like anxiety or defiant behavior. Kids may not want to think about having cancer, yet unconsciously, thoughts and fears about their cancer still exist and may be experienced as worries about other things.  Defiance may be the result of denying that the cancer really had any serious impact on the adolescent, so risky behaviors (smoking, drugs, disregarding necessary health care exams or medications) may be their way of resisting their reality.  In fact, in the Fall 2010 issue of CURE magazine, it was suspected that approximately 16% of teens who survived cancer treatment experienced symptoms that substantiated the diagnosis of PTSD.

Guilt and self-blame are common emotions survivors feel who believe they have caused their own cancer; survivors of lung cancer who have smoked, parents who may have used particular medications and later a child of theirs is diagnosed with cancer, some who believe their negative attitude or sins they have committed are the reasons for their diagnosis. Some feel guilt over the toll their cancer takes on their loved ones; spouses who have to go back to work to augment the family income, or need to pursue their own psychotherapy or take medication to deal with their own intense emotional responses to their loved one’s cancer.

“Survivor’s Guilt” may be better described as “Survivor’s Sadness” for those who have not had the positive results from treatment.  There is probably one reliable solution to survivors guilt (or survivor’s sadness):  recognition of their feelings and communication about those feelings. You know that others have fought as hard as you have, have suffered as much (or more) as you, and still, they did not have the results that you have.  While there was no answer to that question: “Why Me?” when you were first diagnosed, there is no answer to that same question the cancer survivor asks when treatment has been successful.

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