"There were days I was so sore and the heat was so oppressive and it was so exhausting," Cowie recalls. "But I had a commitment to the people I was with. The soldiers counted on me being there. Just knowing that made me stronger, and I couldn't let them down. I put one foot in front of the other; that is how I saw my mission through."
Cowie's can-do attitude is a trait common among the new survivors. According to University of Utah psychologist Lisa Aspinwall, a sense of purpose and positivity is adaptive in cancer's midst. In reviewing the literature on survivorship, Aspinwall found that 30 to 90 percent of patients reported benefits, from increased optimism to better relationships, after diagnosis was made. At first it seemed counterintuitive. But the positive, active mind-set "is likely to help patients manage what they need to do next," she explains. "Those in treatment must make dozens of decisions. To hold things together, you need to pay attention to options. Just think about it—negative emotions orient us to threats, but they also narrow our attention. That's not the best state for navigating a complex and changing situation, just what cancer is."
Post-Traumatic Growth
The benefits seen during the trauma, however, may pale against those reaped later, after survivors have had the chance to reflect. "It's hard to grow much when you are in the middle of a war," says psychologist Lari Wenzel of the University of California at Irvine, who works with women surviving gynecologic cancer at least five years. "Instead, strength and meaning unfold for survivors as they retell their stories, again and again."
University of Connecticut psychologist Keith Bellizzi says the life event is so intense that some people use it to reconstruct their lives; they don't return to the same level of functioning but to a greater level. "Post-traumatic growth is above and beyond resilience," he says. "Life after cancer means finding a new normal, but for many the new normal is better than the old normal."
Bellizzi, 39, speaks from direct experience. He was a well-paid marketing professional when, at age 25, he was diagnosed with stage-three testicular cancer so advanced it had spread to his lymph nodes and lungs. A few months later, a CAT scan revealed a golf-ball-size mass in his kidney. Almost as upsetting as the cancer was the news that he might never have biological children of his own. "It was an opportunity to reflect on my life and face my mortality," says Bellizzi.
Following several surgeries, including removal of a kidney, along with aggressive chemotherapy, he made a vow: "If I survived, I would dedicate my life to the fight against cancer." Bellizzi kept his vow. He quit his lucrative job and went back to school, earning masters degrees in public health and in psychology and a Ph.D. in human development and family studies. In 2005, he was one of 24 cyclists chosen to ride with Lance Armstrong on the Bristol-Myers Squibb Tour of Hope to heighten awareness of cancer research. He also has three daughters—and is a leading researcher in the field of post-traumatic growth.
Bellizzi's sense of purpose is just one type of growth that survivors report. Julia Rowland, head of the Office of Cancer Survivorship at the National Cancer Institute, points to enhanced and altered relationships. "You learn who's going to be there for you and who is not—you learn who your friends are," she says. Some friends, upset by the prospect of loss, may detach temporarily or even permanently. As some friendships fade, others may be forged, especially within the community of survivors. "You also learn to empathize," says Rowland, explaining how survivors acquire new depths of feeling.
Pleasures become more meaningful, too. As a team at the University of Pennsylvania found, those suffering chronic illness end up more immersed in art, music, and books. "Appreciation is often enhanced," points out Bellizzi. Many survivors literally stop to smell the roses even if they didn't before.
The sense of self is often enhanced too. "Some survivors discover an inner strength they didn't realize they had," says Bellizzi. "A situation that might have seemed daunting before cancer may, after cancer, seem like something easily handled."
In one important study, Bellizzi looked at generativity—concerns, often arising at midlife, about the legacy one is likely to leave behind. Generativity can be expressed in many ways—making the planet a better place, giving children the love they need, being creative in work or intimate with family and friends. Midlifers surveying the past may vow to do more with the time they have left. But no matter an individual's age, Bellizzi found, cancer was a catalyst for generativity.
While cancer generally sparked more generativity in women than in men, all the survivors Bellizzi studied were more likely than those without cancer to forge a new life path reflecting their core values. Those reporting the most altered perspective "expressed an increased awareness of the fragility of life and the value of loved ones," he reports. "They also said they had learned not to worry about little annoyances." A patient with colorectal cancer said her disease had convinced her to put an end to meaningless pursuits; she resigned from her management position and spent time with her friends.
Cancer can also promote a sense of inner meaning and add a spiritual dimension to life. Lisa Benaron, an internist and pediatrician from Chico, California, learned she had cancer in the midst of other traumas. Her sister-in-law, a dear friend, had just died of breast cancer. And her marriage was falling apart. Six months after her sister in law died, Benaron, too, was diagnosed with breast cancer. Although in stage one, her cancer was a particularly aggressive kind; further, she had the gene that signals ongoing risk.
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