In this first of a two-part Cancer Chat survivorship series, we listen to MUSC psychologist Dr. Wendy Balliet chat with Charleston resident Liza Patterson about how she handled her fight with Lymphoma and mental health, all while being a new mom. Enjoy the chat!

Coming up on this episode of Cancer Chat…

Being a cancer survivor doesn't mean your journey with cancer has ended as many around you might assume so enduring what you have endured as a cancer survivor likely has changed you physically, mentally, and emotionally, and acknowledging these changes and addressing them are going to help you cope better with the difficult emotions and live life in a more meaningful and present-focused way.

Welcome to Cancer Chat, MUSC Hollings Cancer Center’s podcast. I'm Dawn Brazell communications director at Hollings. We'll be looking at some of the mental health struggles that cancer survivors face both during and after their treatment. In today's episode, we'll also be exploring how those emotions are much more common than you might think. Today. We have Dr. Wendy Balliet a psychologist who practices psych oncology at Hollings and lymphoma survivor Liza Patterson, who received her cancer treatment at Hollings. Welcome to our podcast. So we all know cancer doesn't happen in a vacuum. It happens as part of everyday life and often has a tremendous emotional impact. Dr. Balliet, I know you see a lot of this and hear this from your patients. What do you wish cancer patients knew about the potential mental health stresses that a diagnosis can create?

I think it's pretty common knowledge or at least I hope it is at this point that when people are diagnosed with cancer, it's, it's really common and normal to experience anxiety and depression. But, but more than that, Dawn, like you said, cancer doesn't happen in a vacuum. So when you first receive that diagnosis for, for many of my patients, they describe it as, you know, their rug being pulled out from under them. Oftentimes it's completely unexpected and really shakes your world view. This, this world you were living in, felt safe. You had plans, many people have healthy families and jobs or in school and are looking towards a bright future. And when, when a cancer diagnosis hits, all of that kind of gets put on pause and people are left, needing to live with a whole lot of uncertainty. So while depression and anxiety are really common, it's also common for folks to struggle with other psychosocial concerns like fear of fear of death, fear of losing a job, your identity changes in your relationships.

Both friendships, families with significant others as your body kind of changes while you go through a lot of the treatments that cancer patients have to go through. So it's, it's a whole long trajectory in a journey that never quite has a finish line. I guess I I'd be interested to hear what Liza has to say about that. But I think once you're diagnosed with cancer and move through the treatment and enter into survivorship, it does continue. And many people continue to struggle kind of intermittently throughout their lives with a lot of the concerns I, I mentioned a minute ago,

Liza, tell us what your cancer journey has been like. And if any of what Dr. Balliet said resonates with you?

Yeah, it absolutely does. So my I began getting symptoms when I was probably 25 to 30 weeks pregnant with my daughter. And they were all symptoms that could be related to pregnancy. So nothing was really thought about that until until I would say after my daughter was born, I was having, you know, intense chest pain. And I might, one day I woke up and my neck and my face were swollen. So my mom decided to take me to the ER and that was where they found the mass in my chest. And as Dr. Balliet said I had plans for my future. And it was like, immediately, I, I just said, what about my daughter? Like, what do I do? Because at that point, I didn't know it was cancer. I thought maybe I was going to die. Like an even if I knew it was cancer, I'd still think maybe I'm going to die. What do I do with my family? You know, I had, I had plans to raise my daughter to be with my husband, to be with my parents, my siblings. So I was shocked and I didn't, I didn't really know how to respond. I just, I was just I was stuck. I was really stuck,

You know, I think there's so much focus on the physical part, particularly when you first get a diagnosis, you really don't have much time to think about the emotional part. I found that to be true.

Yes, yes. Yeah. I was ready to just like fight physically I didn't think about how I was feeling. I just went, went forward.

That makes, I was just going to jump in and say, that makes so much sense that when you're given a cancer diagnosis, you really go into fight or flight mode. And it sounds like for you guys, you really went into fight mode do what you need to do to get healthy and be there for your daughter without much time to really spend on the emotional side. Absolutely.

So, Dr. Balliet, when do you usually see cancer patients? Cause I know in the initial phase of the diagnosis they're generally overwhelmed.

Yeah. I mean, I would say it really varies. We, we certainly see people throughout the spectrum of a cancer journey. So there, there are times when we may see people that have a recent diagnosis and need a little bit, or a lot of support as they adjust to the diagnosis and then they are kind of okay to, to move on in their, in their own, in their own way. With some of the coping strategies we can teach other times depending on the patient's background and what other stressors might be happening at the same time. Right. Because the world doesn't stop. I think Liza's story really highlights that, you know, you want the world to stop. So all you can do is focus on getting better, but you're a new mom, or you just had your first grandchild or there are other people in your family that are sick. And so depending on the individual coming in, you know, we, we really see people throughout the journey and sometimes they kind of take it, you know, it's okay to take a break from therapy. We encourage that. And when things like the pandemic, we tend to see an uptick in utilization of services, which is, which is great. We want to be able to help.

So when a patient finds out they're cancer-free and in remission, that should be an exciting, exciting, and happy day. Right. But that is not always the case with some survivors.

So sometimes emotional wounds of cancer take longer to heal than physical wounds. So some of the most common challenges we see among cancer survivors include fear of recurrence, grief over the loss of one's pre-cancer life. What life was like before this diagnosis happened. And kind of your, your pre-cancer view of the world as a safe place. Like I mentioned earlier, there's a lot of body image disturbance that can happen because of the results of surgery and treatments social strain. So there may be strain in your relationship with family and friends because of having to lean on them for so long to get through, to get through the treatment. And I think another piece that that gets that's at play when we're talking about relationships, relationships and survivorship is that once you ring that bell and you're declared cancer free, and I put that in quotes, your friends and family are like, yay, we're done right.

But, but you're not most people aren't as cancer survivors. You're not done, you know, there's that worry might come back. There's some, you know, survivor guilt that I think we'll talk about in a minute, you know, why did I live when all these other people I know died guilt for where you couldn't be, you know, raising your daughter or being there to see your grandchild born. So ringing that bell, it's a, it's a celebratory day and there's still a lot of angst that many, if not most cancer patients experience to some degree.

Liza, have you found that to be true?

Yes, absolutely. I think that when I was declared in remission was when my mental health challenges really began. I, I, I found the fear of recurrence was really strong. I basically, any tiny little symptom I would have blew up and I was like, oh my gosh, I need a scan. I need blood work. I need something. I need to know that I, that I'm okay. Because I was in fight or flight mode and I was immediately with taken out of that. So I just had to focus on the emotional parts. And I really, I had to focus on being a mom again, and I wasn't ready for that. I, I didn't get the transition. I just was cut off from it. You know, I, I had little glimpses here and there when I was home and able to help my husband or help the nanny take care of her, but I I didn't have like the steps that most moms get to learning about their child and how to take care of her.

So yeah, the, the, the emotional part really began for me when I was declared in remission. My, my biggest issue would have been the struggles with the thoughts about death. I had faced my fate at a very young age. I was 29 when I was diagnosed and began treatment. And I realized that, you know, we will die at some point and I might die sooner. And that was so scary. I didn't know what I was going to leave my family with. I had to search for resources to make me accept my fate and give me hope about, you know, if, if I wouldn't make it, what would happen to me and in the afterlife what would happen with my family. So it was just on a real search. Was that surprising to you?

Did you think when this was over you, they would just be over or were you really surprised? Oh, I was so...

Surprised. I was extremely surprised. Everybody asked me when I rang the bell. They were like, aren't you so excited? And I was like, that might've been the worst day of my life to be honest. Because I was done, I didn't have people taking care of me and fixing me anymore. I had to fix me and I didn't no. How

So? Yeah, it was, I was very surprised that that was how I felt. That was not what I was expecting. And it was a real disappointment. It was, yeah, it was a big let down.

In the second half of this episode, Dr. Balliet explains the science behind depression and anxiety after surviving cancer, and Liza takes us back to the beginnings of her cancer journey.

Patients go from having a medical support system and medical family. You know, you've got your favorite nurse infusion nurse. You've got your, you know, the CMA that you talk to every day and kind of this built in social network that once you moved to surveillance no longer is, is there

Now back to the chat.

So Dr. Balliet how normal is this? This is what Liza is describing. Common.

It is incredibly common, much more common than we talk about as a society. Unfortunately, because I think the more we talk about it, the more we can, we can help people like Lysa prepare and get through it. Some, some of the studies I've, I've looked at site up to 20% of cancer survivors experienced some level of anxiety and depression with even more than that kind of meeting subclinical levels of depression and anxiety. And we know people tend to under-report when we're talking about depression and anxiety in general. So I wouldn't be surprised if we're, we're looking at, you know, half of the population of cancer survivors, really struggling with some of the things Lisa has described. And I think, you know, the, the crux of it is when you're in treatment, you're in that kind of problem focused coping. So you're getting surgery, you're getting radiation, you're getting chemotherapy, you're doing something to win this fight to eradicate the cancer. And so it gives people some semblance of control, even if it's not actual control, because we're not sure kind of what's going to happen in terms of the outcome. But it gives you that sense that you're doing something to beat the cancer. And then when that's done, you're left with that emotional piece of it. And I think that's what lies I really described pretty beautifully there.

She really did. Liza, did you feel a loss of control when the treatment ended? Yes.

I definitely felt a loss of control. I felt like I had to all of a sudden learn how to take care of me when I hadn't been taking care of me. I mean, I had been doing all of the things I was told to do to take care of me, and now I had to learn how to do it on my own. So I looked for resources such as books. Podcasts shows that taught me some self-help some self-care I started exercising that well, that came quite a bit down the road because I was still extremely fatigued, but I, once I was really ready to start over again, I began exercising. I reached out to other survivors. I had other survivors reach out to me, which I, because I would put myself out there on social media. And through my husband's social media, people would find me and they were struggling too. So I was able to talk to them. And there aren't a lot of people my age in my situation that have gone through the same experience, but there are a few and they're looking for you too. So it was nice to find them when I was ready, because it took some time also to be ready, to reach out to people and have people reach out to me and really talk about what I dealt with and what I was going through emotionally.

You know, that's interesting that you bring up timing. I think timing is everything. And the other thing I find interesting is it's not always family members that you might need support from. Can both of you sort of address that why other survivors are so important

When you enter survivorship? I think in maybe Liza can speak more personally to this, but patients go from having a medical support system and medical family, you know, you've got your favorite nurse infusion nurse. You've got your, you know, the CMA that you talk to every day and kind of this built-in social network that once you moved to surveillance no longer is, is there. And, and these people, even though they don't have cancer, or that we know of her going through treatment, they understand what you go through as a, as a cancer patient. And so reaching out and, and meeting other people through support groups with, with other, other people who've had similar experiences really helps I think, in reducing that sense of isolation and increasing the sense of hope, you know, that you can, you can get through this, that you're alone and that what you're experiencing is normal.

I mean, how does that sound to you? I know the fatigue, there's just so many issues that cancer patients really just need each other to talk to. Yeah. It's she

Hit that nail on the head. The part that really resonated me with was the instilling hope. I, my family was a great support. They were amazing, but they didn't have cancer. They didn't know what the loss of hope felt like. They had hope pretty much the entire time that things would be fine. And I had hoped throughout the treatment, but afterwards was when I lost hope, a hope and a future, hoping that things could be, feel like that I could feel like me again and finding other survivors gave me hope. And it gave me the feeling that I wasn't alone, that I was going through this and other people had gone through it too, which I wish they hadn't, but I'm glad that they're there for me and I'm there for them. So that was really important to find something, anything that could give me hope to continue my journey in life.

So lots of how old are you now?

I'm 31 now.

And you were diagnosed at 29, is that right? That's correct. Okay. Can you take us back to then when you were 29, what was going on? Did you know about lymphoma? Just talk us through that, create the scene for us.

I had no idea what lymphoma was. They brought that word out and I was like, what is that? And they said cancer. And I was like, I didn't even know that was cancer. So yeah, I when I was initially diagnosed, they did not have the answer that it was lymphoma that took about a week. I had to get a biopsy. And when they finally told me it was lymphoma, highly treatable, even curable, I was almost relieved. I was, I was like, oh, okay. So I just have to fight and I'm good. I have cancer, but it's curable. So let's go. You know, so it was probably good that I was so young and, you know, ready to, to fight for my future, for my daughter's future for my relationship for my family. So I think that that was the benefit of being so young when I was diagnosed.

But I learned a lot about lymphoma since then, and I, you know, I I've done some fundraisers. I've done the light the night for the leukemia lymphoma society. I, I've done a lot of research about my type of lymphoma about others other blood cancers in particular, also some breast cancer, just to know what I've had family members, friends, things that have, you know, experienced people that have that. That's what a lot of the women my age have gone through is breast cancer. So I've really familiarized myself with, with cancer. And now I'm kind of an expert,

You find that help, that process helped you reading researching. Yeah. Yes

And no, I shouldn't have researched while I was in treatment. It probably would've been helpful to do it more so after. But knowing now I do feel that it's been helpful. Yes. To know about just every little detail I like to know. Now, tell me about the personal side though.

New mom, what was going on in your personal?

So in my personal life, yes, I had a five week old daughter. My, my only child and I had to, I had to leave her with my husband, with my mother anybody that was able to come take care of her. We eventually found a really amazing nanny for the weekdays and then another one for the weekends, because I was, I was checked out. I couldn't function as a mother. The cancer really took over the treatment was pretty grueling. I went in patient. I was inpatient every 21 days for five to six days at a time on a four day, 24 hour drip of a mix of chemos. So I was very sick. I would get about a week, maybe a week in between treatments. I did six treatments. I would get maybe a week in between, between treatments where I felt like I could go out to dinner with my family, or maybe a short walk, but that was really pushing it.

So that was a huge struggle. I didn't know how to bond with my daughter anymore because I had to stop breastfeeding immediately. At, when she was about six weeks, I had to stop breastfeeding, which luckily she took right onto the bottle. So she didn't, she didn't care. She was fine with that. It was just strange. I didn't know how to be a mom. And that was really hard for me getting back into it. Once I was declared in remission, learning how to become a mom knowing what her different cries meant, what she liked to eat, what she liked to play with. That was, that was really sad for me. I

Can't even imagine they're just the roller coaster of hormones you have as a new mom. Right. Dr. Balliet, you know, these emotions sound like a lot to handle on someone's on why is it important for, to seek help when needed? Liza seems like quite the extrovert, but I know other patients, you know, they're maybe not as proactive, I'll put it that way.

Yeah. I think seeking help when you're feeling that down or anxious is, is crucial because it doesn't go away. So, so many times, you know, I, I have, I have patients tell me, well, you know, I, the way I grew up was pull yourself up by the bootstraps. Like you don't talk about your feelings. You don't, you know, just suck it up, buttercup kind of thing. And that doesn't eliminate the difficult emotions. Those are still there. Sometimes they come out in different ways. You know, we, we've all probably been guilty at snapping at our, the people we love the most because we're angry at someone else. And when we're talking about cancer and cancer survivors, not managing their emotions or getting help when it is becoming overwhelming, unfortunately we see people stopping, taking care of themselves, whether that means they're no longer going to their surveillance appointments, they go back to maybe old habits like drinking or smoking or drugging or eating a pint of Ben and Jerry's every night.

So some of those health behaviors that really can cause other physical problems down the road. So getting help, learning how to talk through these emotions is, is really crucial in living a meaningful and purposeful life. One of the things I always say, or I often say to patients is the only way out is through I think we've all probably heard that saying that. I think this is a great example where it really resonates as true. You can't hide your feelings under a rock and expect it to stay there forever. So learning how to express them, leaning on other people to help you hold them really goes a long way.

Thank you for listening to this episode of Cancer Chat. Don't forget to follow us on Facebook, Instagram, and Twitter, and visit us online at www.hollingscancercenter.musc.edu. And remember, here at the Hollings Cancer Center, we're finding tomorrow's cure for cancer today.