Thoughts on Confronting Cancer in your Twenties
A decade of transition and uncertainty
If you had to pinpoint one word to define your twenties, it would probably be transition. I have friends who are in full-time education, full-time work, full-time work and part-time education, living alone, living with friends, living with family, renting, meeting with mortgage advisors, married, single, dating, living with partners, travelling, changing jobs, having babies, deciding not to have babies, realising they don’t really know what they want to do, and everything in between. The things that hold true for them today will likely have completely transformed by the time next year rolls round. In other words, life isn’t fully formed yet.
In the no-man’s land between the family you grew up in and the life you’re creating for yourself, this decade, along with your thirties, is the time for building careers and families, for figuring out who you are and what your place is in this world. Life is only just beginning… which makes it an interesting time to get a life-threatening diagnosis. While cancer presents a whole host of problems in every decade of life, here are the ones that are particularly relevant to young adults with cancer.
Shock diagnoses
I thought a cancer diagnosis would hit my family at some point, but I imagined it would strike my parents or an older relative. Statistically at least, that was more likely. I was young, fit, and generally healthy, so neither me nor the doctors were too worried about the swelling in my chest. Probably random inflammation, maybe costochondritis, perhaps inflamed lymph nodes. Caught in the whirlwind of a busy life and a brand-new job, I assumed it was my body’s strange response to stress. When things settled down a bit, I’d look back and think ‘well that was a weird few weeks’ and move on. I still wasn’t expecting anything bad when they sent me for a scan. Neither are most young adults who are generally healthy. They are prime suspects for misdiagnoses morphing into shock diagnoses.
I went alone to a haematology appointment the day after my scan. The results weren’t in yet and I was probably just anaemic. Or burnt out. I was tired, but we all were. Weren’t we? And statistically, burn out is more common than cancer in your twenties. It was a little disconcerting to find that the haematology ward was also the oncology ward, and to sit beside mannequins modelling hair loss gear in the waiting room. “I went to the cancer ward today” I imagined telling my family later, “it’s a different world in there.” An hour later a nurse called them to say that the cancer was inside me.
Receiving news of a likely cancerous tumour while being alone is a life-changing experience. There are so many people who would have been there for me, but nobody was expecting anything sinister, least of all me. This experience is shared by many young cancer patients. One girl got a call on the way to work, another heard the news straight after a scan, another thought he was going to a routine appointment. In young people, the speed at which things escalate from ‘nothing to worry about’ to ‘urgent treatment required’ is shocking to everyone, including the doctors.
Fertility
I didn’t know this before chemo, but quickly found out that chemotherapy and radiotherapy can impact fertility in young adults. Some treatments have the potential to cause damage to eggs and sperm, while others can harm reproductive organs or induce premature menopause. It’s a devastating double blow to find out that surviving the cancer may cost your fertility. While fertility preservation options may be offered in certain cases or locations, they are far from guaranteed and often not an option if treatment needs to be started imminently.
Fertility quickly becomes a crucial topic of discussion, forcing you to think about something that may not have previously been on your radar. Often these discussions are happening at the same time as friends and colleagues are announcing pregnancies. I felt like my body was growing tumours while my friends’ bodies grew babies.
Aside from the grief I felt, I felt most aligned with my pregnant friends when I was going through chemo. They too felt like their body wasn’t their own, had their life controlled by medical appointments and dietary restrictions, spent time in hospitals, nervously awaited scans and struggled to sleep. Yet it felt cruel to sit in the ultrasound waiting room alongside pregnant women my age, not knowing if that experience would ever be an option for me.
Fragile futures
When I was told I had cancer, everyone said that cancer doesn’t discriminate. No matter who you are or where you’re from or what you do, you’re vulnerable. For the longest time though, it wasn’t the Why me? question I got hung up on, it was the agonising Why now? Life had just been getting really good! I was in a happy relationship, loved where I lived, had a great group of friends, a supportive family, and a brand-new job I was enjoying. I’d spent the first half of my twenties figuring out what I wanted to do with my life and I felt like I’d found answers. Then a great gust of cancer came and toppled my carefully constructed house of cards.
Cancer disrupts life plans, regardless of age. When it strikes in your twenties, it delivers a double blow – shattering your life plans and instilling the fear of missing out on significant milestones. Whether it’s career goals, home ownership, relationship dreams, or starting a family, all these aspirations suddenly seem fragile and uncertain. Resuming work or education after cancer treatment becomes a daunting task. Many young adults are in the dating world, or raising young families, or even pregnant when their diagnosis comes, leading to incredible strain on all areas of their lives. Not to mention the devastating financial impact that cancer can have, especially for young adults on short-term contracts, or transitioning between education and work. Long-term survivorship then brings its own set of challenges for those who are lucky enough to come through it.
Loneliness amid support
Undergoing cancer treatment in your twenties is an isolating experience, even with a strong support network. It can feel like all your friends are achieving the expected milestones of the decade while your very life is in question. It’s easy to convince yourself that you’re alone. Even though you’re meant to say you’d never wish this on anyone, deep down I sometimes wished others could experience just a fraction of the cancer experience, because advocacy is exhausting.
Cariad Lloyd, an author and comedian who presents the excellent Griefcast podcast, often shares her experience of joining the ‘grief club’ as a teenager. She was one of the first of her friends to experience profound grief when she lost her Dad, so she held open the door to the club and put out the nibbles. Being diagnosed with cancer in your twenties feels similar. Other people will inevitably join you, but for now you’re the only one wearing the badge which makes you stick out like a sore thumb. The fact that you’re the youngest on the chemo ward and medical professionals are constantly pointing out how young you are doesn’t help matters either. Plus, your identity now includes “cancer patient/survivor” and that shift means you will be the person others think of when someone else they know receives a diagnosis.
It’s a lonely place to be, but you’re also never alone. In the whirlwind of appointments and support, a cancer diagnosis quickly involves a loss of independence, which in your twenties is often newly acquired. This goes hand in hand with becoming dependent on others, and learning to ask for help, when all you really want is to get on with living your life.
Emotional Turmoil
As I sat in the dentist’s waiting room post-chemo, I discussed dental concerns with another patient. “But you’re young!” she exclaimed, “there won’t be anything wrong with you.” I clenched my jaw and remained quiet. Apart from the odd health niggle, most young adults are at their peak health and fitness, so the impact of a diagnosis takes a while to settle in. During a non-cancer related appointment, I automatically ticked ‘NO’ on a form when asked if I had any health conditions. “Remember to write down the cancer”, the nurse kindly prompted me. “Oh yeah,” I mumbled.
Young adults are nearly 60% more likely to develop anxiety and depression following treatment compared to their healthy peers,* challenging the living-your-best-life-after-cancer narrative so often portrayed in the media. Cancer not only robs young adults of their present, but also fills their future with uncertainty and shakes a shaky sense of self and body image. As I sat amongst elderly patients in the chemo room, I couldn’t help but think ‘you’ve had your life! This is so unfair!’
I felt incredibly embarrassed and ashamed when I was diagnosed. My consultant said the cancer could have been lurking in me for up to two years. Two years! Despite repeated advice that ‘I knew my body best’, I clearly didn’t know it at all. Was the body that I knew so well harbouring any other dark secrets? The shame intensified when the scan revealed the size and number of tumours. I felt like I’d neglected myself in some way or could’ve prevented this from happening. My overwhelming feeling was I should’ve known. How didn’t I know? Self-blame is all too common amongst cancer patients, despite many of us recalling how lumps seemingly appear overnight without warning.
Shame comes from feeling like there’s something wrong with you, so it’s tricky when it’s linked to cancer and there actually is something wrong with you. In the past, when I heard cancer stories, I’d subconsciously calculate the reasons why it wouldn’t happen to me. Would others be doing the same calculation when they saw me? It took time for me to accept that my body wasn’t faulty, that it was in fact doing everything it could to contain the disease. Even with advanced cancer I was climbing mountains and swimming in lakes! Viewing the cancer as an invasive force, like the rats in my previous flat, helped me to shift my perspective and see cancer as the problem, not me. Although embarrassment and shame may be misplaced, they are common feelings following a diagnosis and the more you’re told not to feel that way, the louder the feelings become.
The sense of shame and isolation is combined with anger at the diagnosis and grief over what your life should have looked like. I often heard older patients say they had to get through the brutalities of treatment for their kids, who needed them. Their kids were their purpose, but many young adult cancer patients are still trying to find out what their purpose and goals in life are. Victor Frankl, a holocaust survivor, wrote extensively on what it means to live, concluding that meaning and purpose, connection and relationships, personal growth, contribution and service, and enjoyment of beauty and pleasure are all essential. Cancer treatment takes away many of these things, so it’s no surprise that the mental health impact of a diagnosis is huge. When cancer makes the future seem so bleak, it’s important to find a reason to get through it all.
Resilience and Adaptability
Cancer in young adulthood adds an extra layer of complexity and uncertainty to a time already marked by transitions and challenges. The relentless uncertainty feels particularly burdensome as plans are disrupted, milestones are jeopardized, and the future seems fragile. However, there are some ways in which younger adults are better equipped to deal with the challenges cancer presents.
Physically, their health and resilience often enable them to withstand demanding treatments and recover faster. Support systems are often strong, with a bunch of energetic friends willing to help, and their flexibility and adaptability means they can adjust more readily to the disruptions that cancer brings. Young adults are generally more adept at using technology to their advantage, easily accessing online support communities to find and connect with others going through the same experience. When a lot of standard cancer resources are geared towards older people, this is a fantastic thing. (Online proficiency can also be a curse: while previous generations placed complete trust in their doctors, our generation places complete trust in doctors only once we’ve verified everything they’ve told us on the interwebs.)
Without seeming like I’m giving this post the silver lining treatment, let’s be clear that THERE IS NEVER A GOOD TIME FOR THIS. While I looked at older adults in chemo and thought ‘they’ve already had their families’, they probably looked at me and thought ‘I wish I was young and fit enough to take the treatment.’ The grass is always greener, even in cancer wards where all of it is brown.
When cancer strikes at a young age, it inevitably shapes you in some way. The young adults I’ve met going through cancer are some of the most honest, accepting, determined and resilient people I know. They’ve shown me that it is possible to transform a traumatic experience into a catalyst for growth and compassion, and, despite everything, to still find something to laugh about each day.**
**but, to be clear again, none of us wanted it.
Laura writes... 