When You're Diagnosed With Cancer -- Again

The first time Gwen Darien was diagnosed with cancer, she was a 35-year-old, newly divorced art director in California. "It was a completely unexpected and world-altering and mind-altering experience," she says. "I thought I was going to die."

The second time Darien was diagnosed with cancer, she was a 56-year-old wife, stepmom and cancer advocate in New York City. Her biggest concern that time around? "Telling my stepdaughter," says Darien, now a 57-year-old executive vice president of programs and services at the nonprofit Cancer Support Community.

"Having cancer as a young adult and having cancer as a middle-aged woman is very different," says Darien, who had non-Hodgkin lymphoma and then breast cancer. "The relationship to your family and friends is very different, the relationship to your career is very different and the relationship to your values is very different."

The health care system is also different. At the time of Darien's first diagnosis in 1993, doctors didn't talk about how cancer treatment would affect her fertility, quality of life or risk for future cancers -- only about how it would affect her disease. "They really focused on the present," she says.

Today, oncologists talk to their patients "a lot" about how treatments can increase the risk of future cancers, says Dr. Julie Vose, president of the American Society of Clinical Oncology. They're also encouraged to provide patients with a survivorship care plan, or a written document that details the patient's treatments and suggestions for long-term care, she says. Plus, treatment options are new and improved, says Vose, also chief of the University of Nebraska Medical Center's Oncology and Hematology Division. "Treatments nowadays have much fewer side effects" like nausea, she says.

But no matter how much -- or how little -- the medical approach to cancer changes between a patient's cancer diagnoses, hearing "you have cancer" as a cancer survivor is different from hearing those words for the first time. "It's distressing for a patient who has had one cancer and put that behind them to be diagnosed with a second cancer," says Elizabeth Ward, senior vice president of intramural research at the American Cancer Society.

For Ilana Pergola of Bend, Oregon, a non-Hodgkin lymphoma diagnosis at age 27 was blanketed in "the bliss of ignorance," she says. "I did not know what everything was." A melanoma diagnosis at 31, on the other hand, left Pergola, now 39, hysterical -- thanks to the "four years of research and obsession" she acquired in the interim. "I knew that this was bad and that this could kill me way easier than the first one," she says.

For Darien, the knowledge gained working in the cancer field only took her so far. "In some ways, I was much more well-prepared, and in some ways I was shocked at how ill-prepared I was," she says. "You have something like this happen, and a lot of your skills just fly out the window."

When Lightning Strikes Twice

The good news: Today, 2 out of 3 people who have cancer survive at least five years, according to a March Centers for Disease Control and Prevention report. That's a marked change from 1975 to 1977 data, when the survival rate was 50 percent, the American Cancer Society reports.

But with survival comes an increased risk of acquiring another cancer. If patients receive radiation for their first cancer, for example, they might be more likely to develop some types of blood, breast, lung, thyroid or skin cancers later on -- although the benefits of treatment far outweigh the risks of acquiring future cancers, ACS says. Second cancers might also be linked to a mutual underlying cause such as genetics or alcohol use, or simply age, says Ward, who authored ACS's report on survivors with multiple primary cancers.

"Many subsequent cancers that people get are not in any way related to their first cancer -- they're related to the fact that all of us have a certain risk of developing cancer in our lifetimes," she says. For example, only 1 percent of 30-year-olds but 18 percent of 70-year-olds who have never had cancer will develop it in the next 10 years, according to ACS .

While cancer survivors have a 14 percent greater risk of developing a new cancer than the general population, being a multiple-time cancer survivor is still uncommon: About 8 percent of the cancer survivors in the United States in 2005 had been diagnosed with more than one cancer, according to the ACS.

But that doesn't mean cancer survivors can assume their experience with cancer is "one and done." "When patients have been treated for one cancer, they completely forget about their health care maintenance for everything else" -- skipping mammogram screenings if they didn't have breast cancer or eschewing regular checkups for measures like cholesterol, she says. Instead, they focus their vigilance exclusively on preventing a recurrence of the first cancer. "I can't tell you how often that happens," Vose says.

That wasn't what happened to Darien, who was at an annual OB-GYN exam when her doctor suspected breast cancer. This time, it was less startling. "One of the great risks for a second cancer is having a first cancer, so it's always in the back of your mind," she says. "You never really completely let it go."

Pergola, on the other hand, had tried to let it go after being cleared of lymphoma. Her mantra was "no news is good news." "You don't worry until they give you something to worry about," she says. "I never got that really bad news, so I just kind of rolled with it." Then, while showering, Pergola found what turned out to be melanoma in a spot "where the sun doesn't shine." Despite being at the hospital "practically more than my job," says Pergola, who works in grocery management, "[doctors] didn't catch it -- I did."

Treating Cancer ... Again

Because Darien's treatment regimen for lymphoma included radiation to her chest, radiation wasn't an option when it came to treating her early stage breast cancer. Instead, she had a mastectomy and hormone therapy.

"With the lymphoma, I was feeling so sick that, as difficult as the treatment was, it made me feel better almost immediately because I could breathe, I could walk," she says. The breast cancer surgery, on the other hand, was tough in a different way because she never had surgery before and wasn't feeling bad to begin with. "I was very prepared for treatment. I was not quite as prepared for recovery," she says.

How cancer survivors approach a second cancer may hinge on their previous regimen, since you can only receive so much of some treatments like the chemotherapy drug Adriamycin in your lifetime, Vose says. In some cases, a second cancer may be more resistant to treatment, while in others, the immune system may be too compromised to tolerate other treatments. "It's highly individual as far what they've gone through the first time," Vose says.

That's one of the many reasons why it's important for cancer survivors to keep records of their treatments and ask their doctors questions about their likelihood of recurrence or developing another cancer. "Feel entitled to have great communication with your health care team," Darien says. "If you don't' feel that way, you have to think about what you're going to do to change that."

For Pergola, treatment the first time included an unsuccessful six months of chemotherapy, followed by a successful stem cell transplant. The second time around, she underwent multiple surgeries to remove the melanoma -- a treatment not affected by her history of lymphoma. What was affected: her choice of institution. She went back to the same hospital that treated her first cancer, even though it wasn't as highly qualified in treating skin cancer as a neighboring hospital.

"I knew the technicians, I walked around that place in the middle of the night, I knew every inch of that hospital, so I was never scared," she says. "It felt like home."

To others facing a second cancer diagnosis, Pergola suggests turning to whatever coping mechanism worked best the first time, be it activism, an online community like Stupid Cancer (her recommendation for young adult cancer patients) or a hospital support group. "Be strong and reach out, and don't feel like you're alone," she says. Your oncologist -- who is required to screen patients for distress -- can also point you to professionals who specialize in the mental health of cancer patients and survivors, says Mark Lazenby, associate professor at Yale School of Nursing and president of the American Psychosocial Oncology Society.

"Helping patients cope with the emotional, spiritual and practical issues that come with a cancer diagnosis can improve their psychosocial well-being [and] help them adhere to treatment," he says. They'll also be less likely to fall off their treatment regimen due to depression, anxiety or logistical issues like getting to a cancer center.

What coping mechanism not to use? Ruminating on the question, "Why me?" Pergola tried it once -- and won't do it again. "I had one really good cry about it, and then I said, 'Why not me?'" she remembers. "If it wasn't me, it could be my sister, and I don't want that ... because I know I can handle it."