Teens: Learning About Managing Your Mental Health After Cancer

Finishing treatment after cancer is a big milestone. But life may not feel normal right away.

During treatment, most people focus on getting through each day. It's often only after treatment ends that survivors start to process what has happened.

Survivorship care is the care you get after cancer treatment ends. It focuses on how you are doing over the long term. That includes your mental health, your physical health, and your social life.

Health problems can show up months or even years later. These are called late effects. Late effects can change your daily life and how you feel emotionally.

Follow-up care helps your care team keep track of both your body and your feelings. At these visits, your care team checks for late effects on your body, your mood, your emotions, and your thinking.

Your mental health should be checked at every follow-up visit because new feelings or problems can show up at any point after treatment ends.

Emotional concerns are common for teens and young adults, both during and after cancer.

During diagnosis and treatment, many young people feel shocked, afraid, angry, sad, embarrassed, or lonely. Over time, many also feel hopeful, determined, and optimistic about the future.

After treatment ends, everyone's mix of feelings is different.

Common feelings include:

• Relief and happiness.
• Sadness about missing out on a normal childhood or normal teen years.
• Guilt about surviving when other people did not.
• Fear that the cancer will come back.
• Feeling more worried and very careful about your health.
• Feeling like nothing can hurt you, which can sometimes lead to risky choices.

Many young people also feel self-conscious about how their body looks. Scars, hair changes, and other ways their body looks different after treatment can be hard to get used to.

Some events can also stir up strong feelings. These include follow-up tests or anniversaries, such as the day you were diagnosed or the day treatment ended.

While most teens adjust well, some have problems that last longer. These can include anxiety, depression, or post-traumatic stress symptoms. These symptoms can include:

• Memories of cancer that pop up when you do not want them to.
• Strong reactions in your body or your feelings when something reminds you of cancer.
• Staying away from anything that reminds you of cancer.

Even one or two of these symptoms can get in the way of daily life. Though these problems can start during treatment, they can also start years later.

All of your feelings about body image, emotions, and symptoms of stress are common. It's okay to bring them up with your care team.

Some survivors notice positive changes after cancer too. They may feel different about themselves, their relationships, or what matters most to them. Experts call this post-traumatic growth.

Getting back to school and your daily routine takes time. It may take a few weeks or a month to get your energy back. Some survivors start with shorter school days.

You might feel tired or notice changes in how you learn, focus, or remember things. These can affect school, activities, and daily life.

Some supports can help, such as:

• Rest breaks.
• Extra time on schoolwork.
• An IEP (individualized education program), which is a plan for students who need special help at school.
• A 504 plan, which gives a student changes at school like extra time or rest breaks.

Trouble sleeping is also common after cancer. It affects at least 1 in 3 teen and young adult survivors. Poor sleep can make tiredness and mood worse and daily life harder.

Your relationships also may change during or after treatment. This can include your relationship with family, friends, and classmates. Friendships can feel different or awkward at first. Adjusting socially is part of recovery.

Follow-up visits and ongoing healthcare remain an important part of survivorship. This includes keeping a treatment summary and a survivorship care plan. It also includes telling your care team when concerns arise.

Tell your care team how you feel emotionally, just like you would for a physical symptom.

Reach out to family members, friends, or other adults you trust. Being open about what you are going through is important.

Think about joining a support group or a peer program for teens and young adults who have cancer, if one is available.

Eat healthy foods.

Keep your follow-up appointments, and continue to follow your survivorship care plan.

Stay physically active, if your care team says it's safe. Being active is one of the best ways to improve your mood, your sleep, your energy, and how you feel about your body.

Ask about counseling, psychology, social work, or other mental health services if you need more support.

Some survivors also find that journaling, faith communities, or creative programs help.

Contact your doctor if hard feelings last 2 weeks or more. Also contact your doctor if those feelings make it hard to handle daily life at home, at school, or at work.

Signs that you may need help include:

• Changes in your sleep or appetite.
• Feeling tired all the time or feeling hopeless.
• Losing interest in things you used to enjoy.
• Memories of cancer that pop up when you do not want them to.
• Strong reactions in your body when you think about cancer.
• Using alcohol or drugs to escape hard feelings.
• Skipping healthcare visits.

Mental health is an important part of survivorship care and should be part of the conversation at your follow-up visits.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

• Call or text the Suicide and Crisis Lifeline at 988.
• Go online to chat.988lifeline.org to start a chat.
• Text HOME to 741741 to access the Crisis Text Line.

Consider saving these numbers or having this website in your phone.

Go to 988lifeline.org for more information.