The New Survivors

Jasan Zimmerman was 6 months old when he was diagnosed with neuroblastoma of the left neck in 1976. First the cancer was surgically removed, then he was treated with radiation. Perhaps it was exposure to all that radiation that caused the thyroid cancer when he was 15. More surgery, more radiation. But this time, old enough to grasp the situation, he was terrified. "I didn't want to die," recalls Zimmerman, who grit his teeth through the grueling treatment. Almost as difficult was the aftermath:

Traumatized by the experience, he spent his teen years sullen and depressed, without quite knowing why.

He tried to put it all out of his mind—until cancer appeared for a third time in 1997. He was 21 and had just graduated from college. Again Zimmerman was successfully treated. He pursued life goals, including a master's degree in microbiology, but his inner turmoil remained.

For 11 more years, he went for checkups, always fearing a return of the dread disease. "I'd get road rage on the way to the doctor. Even the smell of clinical antiseptic would make me angry," he reports. Despite some scares, the cancer never came back, but living with his history itself became a burden. How soon into a new relationship would he need to confess his medical past? Would he ever be free of the threat? By 2003, he was so angry that he punched a wall and broke his hand.

Today, Zimmerman is able to turn his back on the ordeal. He's done it only by embracing his role as a survivor and speaking out to many of the 1.4 million Americans diagnosed with the disease each year. His message is about the ability to overcome, and he openly describes his own experience. "Each time I share my story people feel hopeful," he says. And he does, too. "I was living under a thundercloud. It's taken me decades to grow from the experience, but the ability to inspire people has turned a negative into a positive and opened me up."

In the past, the very word cancer summoned images of hopelessness, pain, and death; little thought was given to life after cancer because it was considered brief. The cancer "victim" was seen as the passive recipient of ill fate and terrible luck. No more.

Survivorship is increasingly common; some 11.4 million Americans are alive today after treatment and are ever more vocal about their experiences. Emboldened by effective diagnosis and treatment strategies, celebrities such as Melissa Etheridge and Fran Drescher have made public disclosure of the disease increasingly routine and the fight definitely important and profound. Tour de France champion Lance Armstrong, determined to train for the world-class athletic event on the heels of treatment for advanced testicular cancer, turned his achievement into advocacy through his LiveStrong movement.

Many cancer survivors are travelers to a highly intense edge world where they battle death and return transformed. They leave as ordinary and burdened mortals and come back empowered and invigorated. In coming closer to fear, risk, and death than most of us, they wind up marshaling qualities not even they knew they had.

As more patients have lived longer, a body of research on their experiences has developed. It demonstrates that many cancer patients muster enormous grit for highly aggressive treatments and endure considerable pain to accrue small gains in the fight for survival. Despite therapies that weaken them physically, they can be especially psychologically hardy, harnessing and growing from their stress. Even the most narrow-minded or inflexible people may come to love art, beauty, and philosophical truth as a way of getting through the ordeal. Those who survive often come out of the experience with bravery, curiosity, fairness, forgiveness, gratitude, humor, kindness, and an enhanced sense of meaning.

Is there something about cancer itself that is transformative and growth-inspiring? Do we literally need to face death to go beyond the often petty limits of our workaday lives? William Breitbart, chief of the psychiatry service at Memorial Sloan-Kettering Cancer Center in New York City and an international leader in psycho-oncology, says we just might.

"It is in our nature to transcend our limitations, but too often we get distracted by everyday life. If life is always smooth, we're never challenged," he says. "Suffering is probably necessary to make us grow." The ultimate tool may be a brush with death. "The need to find meaning is a primary force," adds Breitbart, himself a cancer survivor, "but we may need to be confronted with our own mortality for that to occur." In the school of hard knocks, cancer amounts to earning a Ph.D.

Learning to Hope

Carol Farran, an eldercare expert from Rush University Medical Center in Chicago, sought to understand why some nursing home residents thrived despite adversity and isolation while others just withered away. The difference between the two groups, she found, was hope—not the blind or rigid optimism that usually passes for hope, but an open sense of possibility, acceptance of risk, and a willingness to work things out. Hopeful people face reality in a clear-eyed fashion, doing the best they can. One woman too sick to go outdoors, for instance, maintained an upbeat attitude by remembering the emotional riches of her past. "The hopeful person looked at reality and then arrived at solutions. If a hoped-for outcome became impossible, the hopeful person would find something else to hope for," Farran found.

The role of hope in cancer has also come under scrutiny. Psychologists at the Royal Marsden Hospital in London and Sutton studied women with early-stage breast cancer and found that risk of recurrence or death increased significantly among those who lacked hope. There was nothing mysterious or mystical about it: Hopeful patients managed their illness themselves instead of letting outsiders pull the strings. They often chose the most aggressive treatments. And envisioning the light at the end of the tunnel helped provide the strength they needed to get through each difficult day.

Yet hope was not a given for them; it was an attitude they wrested from despair. Despite being an expert on hope, Farran could not muster any when she herself was diagnosed with breast cancer. She met the news with anger, grief, and fear of death. Panic propelled her through treatment, in a total daze. Only when she went in for breast reconstruction was a wise nurse able to penetrate her panic: "A year from now you'll be where you want to be, but there is no way to get there except by going through this experience, now."

As despair loosened its hold on Farran, she tried to embrace the flexibility she had studied in others. "I told myself to get a grip," she says. Finally she thought of her love of playing piano and decided to buy a metronome, a symbol of what she called "slow time." It was a palpable reminder to calm down, confront her fear of death, and think things through. "You can start in despair but arrive at hope," says Farran, 18 years later. Hope can be learned.