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Cancer Survivor Guilt

Instead of “Why Me,” “Why Not Me?”

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Updated May 06, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Survivor guilt is something many of us have to cope with as cancer survivors. At the same time we hit the milestones of being cancer free – or at least being alive with cancer – invariably someone we know and love has a downturn or succumbs to the disease. Instead of the “why me” questions we may ask ourselves when diagnosed, the question becomes “why not me?” What do we know about these feelings and what are some ways to cope?

What is Survivor Guilt?

Here we are talking about cancer survivors, but there are many examples of survivor’s guilt. Military veterans have experienced this guilt as they have watched their comrades injured or killed, but survived themselves. September 11, 2001 left many people with survivor guilt. It was experienced by those who worked in the twin towers and for some reason had a day off, or were (fortunately) late to work. It was felt by those who were working, but got out in time. Those who survived while their co-workers and friends died were left with these feelings. Why not me?

Cancer survivors can experience this same guilt. In some ways, having cancer is like being in a war zone (and for that reason, some oncologists argue that most cancer survivors have some degree of post-traumatic stress syndrome.) The enemy isn’t another group of men, or another country, but rather a large army of cancer cells within your body.

We don’t often know why one person survives cancer but another doesn’t. Or why one person can have a cancer that’s kept in check by treatment, while another person’s cancer progresses. As a survivor in this setting you may feel badly for those who don’t survive. You may feel a deep sadness, or even feel guilty that you have survived.

Cancer related survivor guilt occurs to different degrees in different people. It’s important to know that this feeling is normal, and in fact, a healthy sign that you are a compassionate person. Sometimes, however, it can overtake your thoughts enough to interfere with your daily activities. If it gets to that point, it’s a good idea to seek out professional help.

Examples of Survivor Guilt

Survivor guilt is a subjective concept, and sometimes it can be helpful to share real life examples.

My friend Elizabeth (who granted her permission to share her story) is a 4 year cancer survivor. With a diagnosis of an advanced stage cancer, she didn’t expect to be here. Thankfully she is! On the same day that she was celebrating her 4 year anniversary of being cancer free, she attended the funeral of a friend from her support group who passed away from cancer. She told me she felt ripped apart inside. Part of her wanted to “shout from the hills” that she had survived, and part of her was experiencing deep sorrow at the loss of her friend. This “in-between” place--those bittersweet feelings of feeling happiness for yourself but sadness for another--is what we mean by the term survivor guilt.

Another friend shared that she found her heart torn and would cry for hours after each chemotherapy session. While she was receiving treatment that, hopefully, would give her a long term remission from her cancer, each week she sat between two people who were not so fortunate. Both of them were undergoing chemotherapy as an attempt to extend their lives a few months at most. In tears she would call me saying, “why not me?” In other words, why did she deserve the chance to survive, while her new friends didn’t seem to have the same opportunity.

Coping

While there is nothing that can take away your sorrow (and it is important to grieve the loss of our friends and loved ones) there are things you can do to ease some of the pain of survivor’s guilt. Here are some thoughts that have helped others cope:

Acknowledge your guilt – The first step in coping with feelings of survivors guilt is to acknowledge that your feelings are present and real. There is nothing wrong with feeling the way you do – in fact, it’s a sign that you have empathy and truly care about people.

Reach out and express your feelings – Sometimes, just making the effort to express our mixed feelings can bring major relief. Who do you know that you believe would best understand your feelings so they can provide the support you need? Do you know anyone who has “been there,” and has perhaps had similar feelings? For some people, journaling their feelings is a wonderful addition to sharing their feelings openly with friends.

Allow yourself to grieve and remember those less fortunate - If you are feeling that deep sadness that we are calling survivors guilt ask yourself, “Have I taken the time to grieve?” When we are living with cancer day-to-day, many things end up on the back burner, and one of those things can be grieving when we need to grieve.

Remember your friend through an act of kindness - If you are mourning an aquaintance or loved one who passed away from cancer, remembering them through an act of kindness for another may make that memory just a tiny bit less painful.

Accept that there are no answers - We want to have reasons why someone has a cancer that recurs while another person remains in remission. But often, there are no clear answers. Though it's easier said than done, acknowledging that we may never have the answers we are looking for may help us accept that sometimes life, and cancer, just doesn’t make sense.

Take a moment to think about your guilt - Are you feeling guilty because you’re not living life the way you feel you should? Certainly feelings like this can be a motivator to make lifestyle changes that you think are important – but haven’t made yet. On the flip side, you don’t have to prove you are worthy, or that you “deserve to survive.” You don’t have to found and launch a major non-profit to raise awareness to justify your survival. You don’t owe anyone anything for your second chance at life.

Embrace your spirituality – By saying embrace your spirituality I don’t meaning heading to the nearest church. Some people find organized religion meets this need, but for others, spirituality takes another form. Whether it is communing with nature, doing yoga, painting, or attending a service at a church or a synagogue, embracing your spirituality may help you not only cope with feelings of sadness and guilt, but celebrate the wonder of your own survival.

Practice stress relief -- We all know that feeling “stressed” just seems to make coping with anything in our lives more difficult. What can you do to lessen other stressors in order to give yourself more time to cope with cancer survivorship?

Consider joining a support group - Sometimes talking to other people who have "been there" is priceless. In addition to feeling support yourself, being an ear for someone struggling with their own cancer journey can give you a sense of purpose when you are feeling the despair of survivor guilt. Many cancer centers and communities have support groups for people living with cancer. Online communities and chat rooms are available as well.

Ask for help and support - Coping with survivor's guilt isn’t something you do once and move on from. As a survivor you will continually run into people who haven’t survived their cancer or whose cancer has progressed. Think about who in your support network can best help you cope when those feelings arise, and ask for her help and support when needed.

Celebrate your survival – It might help to think about what your less fortunate friend would wish for you at this time. Of course, she would want you to celebrate your own survival from cancer. As you remember her, picture her cheering you on as you venture out into life having survived, or surviving, your own journey with cancer.

Future Research

Unfortunately, despite a plethora of writings I ran across in personal blogs and in chat rooms in which cancer survivors share their struggles, there isn’t a lot of research that has been published about the survivor guilt that nearly all cancer survivors experience to some degree. Hopefully, with the large number of cancer survivors now living worldwide, this area will be addressed more in the future.

Further Reading

Guilt with cancer can take another form as well -- the feeling that somehow you did something that may have caused your cancer. Remember that nobody deserves cancer.

Sources:

Andrykowski, M. et al. Psychological health in cancer survivors. Seminars in Oncology Nursing. 2008. 24(3):193-201.

Centers for Disease Control. A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies. Accessed 10/26/12. http://www.cdc.gov/cancer/survivorship/pdf/plan.pdf

Harvard Health Publications. Harvard Medical School. Harvard Health Blog. Ann MacDonald, editor. The mental and emotional challenges of surviving cancer. 2011.

MD Anderson Cancer Center. Survivorship – Social and Emotional Impacts of Cancer. Accessed 10/26/12. http://www.mdanderson.org/patient-and-cancer-information/cancer-information/cancer-topics/survivorship/survivorship-after-cancer/social-impact.html

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