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What is Survivor’s Guilt and How Can I Manage?

There is a lot of focus these days on surviving breast cancer. And many people do get cured. If your cancer is found early and hasn’t spread, you have a 99 percent chance of beating the disease.1 However, there are other types of breast cancer that will never be cured.

When a friend dies from the same disease you have, you can feel guilty and unworthy of being the one to live. This complicated set of emotions is called survivor’s guilt. It affects people who survive natural disasters, wartime, and other traumatic events that kill many people.2

Statistics on metastatic breast cancer

An estimated 155,000 American women and men live with metastatic breast cancer.3 Also known as Stage 4 cancer, metastatic breast cancer means cancer cells have traveled through the bloodstream and created new tumors in other parts of the body–for example, the lungs, the liver, the bones, or the brain.

Stage 4 breast cancer cannot be cured, but people can take medicine to keep it at bay. Still, only 22 percent of people with the disease live for 5 years after diagnosis.3 For those who do, for the rest of their lives, they have to take medicine and undergo body scans to catch the cancer if it comes back.

Why do we have survivor’s guilt?

Survivors coping with guilt often feel like they have to justify their existence or that they don’t deserve to have lived. “These feelings can come out anytime someone is looking at issues of fairness,” according to Susan Glaser, a clinical social worker at Memorial Sloan Kettering Cancer Center. “People who have experienced trauma are comparing themselves to others. Survivors look at other people who did everything ‘right’ but died anyway and try to make sense of that.”4

What does survivor’s guilt feel like?

Survivor’s guilt can show up in different ways for different people. For example, you might feel guilty during school events or important milestones when you know a dear friend doesn’t get to see her children at these moments. Or you might feel that you are not sufficiently filled with gratitude for everyday life the way some people can be after experiencing a life-threatening event.2

There are a range of ways people experience the feelings of survivor’s guilt. Here is a list of emotions that some people feel.2,4,5,6 But there is no “right” way to experience emotions and struggles, so you might not share any of these and feel a whole separate range of emotions instead.

  • Feeling guilty that we had an easier treatment regimen than others
  • Feeling guilty that our cancer was caught earlier than others
  • Feeling guilty that our cancer responded to treatment better than others
  • Feeling guilty that we are a burden to others during treatment
  • Feeling guilty that we aren’t staying positive and being graceful in battling cancer
  • Feeling guilty that we aren’t there enough for someone who was there for us
  • Feeling guilty that we passed on cancer genes to our children
  • Feeling guilty that we aren’t enough of a cancer advocate
  • Feeling guilty that we are not living the best life
  • Feeling guilty for being praised as strong or brave, when we feel others were more burdened
  • Feeling guilty that we are not doing enough to help others
  • Feeling unworthy of being alive compared to others

How can you manage survivor’s guilt?

Mental health professionals recommend labeling the different emotions that get mixed into survivor’s guilt.2 Recognizing and feeling each emotion can help you take steps to manage and move through them.

The main emotions in survivor’s guilt include:2

  • Sadness
  • Empathy
  • Grief
  • Anger
  • Anxiety or fear
  • Pressure

In general, it is helpful to find times when you can express your feelings and people who are understanding and will be able to listen. It is also important to know ways to help yourself feel better when you are very sad, angry, or anxious. Try not to be too hard on yourself and recognize that your feelings may change from day to day. It is best to be honest about how you are feeling and to find people you can share with.2

For some people, finding ways to give back and help others in need helps them find meaning in survival. Seeking counseling and working with mental health professionals or grief counselors can also help you manage the pain and guilt that can come with cancer survivorship.

Have you ever experienced this?
If so, what are things that have helped you cope with survivor’s guilt?

  1. Dresden, D. Statistics on breast cancer survival rates by stage. Medical News Today. August 19, 2019. Available at https://www.medicalnewstoday.com/articles/316867.php. Accessed 12/15/19.
  2. Long, A. Survivor’s Guilt—Let Me Count the Ways. The Oncology Nurse. July/August 2014 Vol 7 No 4. Available at http://www.theoncologynurse.com/ton-issue-archive/2014-issues/july-august-vol-7-no-4/16184-survivor-s-guilt-let-me-count-the-ways. Accessed 12/15/19.
  3. Mapes, D. Living with Stage 4: The breast cancer no one understands. October 13, 2016. Available at https://www.fredhutch.org/en/news/center-news/2014/10/stage-4-metastatic-misunderstood-breast-cancer.html. Accessed 12/15/19.
  4. Grisham, J. Guilt: A Lasting Side Effect for Cancer Survivors. Memorial Sloan Kettering Cancer Center. June 29, 2016. Available at https://www.mskcc.org/blog/guilt-lasting-side-effect-cancer-survivors. Accessed 12/15/19.
  5. Madiraca, D. Survivors Guilt: Metastatic Breast Cancer Series. Susan G. Komen. August 26, 2016. Available at https://komenphiladelphia.org/survivors-guilt-metastatic-breast-cancer-series/. Accessed 12/15/19.
  6. Annis, B. Surviving Survivors Guilt. Cancer Updates, Research, and Education. August 8, 2019. Available at https://www.curetoday.com/community/bonnie-annis/2019/08/surviving-survivors-guilt. Accessed 12/15/19.

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