Survivors often experience physical changes as concrete reminders of the impact and ongoing meaning of cancer in their lives: “How do I begin to explain the deformities? I have an access for dialysis which is very noticeable. I can see it, feel the blood gushing constantly, and I can hear it. It's a constant reminder, like the scars, of everything that I've been through.” The process of physical recovery after treatment is affected by the process of emotional recovery and vice versa: “I'm 24. I'm tired of being weak, in pain, a cripple.”
Some of the changes will be visible, forcing survivors to develop new systems for negotiating social contact as they determine how best to address the inevitable stares, questions, and comments. Even when changes are not visible, survivors must adapt to the reality of living with physical challenges that only they can choose to disclose. For many, this raises issues related to self-image and the need to define the line between privacy and secrecy: “The image everyone else sees is someone put together and ‘normal.' What we see is scarred, reduced in strength or stature.”
Among young adult survivors, the issue of compromised fertility can be particularly salient.[5–7] It is “invisible,” yet it can have a significant impact on both private and public aspects of identity. Young adult survivors living with cancer-related infertility must not only integrate this change into their own sense of self, but also must determine how and when to disclose this issue to friends, family, and potential partners: “I won't be able to have children. I'm not only dealing with a huge loss but [also] I'm not married, and looking for a partner is difficult enough; all this extra stuff to deal with is overwhelming.”
