Grappling with Guilt

Survivor guilt can be an obstacle for survivors of cancer.
Losing friends to cancer can be devastating for patients whose treatment was successful.

After Karen Shanahan was diagnosed with stage 4 colon cancer in April 2007, she spent the next several years undergoing various types of treatment, including chemotherapy, microwave ablation, cytoablation and surgery.

Shanahan reached out early in her treatment and became close to several young mothers who also were diagnosed with colon cancer. Sadly, several of those friendships were cut by the disease. Shanahan has been in remission since the fall of 2011.

“In 2010, over the course of three months, I lost three individuals I cared deeply for and who were so inspirational to me,” Shanahan says. “I have lost almost all my stage 4 colon cancer friends at this point. When all are dying around you, from exactly what you have, you have to ask yourself why.”

Shanahan, a dental hygienist from Watchung, N.J., suffered what is commonly known as survivor guilt. “I was doing OK in terms of treatment. My tumors were responding, but I felt I didn’t deserve it,” she explains. “I felt ashamed to tell people I was doing well.”

At one point, Shanahan recalls, she and her husband posted some positive news on their blog regarding Shanahan’s progress, only to learn that a friend had just passed away from her cancer. Shaken, Shanahan removed the post. “I just felt so terrible,” she says.


Survivor guilt commonly affects individuals who have lived through a traumatic experience that took the lives of others, such as war, a natural disaster or a prolonged illness such as cancer, experts say.

“Sometimes when I still struggle, when I lose a friend, I have to let myself feel the guilt but know that if I stay there too long it isn’t healthy, and it isn’t honoring the friend I lost.” –Karen Shanahan

“Guilt can be multifaceted,” says Vicki Kennedy, a licensed clinical social worker and vice president of program development and delivery with the Washington, D.C.-based Cancer Support Community. “On one level, there is a sense of guilt that comes from others dying while you survived. There can also be feelings of guilt around the whole cancer experience, such as, ‘Am I a burden to my family?’ So there are many components to it. But it’s completely normal.”

Among patients with cancer, anecdotal reports suggest that women are more prone to developing survivor guilt than men, and that older patients, in general, usually have better coping mechanisms, says Jennifer Klemp, director of cancer survivorship at the University of Kansas Cancer Center in Kansas City and associate professor of medicine in the Division of Clinical Oncology there. “They tend to have met more of their life goals,” she explains. “When you look at the data, younger women have a harder time with coping and developing strategies so they can function to the best of their abilities.”

Common indicators of survivor guilt include depressive symptoms, anxiety and rumination. “Obviously, those symptoms can somaticize to poor sleep, concentration and job performance, and disruption of personal relationships,” Klemp says.

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