ALISON, a 54-year-old mother-of-two, has just undergone months of treatment, including surgery and 30 gruelling rounds of radiotherapy.

Being diagnosed with a rare and aggressive cancer of the salivary glands in April 2011 had been devastating. Now, almost a year on, she’d completed the treatment, doctors were pleased with the outcome – surely she was over the worst of it?

But, though it’s easy to imagine Alison’s reaction to the news was sheer relief, this wasn’t quite the case. “When I was told I was in remission, everyone around me was thrilled. But I just felt numb,”

she said. “I just couldn’t accept it.

“I was very angry at having been let down by my body in the first place.I didn’t smoke, exercised regularly and did everything right, yet I’d still got cancer.

“Even though the doctors were telling me I’d now healed,I still felt angry and confused.”

Alison says she was “reluctant”

to believe she was actually going to be OK, and struggled to shake the fear she’d felt after her diagnosis.

“Cancer’s a bit like Hotel California,” she says. “You can check out,but you can never leave.I still feel the fear and anxiety about every lump,bump and unusual sensation.

It never really leaves you.”

Of course, she’s happy and grateful to be alive. But gratitude doesn’t eliminate the fact that coming to terms with the experience, the anger and confusion have been a massive struggle.

The media loves survivor stories – but often they paint a picture of people coming through a traumatic experience with a new lease of life, sudden urges to conquer the world and live every day as though it’s their last, worry and negativity a long-gone thing of the past.

While finding the positives to life’s challenges is indeed something to celebrate, little attention is paid to the difficulty of life after serious illness. And overlooking the emotional impact of this phase can make it an extremely isolating time.

“There is definitely a lack of awareness of the ongoing emotional impact of cancer. When medical treatment is finished and the obvious symptoms subside, many people assume that things will simply return to normal,” says Joy Reymond, head of vocational rehabilitation services at Unum, an income protection specialist.

“But it takes time to make the adjustments to the psychological changes, as well as to adapt to the longer term and sometimes more subtle consequences; fatigue, memory loss, lack of confidence and fear of recurrence.”

Unum is working with the charity-run Maggie’s Cancer Caring Centres (maggies centres. org) on a campaign supporting people affected by cancer back into work.

Reymond points out that many of the longer-term consequences of serious illness, such as exhaustion, depression and anxiety, can be “invisible” to others, so it’s easy for people’s needs regarding these difficulties to be missed.

“Often cancer patients look well, and are therefore expected to fulfil the same role as before, but don’t feel well. At work, this can lead to misunderstandings and difficulties in making the necessary adjustments, such as taking on a less demanding job or fewer hours.

“Employees can be very reluctant to ask for even the most reasonable of workplace adjustments, for fear it’ll put them at risk of losing their job, while others feel the support quickly drops away once they’re back at work,” Reymond says.

“Cancer is a life-changing illness that can cause deeper psychological issues. Yet there is a lack of knowledge among both people with cancer and employers as to what physical and emotional changes to expect during and after treatment.”

Emma, 40, was stunned by how hard the emotional catch-up hit her following her treatment for ovarian cancer. Although the surgery and chemotherapy had been gruelling to endure, it was after treatment had ended that she “hit rock bottom”.

“I didn’t expect it to happen,” she says. “You think you’re going to be elated, and everybody around you thinks you’re going to be elated, but you’re not.”

Now, almost two years on from her diagnosis, Emma realises that much of the psychological struggle she experienced was rooted in the identity shift that often follows a life-changing trauma.

It’s this, she says, she found most “painful and the biggest struggle”.

“The way in which you frame yourself has suddenly had to shift.

It’s an enormous thing and although what’s just happened physically, and all the treatment, has been very much within a time frame and has happened, in relative terms, quite quickly, the catching up with it, mentally and emotionally, is a much longer journey,” she says.

Emma now acknowledges that she was going through a grieving process in a way. “It’s the grieving of an identity that one might have held on to, and for a future that’s no longer to be,” she says.

Support from Maggie’s made a world of difference. The centres offer a range of services, including yoga and nutrition advice, as well as counselling, which Emma found extremely helpful – partly because the counsellors are trained to recognise this element of the cancer journey and being given permission to “own and talk about”

how she was feeling helped unlock the emotional complexities.

She admits she sometimes found it hard opening up to friends.

“I felt as if I couldn’t keep saying, ‘I’m still feeling rubbish’ or ‘Yes,I’m still in the same place’,” she says, acknowledging she felt unable to admit she hadn’t just “got over it”.

Sue Read, a professor of learning disability nursing at Keele University, is not surprised by stories like these.

“Having a life-limiting condition or serious illness is like being on a rollercoaster ride,” she says.

“Even when the rollercoaster stops – when you’re told you’re OK – you’re still living with the possibility of a recurrence, so it’s very much an ongoing experience.

“And serious events never happen in a vacuum – they always happen within a social context. So it’s not just the illness you’re dealing with, but the impact on and reactions of your friends,family and colleagues, and these things play a big part in the overall experience too.”

Often, Read says, there’s an inevitable period of consideration about what changes to make within the “new life”.

A big part of the problem, she believes, is the fact that many of us are bad at talking about difficult things. Lots of us find it hard to tell people if we’re struggling, and equally other people often don’t know how to ask somebody who’s been through something difficult how they’re doing, opting to say nothing instead.

“Sometimes just saying something simple such as, ‘I’m really sorry you’ve been so unwell, it’s really great you’re back but if there’s ever anything at all I can do or help with, just let me know.I am here for you’,” Read says.

“That gives them the invitation to talk about it if they want to and also acknowledges that it might be a very difficult thing they’re going through, which can make a huge difference.”