My boss was incredible throughout -- she was really supportive and genuinely kind. When I came back to work, she gave me time to adjust, checked in regularly and didn't pressure me to take on more than I could manage. And I know I've needed that space. I'm still on medication and get exhausted. There are days when fear blindsides me out of nowhere. I'm not "back to normal" and I don't think I ever will be.
But lately I've noticed that other people are being promoted. They're being given the kinds of opportunities I used to get. And while I understand why (after all I'm the one who made it clear I needed to go gently!) I also feel this creeping sense of being left behind. I'm scared to ask for more. What if I can't always deliver? What if I try and then crash?
I keep thinking: maybe once I feel totally fine again, then I'll go for it. But what if that day never comes? What if this is just how it is now? Does that mean I don't get to want more from my job? I feel guilty even thinking about promotions when I've already needed so much help. But I also don't want to live in a professional waiting room for ever. How do I ask for more without feeling like I'm betraying the support I've been given?
A. I'm so glad you've written. You capture with clarity the push-and-pull between gratitude, fear, longing and guilt. It's a tangle many people who've been through cancer treatment will recognise.
A diagnosis of cancer shatters the basic trust we have in life. This includes our trust in ourselves, in other people and that good things will happen. Research shows that fear of recurrence is one of the most common and enduring effects after breast cancer treatment -- affecting up to 70 per cent of survivors. It can surge unexpectedly, as you describe, leaving you feeling blindsided. When fear dominates, it shrinks your sense of possibility and makes every decision feel risk-laden. When you block or suppress it, you keep it lodged in the body. When you talk it through with loved ones, a therapist or a support group it helps to metabolise it, so it doesn't control you from the shadows.
You also describe the lingering physical impact. Studies consistently show that post-treatment fatigue, "chemo brain" (cognitive fog) and side-effects of long-term medication are among the strongest predictors of reduced work capacity. This doesn't mean you are weak for ever -- it means your body and mind are still healing, in ways that often take years, not months. Please try to be patient.
* Victoria Derbyshire and Decca Aitkenhead: How breast cancer changed us
At the same time you long for more -- for growth, recognition, promotion -- this is a sign of life. When you desire it does not cancel out gratitude. You can be thankful to your boss and be ambitious for yourself. Survivorship research tells us that returning to work after cancer isn't just about income: it is tied to dignity, identity, agency and a sense of future. People who find a balance between pacing themselves and gradually taking on new challenges report higher wellbeing and better long-term outcomes than those who either push too hard or permanently hold back.
Some thoughts that might help:
* Allow the fear its place. When it rises, see if you can notice it in your body, name it, and let it move through rather than tighten against it. Paradoxically, that reduces its grip.
* Go gently -- but not passively. A phased return to opportunity is possible. Rather than leap back to 150 per cent, you might ask for one new project, framed as a trial, with regular check-ins. This allows you to stretch without the overwhelm.
* Reflect on your "150 per cent" work identity. Was that drive always healthy? A life-threatening illness often acts as a wake-up call to reconsider what truly matters. Work can remain important, but perhaps not at the expense of everything else.
* Seek specialist support. Maggie's Centres, Macmillan Cancer Support and Cancer Research UK all offer tailored programmes for people navigating work and recovery. Some employers even have "cancer and work" policies that include coaching or phased promotion.
* Rebuild strength incrementally. Exercise, rest, strength work, counselling and peer groups have all been shown to improve recovery and work capacity after breast cancer.
You ask: "Does that mean I don't get to want more?" My answer is: of course you do. You are still the same capable, ambitious person -- just one whose life has been profoundly altered. Find ways to accommodate this unwanted experience and you may well find an expanded more alive version of yourself. The challenge now is to align your career with this new reality, not with the old "all-or-nothing" self.
* Read more from Julia Samuel
You do not betray your boss by your wish for growth. You honour yourself -- and model it to others that life after cancer is not just survival but also renewal.
A final thought : I encourage you to take small steps towards intentional joy -- whatever that might look like for you. It might be as simple as sitting in the sun with a friend, listening to music that lifts you, or noticing one thing each day that makes you smile. These small, intentional acts of joy help rebalance your nervous system and remind you that life is not only about surviving illness, but also about living fully, even in the in-between times.