In my column "The Medicine of Letting Go" (OT 3/25/15 issue), I discussed how patients may continue to feel guilty about past smoking, instead of just letting go of that guilt. Or how they may keep riding a motorcycle despite the risks of thrombocytopenia. In your efforts to help your patients overcome obstacles to letting go, feel free to edit and use this patient handout in whatever way works for you.

Letting Things Go

Dear Patient,

The cancer experience puts an everyday life skill to the test: The ability to let things go. Problems can arise if you hold on when you'd do best to let something go. Please read this handout to help us minimize difficulties.

What does "letting it go" mean?

I'm talking about choosing to stop owning or stop being concerned about "it"-whether "it" is a problem, injustice, opportunity, role, relationship, emotion, or material thing.

For example, due to your medical condition, you may need to let some opportunities go, such as attending an event or taking a big trip. Or, to enjoy the moment, you may need to let go of anger about insensitive comments or needless hassles.

Why is "letting it go" a vital step in healing?

Cancer changes the equation when deciding how to respond to problems or how to spend your time and energy.

Right now, your condition may make it too risky or too physically demanding to do something you normally do, such as socializing in a crowd or working full-time. If so, letting go of these activities for now gives you some control over your health and outcome.

Or, your current circumstances may make it wise to avoid confrontations and stressful relationships. Faced with a troubling encounter, the most healing approach (for now) may be to just let it go.

Even private thoughts and feelings can interfere with getting good care and can spoil otherwise happy times. You need to let them go, especially if they're not serving any useful function.

What makes "letting it go" difficult?

Almost always, letting something go involves loss. So the anticipation of the loss or the first twinges of grief-the natural but painful response to loss-can cause you to keep holding on to avoid that pain.

Also, letting go often exacerbates feelings of vulnerability and powerlessness that naturally arise during treatment and recovery. If anyone suggests or insists that "you have to let go" of something that matters to you, you may instinctively hold on even tighter to that one thing for some sense of control.

Yet another common obstacle to letting go is this: Fear of misjudging and letting go too soon, especially if letting go means closing the door forever to something you value. That's an understandable fear.

The media trumpets stories of individuals who recovered fully after being told there was no hope. They post images of cancer survivors who ignored everyone's urging to retire from sports and then successfully climbed mountains or won races. The problem is that the media doesn't report on patients who regret having held on, failing in their quest, and/or becoming sicker (or dying) because they went against medical advice and did not let go.

It's true: Nobody can predict your future. But holding on to something may be the worst choice you can make under your current circumstances.

How do I know if it is time to let something go?"

By weighing the pros and cons of holding on and of letting go, and then making a judgment call. To do that, you need the facts about the issues involved in your decision.

We will assess your condition and review the expected recovery time for whatever (e.g., low blood counts, decreased stamina) is making it best for you to let it go. In addition, we will address conditions (such as pain, fatigue, or mood) that can interfere with the ability to judge the best time to let go. During our discussion, we will dispel common myths and misinformation that interfere with making wise decisions.

What if letting go makes me feel powerless?

Letting go can feel like giving in or giving up. In fact, choosing to let something go gives you more control over the risks, strains, and pain in your life now. In other words, letting go is an act of empowerment-even if it doesn't feel like one.

What if I'm still having trouble letting something go?

You may want to let something go and still find it difficult.

It takes strength and courage to let go of something that matters to you. It requires fortitude and others' support to get through the associated emotions and changes. So as you go through the adjustment period...

* Look forward. Focus on how letting go will make your life better.

* Find and create meaningful or joyful distractions.

* Grieve, as needed. Even if your loss is permanent, the painful grief is temporary-and healing.

These mantras may help:

* More than I want the benefits of holding on, I want the benefits of letting go.

* Letting go frees me to move forward as safely and/or happily as possible.

* Letting go is not giving up or giving in, but taking charge under the circumstances.

What now?

Keep us informed of how you are doing with the challenges of letting go. Please allow us to support your efforts and connect you in a timely fashion with resources aimed at making your adjustment safer or easier in some way.

At times, you can make your life better by letting go of something that matters to you. Cancer offers innumerable opportunities to develop this valuable life skill. Then, forever after, your ability to let things go will help you get good care and live as fully as possible every day.