After a decadeslong battle, Olivia Newton-John, a self-proclaimed "breast cancer thriver," died "peacefully" Monday at the age of 73. Fans and Hollywood mourned the legendary "Grease" actress, remembering her for her inspiringly positive outlook on life ("I'm winning," she would frequently remind fans in interviews). But what outsiders may not recognize is the mental strength and bravery required not only to live with cancer, but also thrive amid a life-changing condition.
"I am strong and I am back and I'm feeling good and loving every minute," Olivia Newton-John said in 2018. These encouraging words came months after she revealed her third breast cancer diagnosis in a 30-year span; the first was when she was 43. Doctors later found the cancer had returned in 2012, and then again, this time with Stage 4 cancer, four years ago.
"Cancer is a particularly frightening illness. It's one that people can picture doing terrible things to them and they fear that the outcome will always be the worst," says Dr. David Spiegel, a Willson professor and associate chair of psychiatry and behavioral sciences at Stanford University School of Medicine and author of "Living Beyond Limits: New Hope and Help for Facing Life-Threatening Illness."
But what was so "striking" about Newton-John's journey in particular, he says, was her courage to open up about a private and unpredictable journey to millions of people:
"She's not trying to pretend she doesn't have (cancer). She's not trying to hide the fact that she has it … People often have the mistaken idea that being open about it means you're giving in or giving up, and she's made it very clear that the opposite is the case: When you face it head on … you are not limited by the cancer."
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Cancer survival: A tangled web of emotions
Coping with cancer is often a twofold process. The first is bodily, overcoming pain and fatigue.
The second, arguably more difficult, is emotional.
When you are told you have a life-threatening condition, paralytic fear and panic are often instinctual. Along with the mental exhaustion that comes with the marathon of doctors appointments, lingering uncertainties about the course of your life, well, linger: What if treatment doesn't work? What if the cancer comes back?
On the outside, Newton-John's optimism seemed natural, almost effortless. Though we don't know her private experience, experts say her positivity likely required an exceptional amount of resilience, as research supports that many patients are uniquely vulnerable to depression and anxiety.
"Anybody would be distressed when having a diagnosis of cancer, but for a large portion of people with cancer, mild distress becomes moderate or severe and can impact their ability to lead a good life," says Dr. Michelle Riba, a professor of psychiatry and director of the psycho-oncology Program at the University of Michigan. "It really turns people around. Their jobs may need to change. They may not be able to make dinner or get their kids off to school."
As a psychologist providing behavioral care for oncology patients, it's part of Dr. Jennifer Kilkus' job to help them adjust to this lifestyle in the short and long term. One of the most important coping strategies, according to Kilkus, an assistant professor at Yale University School of Medicine, is acknowledging that it's possible to be strong and scared at the same time.
"We often don't like to feel two conflicting emotions at the same time because it can be hard to navigate, but I have not met anyone who's had a cancer diagnosis that isn't scared sometimes or isn't exhausted from the treatment, or even angry this is happening to them," Kilkus says.
"That's part of the strength: being able to acknowledge the things you're feeling as a part of being human, especially during a very difficult situation."
Olivia Newton-John and the importance of living life to the fullest
Toward the end of her career, Newton-John continued to live life to the fullest. She revitalized "Grease" nostalgia as a 2015 guest judge on "Dancing with the Stars"; she continued to act, starring in "The Very Excellent Mr. Dundee" in 2020; she even performed in front of thousands during the Fire Fight Australia concert that year – all while maintaining a radiant smile in the spotlight.
In the midst of adversity, Newton-John refreshingly represented hope, says cancer survivor Elizabeth Cohn Stuntz, who co-wrote "Coping with Cancer: DBT Skills to Manage Your Emotions – and Balance Uncertainty with Hope" after her own experience. Not necessarily the hope to not die, but rather the hope to treasure each day we're alive.
"We're all going to die sometime, and so our hope is to live as fully as we can for as long as we can," Stuntz says. "Whether we have cancer today or we're hit by a bus tomorrow, that's what people say is the gift of cancer: For many, it's a wake-up call to live fully right now. To do the things and activities you want and to be with the people who matter most."
Beyond her words of encouragement, Newton-John also made a tangible impact with her openness as a public figure. Until her dying days, she championed for a life beyond cancer with her ONJ Foundation Fund, and her vast career served as a human reminder that living with cancer doesn't have to be isolating, nor does it have to be limiting.
"She set an example for people," Spiegel says. "She helped people be more open to being examined, diagnosed, getting tested, having mammograms, and if it happens, to face it directly as she did. She's saying this is a part of her, but not all of her, and she lived her life as well and as long as she could."
That's a story for all of us.
This article originally appeared on USA TODAY: Olivia Newton-John and the resilience of living with cancer