• Although I've worked in the greeting-card industry for years, I hate most thank-you notes.
• I don't need thank-you notes for wedding or birthday gifts — they're often sent out of obligation.
• The thank-you cards that really matter come from the heart, and when they're not expected.

I have a secret: I really hate thank-you notes.

Now, for most people, that might not be the biggest deal. After all, the heyday of the greeting card has long since passed, and these days, plenty of folks don't send mail at all.

However, those people also likely didn't spend a decade working in the greeting-card industry.

There's a big difference between 'obligatory' thank-you cards and ones from the heart

Throughout my career, I've edited and written cards for places like Hallmark, American Greetings, and Lovepop.

One of the most useful things I learned was a term called "obligatory sending" — the idea that you're "required" to send certain cards if you don't want to seem rude.

Most thank-you notes fall into this category, especially the sort that get sent en masse, such as after a graduation or wedding.

Let's be clear: I'm not against gratitude, and I understand why my mom insisted I write thank-you notes as a kid.

However, in my opinion, gifts should always be about sharing something with a person you care about — not the gratitude they show in return.

Personally, I don't need a "thank you for the toaster" note after an event like a bridal shower. The hosts already invited me to share their big moment, usually throwing an elaborate party in the process.

Consider my present a "thank you for including me," and let's just call it even. (Rinse and repeat this approach with any graduations, baby showers, birthday parties, or other big shindigs.)

This doesn't mean I hate all thank-you cards, though. In fact, it's quite the opposite.

To me, the ones that matter are the ones that you were never obligated to send. They're cards from my mentees at work, sharing the ways that they've grown thanks to my help. Or ones I've received during tough times that tell me how much I've helped someone in the past and remind me I have a support system, too.

They're the thank-yous that are unexpected, but never unwanted — ones that come straight from the heart.

One experience always reminds me of the power of genuine gratitude over obligatory politeness

A few years ago, my mom was sick with terminal cancer. During chemo, she had trouble eating and drinking much of anything, and she had an intolerance for any cold or spicy foods.

By that point, my mom was reluctant to go to most restaurants. She hated feeling like a "bother" to the staff, and too often, waiters would interpret her requests for ice-free drinks and spice-free foods as high-maintenance customer nitpicking.

However, we found sanctuary when we visited a nearby Indian restaurant, Taj Palace. The welcoming staff took my mom's concerns seriously without making her feel singled out.

When the owner learned that masala chai (a type of tea) was one thing my mom could almost always enjoy, he insisted we stop by whenever it would help — and he was always ready with a cup (or several).

After my mom died, my family brought Taj Palace a card to let them know and, more importantly, to ensure they knew how much their kindness had meant to us.

Five years later, the thank-you card from my family is still on the wall, prominently displayed next to the counter.

Whenever I see it, it reminds me that even the smallest things, like a cup of tea, may have a huge impact — and that saying "thank you" really does matter, and sometimes a card is the best way to do so.

I still hate most thank-you notes, and you won't find me writing the "obligatory" sort anytime soon.

But for those who've made a real difference? Well, those are the cards that I'll always want to send.

• Jenna Scott was diagnosed with stage four colon cancer aged 31 despite being fit and healthy.
• Misdiagnosed symptoms during pregnancy delayed her cancer diagnosis, complicating treatment.
• She expects to undergo treatment for the rest of her life to keep the cancer at bay.

This as-told-to essay is based on a conversation with Jenna Scott a 39-year-old Chief Operating Officer in Peach Tree Corners, Georgia. The following has been edited for length and clarity.

For the first three decades of my life, everything was great. I was a cheerleader in middle school and college, where I met my husband.

We got married in 2015 and our friends would say we were living a fairytale.

I got pregnant with our son, Cameron, that year and I thought, "Oh, how could life get any better?"

But in 2017, at the age of 31, I was diagnosed with stage four colorectal cancer.

The doctor said my symptoms were related to my pregnancy

My symptoms started when I was around seven or eight months pregnant. I told my obstetrician I had really bad abdominal cramping and rectal and vaginal bleeding, but he said not to worry because they were pregnancy symptoms.

It was my first pregnancy so I thought: "This is what pregnancy is like, I can handle it, I'm tough."

My abdominal pain didn't go away after I gave birth and my obstetrician put it down to the C-section. Cameron was my main concern. I was always tired, too, but didn't want to complain.

I saw a doctor who gave me some IBS pills and said he'd refer me to a GI specialist if they didn't work.

They didn't, so he sent me to a GI specialist who told me: "Why are you in my office? You're way too young."

On June 29, 2017, just over a year after Cameron was born, I had a colonoscopy and woke up to four nurses, my doctor, and my husband in the room.

The doctor told me: We found cancer.

Cancer doesn't run in my family and I didn't understand how it could have happened to me at 31.

Stage four cancer changed everything

I was diagnosed with stage 4 cancer. The oncologist said they couldn't see the cancer that well on the CT scan because I had so much muscle and so little fat.

It didn't make sense and I shut down. My husband and mom were more emotional than me.

After that appointment, we collected my son from day care and I just held him. He'd just turned one: how could I process the thought that he might not know me?

Life quickly became full of doctors' appointments and scans, and my employer took away my larger projects so I could focus on my health. I had worked hard to get them so it felt unfair but in hindsight, they were right.

I started chemo on August 9. It took eight hours every other week at the hospital, then a 46-hour drip at home with a portable pack. I had insomnia, hallucinations, and anxiety. I would look at the baby monitor and see one of my coworkers in my son's crib, or tarantulas crawling across my hands.

I had 11 months of chemo, stopped for a few months, then was told it had spread to my colon, liver, and lungs, so I started another 11 months of treatments and surgeries.

By 2021, I was on a lower "maintenance" chemo dose to keep the cancer at bay. I would take six chemo pills every day, alongside various others, which made me very sick and kept me at home when I wanted to be present for my son.

One day I decided I just didn't want to do it anymore and my doctor said I could stop for a while. But by Christmas 2022, the cancer was in my lymph nodes. I waited until the new year to start treatment so I could have my storybook Christmas.

Even with insurance, medical bills were a nightmare

I had to pay a lot out of pocket that first year before my insurance provider could reimburse me, including $500 upfront for the colonoscopy. That was a lot alongside expenses like our mortgage and day care costs.

My husband's insurance plan was really good but I started having issues a couple of years in when appointments were back-to-back and I was racking up bills of about $3,000 a month. The hospital kept calling me for payments and we considered selling our house and moving in with our parents.

Eventually, my husband's friends encouraged him to set up a GoFundMe page, which raised $17,000 in just a few hours while I was having surgery, and $30,000 in 17 days. I felt betrayed at first, but my mom helped me see it as a blessing.

My son looks out for me

Seeing my son grow up has been keeping me together this whole time. We've been reading kids' books about cancer and emotions to Cameron for years and he's starting to understand what's happening.

Once he asked me, "Mommy, can you die from cancer?" and I froze. I didn't know what to say. He cries at night about it, holds me, and tells me he doesn't want me to leave. But he takes good care of me. When my hair was longer, he used to put it in a ponytail for me and put chapstick on my lips.

Today, my cancer status is "non-detectable." I have chemo every four weeks and expect to be on this maintenance regime indefinitely, an idea I struggled to cope with at first.

I work full time, which is hard as I've had a lot of side effects. I've passed out a few times, my body overheats so badly I have to take off all my clothes, I feel like I have to vomit but my body won't do it, and I barely sleep for days at a time. This is my life now.

I try to stay busy to take my mind off the tough treatments. When I have chemo on Fridays and Cameron, who's now nearly nine, has a baseball game on Saturday morning, I'm there with my portable pack just doing everything that I can, even though I feel tired and nauseous and vomit a lot.

And I'm so grateful to our family and friends who still come over to cook and clean for us after eight years. But because the cancer treatment side effects are cumulative, having a happy life is really hard.

I'm hoping I have a long life ahead of me, but I don't want to be on this treatment forever and am perpetually crossing my fingers that science can discover new treatments.

I've realized the things I used to stress about are completely manageable and I have so many blessings. I tell everybody that life is good, it's just how you look at it.

I want young people to understand that they're not untouchable. You need to get regular check-ups and advocate for yourself.

Exercise is generally good for you, but a new high-quality clinical trial finds that it's so good, it can even knock back colon cancer—and, in fact, rival some chemotherapy treatments.

The finding comes from a phase 3, randomized clinical trial led by researchers in Canada, who studied nearly 900 people who had undergone surgery and chemotherapy for colon cancer. After those treatments, patients were evenly split into groups that either bulked up their regular exercise routines in a three-year program that included coaching and supervision or were simply given health education. The researchers found that the exercise group had a 28 percent lower risk of their colon cancer recurring, new cancers developing, or dying over eight years compared with the health education group.

The benefits of exercise, published in the New England Journal of Medicine, became visible after just one year and increased over time, the researchers found. The rate of people who survived for five years and remained cancer-free was 80.3 percent among the exercise group. That's a 6.4 percentage-point survival boost over the education group, which had a 73.9 percent cancer-free survival rate. The overall survival rate (with or without cancer) during the study's eight-year follow-up was 90.3 percent in the exercise group compared with 83.2 percent in the education group—a 7.1 percentage point difference. Exercise reduced the relative risk of death by 37 percent (41 people died in the exercise group compared with 66 in the education group).

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• Eric Morrow was diagnosed with severe prostate cancer at age 49.
• He had no symptoms aside from a slightly enlarged prostate that showed up during a colonoscopy.
• His primary care physician never tested him for prostate cancer despite Morrow's family history.

This as-told-to essay is based on a conversation with Eric Morrow, a prostate cancer survivor, US Air Force veteran, and volunteer advocate for Zero Prostate Cancer, a nonprofit focused on supporting patients and eliminating prostate cancer. It's been edited for length and clarity.

I was diagnosed with prostate cancer on June 8, 2021, at 49. It was shortly before my 50th birthday.

I'll admit I did not know a lot about prostate cancer then. I knew it was fairly common and, to the best of my knowledge at the time, I thought it primarily affected older men in their 70s and 80s.

Five years prior, in 2016, I'd learned that my father had previously had prostate cancer and that he was in remission after being successfully treated.

So, the next time I saw my primary care physician, who was assigned to me through the Air Force, I told her about my family history and asked if I should get checked for prostate cancer.

She said that I was too young and didn't need to worry about getting screened until my 50s.

The phone call that probably saved my life

In 2020, my PCP said I was old enough to have a colonoscopy to check for colon cancer. That's when it all started.

After my colonoscopy, the gastroenterologist said my colon looked great, but my prostate looked a little enlarged, and I should schedule an appointment with a urologist.

I had no other symptoms to suggest I had prostate cancer. Also, this was during the height of the pandemic. I got distracted by work and didn't make the appointment immediately.

I was really lucky that the doctor called me back a month later to see if I'd seen the urologist. It was a really simple follow-up, but that phone call prompted me to make the appointment and probably saved my life.

My PSA level was in the hundreds

The urologist scheduled me for a digital rectal exam and an MRI, and then drew my blood for a PSA test, which measures specific proteins in the blood to identify possible prostate cancer.

I got a call a few hours later about my PSA level. I was told that anything over four would be a concern for a man of my age. My PSA level was 225.

The urologist said there could be many reasons for my extremely high PSA levels, but a later biopsy revealed that I had prostate cancer with a Gleason score, which measures how aggressive the cancer is, of nine. The highest the scale goes is 10.

I got the trifecta of treatment: surgery, radiation, and pills

I was lucky enough that the Department of Defense's Center for Prostate Disease Research at Walter Reed National Military Medical Center in Bethesda, Maryland, was nearby, and my case was aggressive enough to qualify for their treatment.

There, I had a cancer team including a urologic oncologist and radiation oncologist who recommended a multi-step treatment involving surgery, radiation therapy, and hormone therapy to turn off testosterone production in my body.

I started surgery in July 2021, after which I had issues with incontinence. Despite physical therapy to improve it, I never regained full control of my bladder. This made the radiation therapy, which came about five-and-a-half months later, very challenging.

Each time, I had to come in with an empty rectum and a full bladder. The full bladder basically pushes the rectum, so it's not as much in the field where they're going to shoot with radiation.

Each of the 39 radiation sessions I completed only lasts about 15 minutes, but I had a hard time getting my bladder full enough and then holding it long enough for the therapy.

To get through it, I'd play a game with myself: They had music going, and I would just listen to the music and try to memorize it. Then, I went on Facebook afterward and posted a list of all the songs — it became my "Playlist of the day" for friends and family.

The androgen deprivation therapy, aka hormone therapy, was a shot that I got every three months, along with pills that I was taking every day. I did this therapy for about 24 months.

The side effects were pretty harsh. I experienced hot flashes, mood swings, additional abdominal fat, loss of muscle mass and bone density, and it killed my libido. I got back into lifting weights that I hadn't been doing for probably more than a decade, and that helped minimize some of the weight gain and muscle loss.

Since coming off hormone therapy, my testosterone has luckily gone back to pre-treatment levels, and my PSA level has remained undetectable.

I quit my job after getting cancer

I wouldn't wish cancer on anybody, but the one thing it does give you is perspective. I realized I wanted to do something more.

So in December of 2022, I left my job with a medical device company I'd been with for over nine years. I was ready to give back to the prostate cancer community.

I'm now doing a lot of work on a year-round basis with Zero Prostate Cancer. I also volunteer at Walter Reed, where I received my cancer treatment.

I also speak with new prostate cancer patients and try to give them hope. I tell them, "Four years ago, I was sitting right where you are and I thought I was going to die. But I'm still here, and I'm doing OK."