Nothing instills more fear than a diagnosis of cancer or another life-challenging illness. Will your health continue to deteriorate? Will treatments disfigure your body? How will you find the energy to cope with insurance…household responsibilities…and endless rounds of doctor visits and follow-up tests?
Even if the treatments for a serious diagnosis are successful and you (finally!) get a clean bill of health, the fearful feelings won’t necessarily stop. You’ll always wonder whether you might hear the dreaded words, “Your disease has come back.”
Eye-opening research: Among cancer patients—including those who eventually have a full remission—30% to 50% experience some degree of distress, an extreme form of psychological stress. Up to 32% of cancer survivors experience post-traumatic stress disorder (PTSD), compared with just 1% to 4% of the general population.
How do you push through the crushing fear and helpless uncertainty? To learn more, Bottom Line Health spoke with Michael E. Ryan, PsyD, a psychologist at Henry Ford Cancer Institute who cares for patients and disease survivors.
What are patients’ biggest fears? For those with cancer, the fear of a recurrence is huge. Even those who have been cancer-free for years admit that they often worry the disease will come back and they’ll have to go through the same grueling process all over again, or this time they won’t be so lucky.
But cancer patients aren’t alone in harboring these worries. No one with a chronic or life-threatening illness, whether it’s heart failure, Alzheimer’s disease or Parkinson’s disease, feels completely secure. Every exam (especially imaging scans) and follow-up tests can trigger intense “scanxiety,” the fear that the other shoe is about to drop. They think about death and mortality—and what will happen to their loved ones should their lives be cut short.
Some people deal with anxiety by avoiding uncomfortable thoughts. Others worry about everything—that every bruise, rash or ache means that the disease has come back. It can be difficult to strike a balance between symptoms that need further medical evaluation and ones that are just part of normal life.
I reassure my patients that their anxiety will tend to lessen over time—but initially it’s going to be high.
Isn’t it normal to be afraid? It’s more important to ask about the degree of anxiety, fear and depression. Everyone deals with stress, but not everyone develops a disorder that requires medication or therapeutic management. Some people have the ability to remain reasonably upbeat and optimistic, regardless of the diagnosis.
Others do need help. Some people experience depression or a traumatic response to a diagnosis and treatment, which can cause symptoms such as anxiety, insomnia, nightmares, memory loss, poor concentration, etc.—long after the initial diagnosis. Up to 58% of cancer patients experience clinical depression, and between 6% and 23% experience anxiety disorders, according to research published in Seminars in Oncology Nursing.
How can someone tell the difference between “average” and severe stress? It’s normal to feel anxious, worried, down or discouraged when you discover that you have a serious illness. This begins to improve for most people once treatment has started and they know what to expect or as they get further out from remission. They regain a sense of control.
It’s reasonable to be concerned, however, when you realize that all you think about is your illness—and that stress/anxiety are interfering with your ability to enjoy a good quality of life. You might lose interest in activities that used to give you pleasure…feel perpetually angry, depressed or morose…or notice that your personal relationships have become strained (or nonexistent).
Some people cope well with adversity, but others struggle. At our cancer center, we routinely assess patients for stress, anxiety and depression…and we repeat the assessment every six months during treatments.
Are there personal characteristics that predict who will do well/poorly after a frightening diagnosis? We’ve found that people who perceive that they have good social support—from friends, a spouse, a faith group, etc.—tend to have fewer negative emotions than those who are more isolated or feel they have poor support.
I tell patients that this is a time in their lives when they should reach out to others. You can’t always generalize because some people are naturally more solitary and reclusive, but nearly everyone can benefit from some kind of support.
Practically every community has support groups for cancer patients and cancer survivors. Such groups also exist for other serious illnesses, including heart disease and multiple sclerosis.
In general, I worry more about patients who live alone and don’t have a close network of friends/loved ones. Inadequate social support often increases risks of not being able to follow through with necessary treatments.
Does stress increase the risk for a cancer recurrence? We know from laboratory studies that animals that are well cared for respond to treatments better, have slower disease progression and a better response to treatment than animals with high levels of stress.
A study in Annals of Oncology that looked at breast cancer patients found that those who took beta-blockers (blood pressure drugs that also block the effects of stress hormones) were more likely to survive their cancer treatments.
Regardless of the medical condition a person is coping with, stress can lead to poor lifestyle behaviors that do affect survival—things like not exercising, smoking, getting poor sleep, eating junk food, etc.
What advice do you give for managing anxiety? It’s different for everyone. In general, the most important step is to do anything besides sitting alone and dwelling on your fears. See your friends…take daily walks…join a book club…or take up yoga.
Of course, you should also take advantage of professional resources—psychologists, social workers, hospital programs, etc. In many large hospital systems, these services are often available right where you have other medical appointments for convenience. Behavioral health services often are covered by insurance for a typical co-pay, but check with your insurer.
There are also many free programs available through local medical centers and the community—either in person, over the phone or online. A social worker, if available, can help identify resources and assess the supportive care services that are needed.
I also stress remaining well-informed. Talk to your doctor about your condition and the main treatments. Ask for printed materials or reputable online resources. Independent online searches can provide both good and bad sources of information. Be sure to stick with reliable websites, such as the National Institutes of Health and groups that focus on specific chronic illnesses such as the American Heart Association or American Cancer Society.
Talk to other patients in a support group. Information is empowering, even when things seem discouraging. However, not everyone thrives on more information, and it can increase sadness and anxiety, which is not helpful. For these individuals, it makes sense to perhaps discuss their illness and treatments only with their doctors.
You don’t want to let cancer or any other disease always take center stage. You need to inject joy in your life—whether it’s spending time with your grandkids or spending an afternoon in nature. It’s important to acknowledge that not every moment will be perfect, but there are often opportunities to find moments of happiness.