A cancer diagnosis is an all-consuming and stressful event that drastically takes over a patient with cancer’s life. Patients with cancer may eventually get used to certain ways of doing things, including their treatment routine, and they may also get used to receiving the care and attention of their medical team and loved ones, said Karen L. Syrjala, PhD, Clinical Psychologist at the Fred Hutchinson Cancer Research Center in Seattle, Washington, in a blog on the National Cancer Institute website.
But what happens when patients with cancer successfully complete their treatment, including those who may be dealing with the aftermath of cancer treatment for the rest of their life, and transition to being survivors?
What are the challenges and stressors that are specific to anyone who has survived cancer or is living with cancer as a chronic disease, which can be detrimental to their well-being?
“Stress can interfere with clear thinking, memory, and sleep. And although stress is a normal part of life, it can become overwhelming,” Susan Yaguda, RN, MSN, at Integrative Oncology, Levine Cancer Institute, in Charlotte, North Carolina, wrote in an article in CONQUER magazine.
An article published in Lancet Oncology demonstrated that anxiety, not depression, is the most common problem seen in long-term cancer survivors compared with people who have not been affected by cancer.1 Dealing with anxiety, the authors wrote, should be a priority for cancer survivors and for their healthcare providers.
So let’s look at some of the anxieties that are common for those who have gone through cancer treatment and are dealing with what comes next as cancer survivors, including the new challenges for the new anxieties that have been brought about by the recent COVID-19 pandemic, and how to deal with those stressors.
Fear of Recurrence
One of the main sources of stress and anxiety for a survivor is the fear of cancer recurrence (coming back).
“Fear of recurrence is the most common emotional difficulty that people tell us they have after they’ve completed [cancer] treatment,” Dr. Syrjala said. She noted that survivors need to know that some anxiety and distress is normal, and this fear does not add to the risk that the cancer will come back.
“Cancer survivors need the expertise of someone who knows cancer and understands what is ‘normal’ for cancer survivors,” Dr. Syrjala emphasized. People will face a different level of stress associated with a fear of recurrence, and caregivers and loved ones should be ready to offer support for these trying concerns.
It is, therefore, important to remember that you may have some days when you manage your anxiety better than in other days, which is quite normal and to be expected, as Dr. Syrjala said. So, don’t be hard on yourself. You have been through so much to get to this point in your survivorship, and you can use that knowledge to empower yourself, and realize that you can, and will, get through this anxiety too.
Another common source of anxiety is the need for ongoing testing and imaging scans to make sure the cancer did not come back. In a June 2011 article in Time magazine, cancer survivor Bruce Feiler discussed the special type of anxiety, often referred to by cancer survivors as “scanxiety,” which many survivors have before their periodical scans.
Mr. Feiler wrote: “There’s one thing all scans have in common: they engender “scanxiety” as they approach,” adding that “Scans are like revolving doors, emotional roulette wheels that spin us around for a few days and spit us out the other side. Land on red, we’re in for another trip to Cancerland; land on black, we have a few more months of freedom” (http://content.time.com/time/specials/packages/article/0,28804,2075133_2075127_2075107,00.html).
A variety of tools are available to help cancer survivors deal with the stress and anxiety they face during survivorship. If you find that you are missing the support you were receiving through treatment, let the important people in your life know that you are looking for companionship or activities that will help you to occupy your time.
Know that some people will always be there for you; they don’t stop being there for you just because you have “finished treatment.” Caring for someone does not stop after treatment ends.
Most people can find help through some type of emotional support, such as family members, friends, or cancer support groups—don’t feel guilty asking for support just because you were told your treatment was over.
Putting your attention on specific activities will help to alleviate the stress you feel. One great exercise is to keep a diary or a journal; expressing your feelings through words can help to reduce the emotional stress associated with those feelings.
The act of reflecting and expressing one’s thoughts in writing can offer a sense of control during a stressful time. If you don’t like writing, another option may be to take an art class or try to paint on your own, which is another way to express your feelings.
You don’t have to become an “artist,” but people often say that art projects help them deal with cancer-related anxiety. One example for this are the Art Therapy articles published in this magazine, showing painting, photography, or other media people have used to deal with the stress of their cancer experience.
Practicing meditation and focusing on breathing may be just what you need to help alleviate some of the anxiety. When we are stressed, our mind is usually racing with thoughts in a way that feels out of our control. Meditation, especially mindfulness meditation, can help you to slow yourself down and manage and compose your thoughts to keep your mind at ease.
If you find yourself consumed with worrisome thoughts, meditation can be a helpful tool to calming yourself. Meditation may also be an activity you can share with others to help them get better control over their anxiety.
According to Ms. Yaguda, you can relax your nervous system just by changing the way you breathe. “When we are stressed or nervous, we tend to breathe very shallow breaths in the upper part of our lungs. Pausing to take a deeper, slower breath helps to smooth your nervous system, which helps you feel calmer,” she says.
It is a good idea to practice slow and deep breathing to get familiar with this type of directed breathing, so you can use it when you get stressed. Breathing through your nose for a few seconds and exhaling through your mouth for a few seconds is one form of breathing used in yoga and meditation.
We are facing a challenging time for everyone these days with the COVID-19 pandemic, and because patients with cancer and cancer survivors are immunocompromised, they need to be extra cautious in avoiding exposure to the coronavirus to prevent infection, which affects particularly those with weak immune systems.
There are several reasons why COVID-19 “has been a significant added burden” for patients with cancer and cancer survivors, said Clinical Psychologist Shelley Johns, PsyD, of the Regenstrief Institute and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, in the National Cancer Institute blog. However, she noted that these reasons “are delaying or affecting the manner in which some patients are receiving their scheduled cancer treatments.”
Survivors who have completed their treatment may be okay to delay office visits, but for anyone who is receiving active treatment, delaying or avoiding life-saving treatment is not an option. For them, treatment should be the priority, using precautions as provided by the Centers for Disease Control and Prevention (CDC).
Specific advice on how to deal with stress during the coronavirus pandemic is available on the CDC’s website, at www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html.
Recent technological advancements in telehealth have allowed cancer survivors, especially those in rural communities who don’t have easy access to medical services, to talk to experts to address their anxiety-related issues to receive assistance.
Telemedicine is especially relevant for psychological services and support. These services are available by a phone call or through online services for most cancer centers, hospitals, and doctors’ offices. As a survivor, you can have a follow-up visit or talk to someone about your anxiety without driving long distances, and without the extra time and expenses often required for an in-person visit.
Speaking to someone on the phone or connecting online may help to alleviate your stress and anxiety these days. It is a practical option that doesn’t require you to leave your home, which is especially useful during a pandemic.
- Mitchell AJ, Ferguson DW, Gill J, et al. Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis. Lancet Oncology. 2013;14(8):721-732.
- Different tools are available to help cancer survivors deal with the stress and anxiety they face
- Keeping a diary or a journal helps to express your feelings through words and reduce stress
- Taking an art class or painting is another way to express your feelings and relieve stress
- If you are consumed by worrisome thoughts, meditation or breathing exercises can help to calm yourself
American Cancer Society
CDC: Centers for Disease Control and Prevention
National Cancer Institute