After Treatment: Handling Fear of Recurrence

Patients undergoing treatment often worry about whether therapy will be effective and cure their disease. But a different kind of worry—fear of the cancer returning—rears its ugly head at the completion of therapy when, after an extended period, the medical team is no longer at the forefront.

Although it may never go away, fear of recurrence should diminish over time, especially if a patient has a positive experience of being a survivor and a well person. Managing fear is essential when external stimuli, known as triggers, feed anxiety. Some common triggers include a relative or friend receiving a cancer diagnosis, aches and pains previously associated with cancer, media coverage of cancer and follow-up medical appointments. Having to revisit those emotions during doctor’s visits can sometimes cause survivors to avoid necessary follow-up testing. But for others, fear becomes part of an action plan, motivating survivors to seriously look at maintaining a proper diet and healthy lifestyle.

Helpful coping strategies include using calming self-statements, imagery and distraction; talking to family, friends, doctors or nurses about the fear; and writing in a journal, which provides a setting for a personal monologue to explore issues behind the fear can and ways to overcome it.

Creating a “worry list” may also be helpful. Here’s how it works:

Make a list of worries and include specific examples. Many worries look different when written out, and may seem less problematic. Even the simple task of expressing specific concerns may release some of their power.

Write down every recollection of worries that actually materialized in some concrete way. Scan the notes and find the number of times a “false alarm” outnumbered the times a worry became reality.

Every day at about the same time, revisit the list, carefully noting how, since the day before, nothing actually happened. Allow a specific amount of time for this activity and cut down the time allowed for “worry list” review each week until it is diminished to one minute each day.

Seek out someone who is dealing with cancer and share this approach with them. Showing others that worry is a drain on energy may lift the spirits of other survivors, as well.

Sometimes people become so fearful that they fall into despair. If a patient feels overwhelmed by fear, it is time to get help from a mental health professional. Symptoms of fear that may indicate a need for mental health care include anger and irritability, difficulty with concentration and problem solving, and physical symptoms, such as muscle tension, dry mouth, trembling, shaking, or restlessness. Changes in appetite or sleep can be important symptoms that indicate a need for help. Some people find that medication is appropriate in helping them get through the most stressful periods.

[Predicting Future Risk of Cancer]