Coping with the Fear of Recurrence
by Mary K. Hughes, MS, RN, CNS
In You Learn by Living, Eleanor Roosevelt wrote, “You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, ' I lived through this horror. I can take the next thing that comes along.' ” Living through cancer treatment can be the horror, but for some, living with the fear of recurrence is even worse.
Fear can be both a positive and a negative emotion. On the positive side, it protects you from the threat of danger. Fear can also protect you until you can deal with the reality of the threat (cancer). It can give you time to organize your thoughts and emotions.
On the negative side, fear can paralyze you and cause worry. Fear also heightens the imagination, which conjures up all sorts of negative situations. It can keep you from enjoying and living your life because of the “what ifs.” What if my cancer comes back? What if this headache is from cancer spreading? What if the chemo doesn't work? All of the unknowns that are part of your life after cancer can increase fear. If you are a worrier, you are more likely to live with the negative side of fear.
Fear affects people both psychologically and physically. Psychologically, it can cause anxiety, irritability, depression, anger, difficulty focusing, preoccupation with symptoms, or sadness. Physical symptoms include breathing difficulties, sighing, jitteriness, crying, decreased sexual interest, fatigue, weakness, change in appetite or sleep patterns, or a racing heart. It can cause muscle tension, which manifests in shoulder pain or headaches.
Fear can keep you from enjoying and living your life because of the “what ifs.”
Fear manifests itself in different behaviors, such as talking a lot or becoming silent, wanting to be alone or needing to be with people, and crying or being stoic. Some people socially isolate – they don't return phone calls or want to have any social contact – while others dive headlong into social activities.
Fear of cancer recurrence is both common and predictable. Common times for fears to increase are after treatment ends, the anniversary of your diagnosis, when treatment changes, when it?s time for a check-up, when you have a suspicious symptom, or when awaiting test results. Fears also increase when a public figure is diagnosed with cancer or has a recurrence.
Coping is dependant on your type of cancer, its stage and symptoms, the kind of treatments you have had, the side effects of treatment, the effect of treatment on the cancer, and your prognosis. Coping is also related to your prior level of adjustment to other crises, your personality, your individual coping style, and your prior experience with loss. Being diagnosed with cancer is itself a loss, which causes grieving.
Coping is associated with how you handle stressful situations, and what worked for you in the past is what you will tend to use to cope with your fears. Coping is a temporary solution until you can adapt to a situation. It is important to identify your fear so you can learn to cope with it. Coping is both an internal and an external process. It is how you think and feel about a problem as well as what you do about those feelings.
Complementary therapies like journaling, visual imagery, massage, meditation, exercising, and music and art therapy can help you cope because they help you learn to relax. Gathering information about your cancer, such as what symptoms to report to your doctor, can also help ease your fears. For example, if you have a headache, take an aspirin first. If that doesn't work and you continue to have headaches, talk to your doctor.
Other coping mechanisms are emotion-focused. You can learn to focus on how you feel and then on what you can do about those feelings. Feelings are neither right nor wrong, but what you do with your feelings is important. Sharing your concerns – perhaps with a friend or a support group – can also help relieve the burden. Talking about your fears instead of just thinking about them can take away some of their power. When you express your fears, they don?t seem so overwhelming or unmanageable.
Being able to distract and control your fear rather than letting it control you is a skill you can learn. Focusing on the here and now, rather than on the unknown, will help you get through each day.
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Mary Hughes has been a clinical nurse specialist in the psychiatry department at The University of Texas M. D. Anderson Cancer Center in Houston, TX, since 1990.
This article was originally published in Coping® with Cancer magazine, July/August 2008.