Six Ways You Can Regain Control
by Daniel L. Hall, PhD, and Helen R. Mizrach, BS
Many people with cancer count down the days until their treatment is over, looking forward to finally putting the disease behind them. However, after their primary treatment has been completed, cancer survivors commonly face uncertainty and fear.
Fear of cancer recurrence – which is defined as fear, worry, or concern about cancer returning or progressing – can take a toll on cancer survivors’ emotional well-being. Fear of recurrence can also affect your physical well-being. For example, higher levels of fear have been linked with lower physical activity, higher rates of alcohol consumption, and poorer sleep in cancer survivors.
Fortunately, a variety of evidence-based strategies are available to help cancer survivors regain control over their fears. Here are six things you can do to conquer your fear of cancer recurrence.
1. Remember that fear of cancer recurrence is common for cancer survivors.
When active treatment for cancer is over, it doesn’t mean that your worries are over. At the end of active treatment, cancer survivors may find themselves facing a new, unexpected challenge: persistent fear and distress about their current and future health.
These worries about disease recurrence can last for years after treatment ends. In fact, 30 to 70 percent of cancer survivors report moderate to high levels of fear of cancer recurrence.
Set aside a short window each day – about 10 to 15 minutes – where you allow yourself to worry.
2. Identify your triggers and come up with a plan to address them.
For most survivors who are experiencing fear of cancer recurrence, various sensations or experiences in their day-to-day lives can be triggering. Things like follow-up appointments, cancer-related anniversaries, scans, public health campaigns, and new diagnoses among family and friends can provoke fear and uncertainty. Physical symptoms (such as treatment-related pain and fatigue), normal signs of aging, and other common ailments may also increase worries that cancer has recurred.
By naming your triggers ahead of time and thinking about how particular situations might make you feel, you can make a plan for addressing these emotions before they arise. For example, if you know that an upcoming scan might trigger fear and anxiety, you can plan some enjoyable activities for the days before and after to help distract you from thinking about the scan and the subsequent results.
3. Stick to your follow-up care plan.
Fear of cancer recurrence can change the way that cancer survivors interact with the healthcare system and their cancer treatment team. Some cancer survivors may engage in what is called reassurance-seeking behavior. This can include trying to schedule extra visits with their oncologists, requesting additional screening, or excessively examining their bodies for signs of recurrence. On the other end of the spectrum are cancer survivors who cope with fear of cancer recurrence through avoidance. They may skip or delay follow-up visits, engage in substance use, or refuse to discuss their fears and concerns with their healthcare providers.
Both reassurance seeking and avoidance can place cancer survivors at greater risk for poorer clinical outcomes, increased costs, and – over time – even higher levels of fear. It’s important to strike a balance between these extremes and go with your treatment team’s guidance on follow-up care.
30–70% of cancer survivors report moderate to high levels of fear of cancer recurrence.
4. Focus on what you can control.
A cancer diagnosis can make you feel like you’ve lost control over your health. However, there are many aspects of your health that you can control. Things like how often you exercise, your diet, sleep habits, and other healthy lifestyle choices are all within your control.
Get outside and get moving every day in a way that feels manageable. Make healthy nutrition choices to help prevent and treat diet-related health conditions, such as obesity and diabetes. Prioritize getting enough sleep to boost your energy levels, mood, and cognitive function. Avoid smoking and substance use, limit your alcohol consumption, and seek help if you are struggling with addiction. For support and guidance in implementing these healthy lifestyle changes, you can also seek help from a professional – such as a personal trainer, registered dietitian, or sleep specialist – who has experience working with cancer survivors.
5. Set aside a “worry window.”
Worrying can be paralyzing and can keep you from being able to fully engage in conversations and daily activities. One way to keep worries from taking over is using a technique called “worry time.”
Set aside a short window each day – about 10 to 15 minutes – where you allow yourself to worry. This could be in the morning while you’re showering, when you’re walking the dog, or any time that won’t disrupt your daily routine. If worries pop up at other times, simply make a mental reminder to save those worries until your designated worry time. Limiting your worries to a short window can be challenging, but this cognitive tool can help you keep your worries and fears of cancer recurrence from interfering with your daily life.
6. Try mind-body techniques.
Mind-body techniques, such as cognitive-behavioral skills, mindfulness meditation, and yoga, can help cancer survivors tame their fears of cancer recurrence. In fact, a 2018 meta-analysis of randomized controlled trials found that mind-body techniques are effective in reducing fear of cancer recurrence that persists over time. Moreover, the research showed that the benefits lasted as long as two years.
The mind-body techniques that have been tested most frequently and rigorously are
- Meditative movement, like yoga and tai chi
- Cognitive-behavioral skills, such as setting aside “worry time” and learning to recognize and reframe fears
- Relaxation techniques, such as deep breathing and guided imagery
- Art therapy, dance therapy, music therapy, and other forms of creative expression
Many of these techniques involve focusing on the present moment, which can help cancer survivors reframe their relationship to uncertainty. Using mindfulness meditation and cognitive-behavioral skills can help you tackle both problematic reassurance-seeking and avoidance behaviors. They can also help you learn to let go of negative thoughts and judgements, tolerate waves of uncertainty, and develop an appreciation for impermanence, particularly regarding physical symptoms.
The Key Takeaway
Cancer survivors struggling with fear of cancer recurrence should not hesitate to ask their cancer care team, primary care provider, or psychotherapist for support. These providers can direct you to services and resources that can help you manage your fear and uncertainty. Although fear of recurrence is common among cancer survivors, there are things you can do to take control and conquer your fear of cancer recurrence.
Dr. Daniel Hall is a staff psychologist at Massachusetts General Hospital in Boston, MA, and an assistant professor of Psychology at Harvard Medical School. His research is currently supported by the National Institutes of Health and the American Cancer Society. You can follow him on Twitter, @DanielHallPhD.
Helen Mizrach is a clinical research coordinator at the Massachusetts General Hospital Mongan Institute, working in the Cancer Outcomes Research and Education (CORE) Program and the Health Policy Research Center. She plans to attend medical school to pursue her interest in psychiatric oncology.
This article was published in Coping® with Cancer magazine, July/August 2021.