Beyond Cancer: Fear Factor

Managing fears of recurrence in survivorship

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Cute three colored adult calico cat fearing the height. This lovely cat is one year old and has a very healthy fur

Everyone who receives cancer treatment hopes that their cancer never returns and that they can gradually return to their “new normal” by re-engaging work, relationships and life goals. Cancer survivorship has come to describe many different paths post-treatment. In addition to beating the odds and living cancer-free, for an increasing number of people the path includes a second cancer diagnosis, a recurrence of the same cancer or a metastasis to another organ. People are living so much longer following treatment and they may go through repeated cancer diagnoses and treatments. Knowing these odds can mean that many survivors live with ongoing fears, act on misinformation or suffer unnecessarily living with a past cancer diagnosis.

Fear of recurrence is one of the most common difficulties cancer survivors face as they end treatment, and for some survivors these fears continue long into survivorship. Recent research documents that it is in the top two difficulties for most survivors, but varies in how much it affects quality of life. A majority of survivors report ongoing unmet fear-of-recurrence needs because there are few interventions available to address these fears. For the 22 per cent to 87 per cent of survivors who report high levels of fear, research is showing that if survivors do not address these concerns, these fears can lead to increasing and long-term psychological distress and decreasing quality of life.

Intervention research shows that a combination of actions can help to reduce the debilitating aspects of those fears of recurrence even if your actual risk of recurrence remains unchanged.

Most importantly, many people assume that if they simply ignore, suppress or bottle up those fears by not talking about them, that they will gradually disappear. However, the most effective interventions to reduce these fears ask survivors to do just the opposite. It is difficult to confront those fears head-on, to talk about them with others and to take a course of action to reduce them, but these are the most effective strategies to improve your quality of life. To confront your fears, researchers recommend a combination of strategies.

The first strategy is to ask your oncology team to provide very specific details about signs and symptoms of a recurrence of your cancer and an action plan for you if you should begin to experience these. It is also important to understand what symptoms are safe to ignore. By taking control over your knowledge of your particular cancer and what symptoms matter, you learn how to relax and not monitor each and every physical change you experience.

An additional strategy is to talk about these fears with your oncology team, your family physician, and your loved ones. Confronting these fears can take away their power. Just saying the words out loud has an almost immediate effect. We are social animals and programmed for sharing. Especially when confronting fear, this sharing can dramatically improve how you feel. It can also allow you to gain important information from your medical team and it can allow your family to join in supporting you. Family members often also share this fear of recurrence and will be relieved to be able to talk with you about it.

Another strategy is to make use of guidance along your journey. Joining a support group, seeing a therapist and learning relaxation techniques can all shorten the road to improvement. Because licensed therapists are trained to facilitate the techniques shown to most quickly relieve these symptoms, you might consider accessing these services if you are experiencing a high level of fear.

If you are experiencing fears of recurrence, but they are not intruding on your well-being, simply reaching out to friends, non-therapist-led support groups, loved ones and the peer support that other cancer patients can provide can help you gain tips and learn coping strategies.

Lastly, reducing your stress levels through self-care can dramatically improve your well-being. Exercise reduces distress and improves feelings of control. Engaging with loved ones doing things you enjoy allows you to regain feelings of normalcy. Reading humorous books or seeing funny movies can allow you to relax and take a different perspective. In addition, making healthy choices to eat well, eliminate smoking and limit drinking and drug use will allow you to feel confident that you are doing all you can to survive cancer.

Where to Find Help

In Alberta, if seeking professional help, contact Psychosocial Oncology groups through the Tom Baker Cancer Centre in Calgary or Cross Cancer Institute in Edmonton for appointments or referrals. Many community-based organizations also provide peer support that can be helpful.

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