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Pharmacy Links

AFTER CANCER: RECURRENCE SCARES

March 12, 2009

Invariably, all cancer survivors suffer recurrence scares. A lump, a swollen arm, a backache, or a headache can trigger a cascade of thoughts that culminates in the fear of recurrence. This is a normal part of survivorship. You need to have a practiced plan of action of what to do and think when faced with a recurrence scare. An effective plan will minimize unnecessary emotional trauma and help you do the right thing.

First, look at what has triggered the scare, and ask yourself whether it is at all possible that you really do have a recurrence of your cancer. If logic tells you that your problem is not related to a recurrence, you can deal with it as you would with any other non-cancer-related problem.

If, through logical or illogical thought, you have worries or anxieties about recurrence, you need a trusted expert to tell you whether the concern is real and, if so, what must be done. In a good doctor-patient relationship, you can tell your doctor, “I know I’m fine, but I need you to tell me so.” This expert is your regular doctor, either your internist, family practitioner, or oncologist.

If you are having pain that needs attention or are getting worse very quickly, call your doctor immediately. Otherwise, call your doctor’s office during office hours and explain that you have a symptom that is concerning you and that you need to be seen as soon as possible.

If your doctor agrees that there is reason for concern about recurrence, be sure to do the right thing: get more information about the problem. Proceed with whatever evaluations or tests are needed. If you are advised to have a biopsy, proceed. If you do not feel comfortable with this advice, get a second opinion as soon as possible. Delaying a biopsy will not make the problem go away; it may only lessen your treatment options and lessen the chance for controlling or curing a recurrence or a noncancerous problem.

Remember that whether or not you have a recurrence is already determined at the time you notice a problem. Thinking or fearing that you might have a recurrence does not create a recurrence.

Denying that you might have a recurrence does not prevent it. You do not have a choice about whether your current symptom is due to cancer. You do have a choice about whether you get it evaluated. Do not waste time or energy worrying about how much you are worried or afraid. Do not try to figure out whether you are too hypochondriacal or too alarmist. When there is concern about recurrence, you can expect to have some emotions. Reassure yourself that you have a plan of action and that you are doing the right thing.

You owe it to yourself to be evaluated as soon as possible. You deserve to minimize the physical and emotional impact of any problem through early evaluation.

As you go through the motions of getting your problem evaluated, remind yourself that

• not every cough or lump is a sign of cancer

•you owe it to yourself and those people who care about you to get evaluated at the earliest opportunity, which will influence the impact of the findings

• even if it is recurrence, you can be treated again

Recurrence is not a death sentence.

For many people, it helps to imagine receiving good test results. Training yourself to stop bad-outcome scenarios in their tracks will not change the outcome, but it will definitely change the experience you have waiting for tests and evaluations to be completed. If things do not turn out well and your greatest fear is again realized, you will deal with your recurrence then. If everything turns out okay, as many times it does, you will have saved yourself much anxiety and disruption.

It helps some people to imagine bad test results and then plan how they will handle bad news, practically and emotionally. Thinking through contingency plans for work and home in case the biopsy is positive seems to offer some people a sense of control over the anxiety of the unknown. Imagining bad results makes others feel that if they think the worst, it will not happen. This is a paradoxical way of using magical thinking for comfort, but it is effective for some people.

Do what feels best to you. You may have to try different ways of coping with fear and anxiety to find the style that works best for you.