A whopping 18-25 percent of long term cancer survivors report anxiety symptoms. That’s a large percentage. What that number tells me is that we’ve got to do better taking care of the mental health of cancer survivors.
Preparing you for the anxiety that happens AFTER cancer is one place to start. So let’s talk about how it looks for cancer survivors with anxiety.
And if you’ve got some anxiety you’re dealing with after cancer, I’d like to give you one simple technique you can start using today that might help you create more calm in your life.
Anxiety in Cancer Survivors
Cancer survivors can experience a complex mixture of physical and psychological symptoms including:
● Rapid heartbeat and sweating
● Being over watchful regarding symptoms and events
● Shortness of breath
● Emotional numbness
Although many of these symptoms might be normal reactions to having cancer, if they’re severe to the point of interfering with your day-to-day function and quality of life, they may require medical treatment.
Fear of Recurrence
The fear of recurrence is particularly common after cancer. Fear of recurrence has both emotional and cognitive aspects and happens commonly in the days or weeks prior to regular surveillance visits, the time when cancer survivors may have more intrusive thoughts about cancer and more irritability and anxiety.
Fear of recurrence can be cyclic. In a study of fear of recurrence in breast cancer survivors, it increased before a mammogram, decreased after receiving negative results, and then increased again one month after the mammogram.
While some degree of fear of recurrence may be considered normal, it can be severe enough to cause a negative effect on medical care or quality of life. Examples of this are:
● Avoidance of health professionals and office visits
● Being over watchful for changes in physical sensations or the onset of new symptoms
● Increased use of healthcare, like frequent visits to the doctor or emergency room
Higher levels of fear of recurrence are associated with a later cancer stage at diagnosis, younger age (age <60), prior cancer recurrence, lower education levels and lower levels of social support, self-identification as a cancer patient, female gender, and particularly for women, having children, regardless of their ages.
Prior mental health issues including other anxiety disorders and depression, being diagnosed with skin, colon, or a hematologic cancer, and high levels of pain and other physical symptoms also puts you at higher risk for fear of recurrence.
Unfortunately, post-traumatic stress is under-diagnosed in cancer survivors. It’s possible that the under recognition and diagnosis of PTS results from the tendency of many cancer survivors with PTS to avoid health care environments as part of their coping strategy.
While avoidance doesn’t help you get the care you need, it does serve to reduce anxiety and other symptoms in survivors with post traumatic stress. Post traumatic stress symptoms may not rise to the level of post traumatic stress DISORDER in survivors, but they may still disrupt quality of life and functioning.
The incidence of PTS and PTSD is not well studied in cancer survivors, but there is some evidence to mention:
● In one study of non-Hodgkin lymphoma survivors, 37 percent reported increasing or persisting symptoms of PTS. 8 percent reported symptoms consistent with PTSD.
● In a study of long-term breast cancer survivors, PTSD was diagnosed in 12 percent of them.
● A meta-analysis found a rate of 5 to 7.3 percent for PTSD in cancer survivors, compared with 2.4 percent in the general population.
Studies have consistently shown that in adults, an increased risk of PTS is associated with:
● Lower economic resources
● Poorer social support
● Non-white race
● Less education
● A more recent diagnosis
● More perceived negative impacts of cancer
● Younger age at diagnosis
Cancer-related distress is different from anxiety because it’s actually the consequence of living with a heightened awareness of the uncertainties in life and does not generalize to anxiety in all aspects of life.
Cancer-related distress is more common in survivors than other psychological issues and has multiple components, including:
● Fear of recurrence
● Hyper watchfulness about new or persistent symptoms
● Concerns about family and finances
● Stress from managing health needs
● Changes in self perception and body image
● Increased awareness of vulnerability
Cancer-related distress may also include symptoms like concentration problems, fatigue, and insomnia. It often does not meet the criteria of diagnosis for a formal anxiety or depressive disorders. Cancer-related distress has been reported in 36 to 43 percent of cancer survivors of all types.
So what do you do about it?
There are two things you should know about anxiety in cancer survivors:
If your life is being disrupted by anxiety to the point you can’t function, you need to get medical help.
Many symptoms don’t rise to the severity of a medical diagnosis, but they’re incredibly distressing nonetheless.
Treatment of anxiety after cancer can come in the form of medications and/or cognitive behavioral therapy. You really need to seek these interventions if you’re overcome by anxiety. You deserve it.
For less severe symptoms, you might try:
Physical activity — Physical activity is safe and improves distress and depression in cancer survivors. And a great bonus is it can improve other of physical health, emotional well-being, body image, and overall quality of life.
Mind-body interactions — Activities such as yoga and qi-gong have been the subject of scientific study and consistently show they can improve quality of life. As an example, a meta-analysis of randomized trials looking at yoga in cancer survivors showed that yoga can have a positive impact on distress, anxiety, and depression. In another, separate study in prostate cancer survivors, qi-gong was associated with reductions in the level of fatigue distress.
Increase Calm in 2 Steps
But what can you do for your anxiety, right this very minute?
I have two steps for you.
The next time you feel anxious, the next time you meet a trigger of your anxiety, like a pharmaceutical commercial, or when you drive by the infusion room, try feeling CURIOUS about your physical symptoms and thoughts.
Curiosity sets an objective tone over your anxiousness. It’s essentially practice in non-judgmental acknowledgement of your thoughts, and this is the cornerstone of a mindfulness practice.
What do you notice? How is your breathing? How does your skin feel? What do you hear? What thoughts are floating through your mind? Did your mind go blank? Is your mind too full of thoughts to notice one in particular?
Once you practice getting curious, ask yourself, “Are these curiosities serving me, right this very moment?”
This is not to ask if your fears are justified, if you have been through too much, or if you have too much to lose.
The question is, “Is the way I feel right this very moment serving me?”
Only you know the answer to that question.
These two steps are just one way to stop the automatic reactions you’re having to your anxiety triggers. This takes practice, but it works.
It’s clear that experiencing anxiety after cancer is totally normal, but I want you to feel better than that. Start today with these two steps, talk to your doctor and the people who support you if you need more help, and be well.
Take care, Surivivor.
If you’re interested in going deeper with Brio Survivor Wellness, download Brio’s FREE Morning Checklist. It includes 7 easy things cancer survivors can do each morning to give you more energy in your day, starting right now! Click the button below to download the checklist.