Cancer anxiety

Anxiety is one of those words that is commonly used, but almost always without specifics and clarity. There are lots of other words that mean more or less the same thing: worry, distress, upset, fear, even panic. There is one word that is very cancer specific and captures a particular feeling and moment: scanxiety. This refers to the worry/fear/panic that almost all of us feel around the time of scans or other cancer tests. This is an experience that does not seem to get easier with practice. If recent news has been good, we worry that our luck is about to run out. If the recent news has not been good, we worry that things are getting even worse. Especially since scans or MRIs or ultrasounds are looking inside our bodies, there is nothing that we can feel or measure ourselves.

And, since nothing in Cancer World, is so simple, if there is a tumor that is visible or palpable, that can increase our anxiety, too. Is it bigger than it was yesterday when I felt it? Is it maybe a little smaller than it was last week? It can be impossible to stop constantly probing and guessing and worrying.

Over the past week, I have had several conversations with worried patients who were scheduled for scans in the near future. I have learned that it is absolutely necessary to have a plan in place before the scan, a plan that lays out how you will learn the results. It does not much matter what the plan is as long as you are comfortable with it, and have discussed and arranged it with your doctor. Some people prefer to wait until their next scheduled appointment, hopefully soon after the scan, to hear the results. Others want a phone call as soon as the doctor can access the report. If you want a phone call, it is especially important to be clear that you want this call regardless of the results. If that is left at all fuzzy, you will be in a maze of worry: Is my doctor not calling because the news is bad? Or was she only going to call if things have changed? Or what exactly was the agreement about the call? You get the idea: it needs to be clear that there will or will not be a call, no matter what the news turns out to be.

In the not so distant past, many doctors were reluctant to give bad news by phone. There are some good reasons for this; I have heard horror stories of hearing of a cancer diagnosis while driving 70 mph down the Mass Pike or taking a call in the middle of a child's birthday party. The most commonly expressed worry by doctors was that it would be too upsetting for a patient to hear bad news without immediately having the conversation about what will come next. There are easy ways around this one: first, if you want a call, you will both have already agreed to transmit the information this way. Next, the doctor can add something short like: "I know this isn't what we hoped to learn, but I have several ideas about new therapies that we can discuss when we meet on Thursday." Many people have told me that they actually prefer to hear difficult news by phone because they can they cry in private and begin to collect their thoughts and questions. Best of all, of course, is hearing good news!

Scanxiety is not the only kind of anxiety that often accompanies cancer. It would be impossible to be diagnosed and go through cancer treatment without having worries. Some people worry most about post-surgical pain. Others are scared by chemotherapy side effects or radiation therapy. Most of us are worried about dying, and it can be all too easy to let our anxiety flourish. To some extent, it is impossible to completely banish anxiety from our lives, and we may as well recognize that truth.

There are some strategies to help manage anxiety even as we acknowledge that it is part of the experience. If anxiety is overtaking your days, making it impossible to enjoy activities or relationships or to focus on your work or to sleep at night, it is likely time to speak with a therapist and, maybe, to consider anti-anxiety medication. There are a number of possible drugs that can help and won't turn you into a zombie. If anxiety is a problem, but not an overpowering one, there are some tricks:

1. Set aside a worry time. For example, between 5:00 and 5:15 every afternoon can be designated your Worry Space. If upsetting thoughts come into your mind at any other time of day, recognize them and tuck them away until 5:00. This often works because when 5:00 rolls around, you may well be occupied with something else.
2. Imagine a worry bully on your shoulder, a constant unpleasant companion. Each time you worry, you are feeding and growing him. Each time you dismiss the thought, he shrinks a bit. If you like this idea, it helps to visualize the little guy, so you can see him grow or shrink.
3. Put a rubber band on your wrist. Each time you begin to think about your fear, snap the rubber band hard enough so it strings. This often works.
4. Visualize a stop sign and pull up the image when the thoughts intrude.
5. Write it down. Putting something on paper, whether by hand or by computer, often makes it easier to put it away.