Handling Cancer and COVID-19 Fears

I have written about cancer fears in the past, but the world feels scarier than usual. Now we have added fear of COVID-19 exposure to our already long list of cancer worries. Many conversations I've had this week revolve around fear: fear about a new cancer diagnosis, fear about a new recurrence, fear of surgery, fear of chemotherapy, and, most commonly, fear of catching COVID-19.

It is worth a reminder here: most people who are diagnosed with the coronavirus survive it. So far, in Massachusetts, the mortality rate is about 1%. That is not at all comforting for people who fall into that 1%, but it should remind the rest of us that a diagnosis is not necessarily a death sentence.

People diagnosed with metastatic or Stage IV cancer usually understand that their disease is not likely curable. Those with earlier stage disease hope that their cancer will not return after treatment, but their biggest challenge will be living with the threat of recurrence. The catch is that none of us ever has a promise that the cancer will not return; being anxious about every cough or ache and pain is not neurotic but is a reality-based concern that there could be a big problem. Having cancer is likely to turn all of us into hypochondriacs, hyper alert to every physical symptom and reluctant to trust our bodies and believe in our good health. Living now in a virus-filled world compounds these feelings. If we awaken with a sore throat or a headache, we immediately wonder if we Have It.

Don't Let Cancer and COVID-19 Fears Dominate Your Life

Learning to live with this real threat without being consumed by anxiety and sadness is often the most difficult task before us. I am certain that the goal is to live as though the cancer will never return. Living "as if" is easier said than done, harder some days than others. Beyond having appropriate treatment, there is nothing that we can do about the possibilities. It is out of our control. Similarly, we must try to live "as if" we are not going to contract the virus.

Most certainly, however, if we permit our fears to dominate our days, the cancer or our fears win. Whether or not it does return, we have wasted our time and our lives if we live them in sorrow and fear. The fact is that, if the cancer does return, we will most certainly have to deal with it then — but we do not have to deal with it today. We must somehow cultivate Scarlett's attitude in Gone with the Wind; she promised herself that she would survive each day and leave the worry to tomorrow.

Use the "Two-Week Rule"

How do we begin to do this? One useful and practical tool is the "Two-Week Rule." Most oncologists will tell you that it is not necessary to call about a symptom unless it persists for two weeks or longer. Most don't. Obviously, this does not apply to potential emergencies — don't wait five minutes to call about chest pain or sudden double vision or something else that you know is possibly acutely serious. This rule does apply to lower back pain or hip pain or a lingering cough. Note when you first noticed the problem, make a note in your calendar two weeks hence, and then try to ignore it until then. Chances are, when the marked date comes around, the symptom will be gone.

Identify Your Specific Fears

What are you really afraid of? If you think more about your fear, it is possible to identify the specifics. Rather than just thinking "I am afraid of dying," try to tease out what your real worry is. Are you afraid of pain? Of being a burden to your family? Of being alone? Of leaving your children? Although there may not be comforting answers or solutions to your fears, it almost always helps to think specifically about them and then try to imagine what might help.

Taking Action on Those Fears

If, for example, you are most fearful of pain, you can talk to your doctor about it. There are many medications that can be used to control pain for people who are very ill with cancer. The trade off is sometimes alertness — pain medications make you sleepy. If, however, you are willing to be sleepy or asleep, it is likely that your doctor can virtually promise you that you will never suffer.

If you are most afraid of leaving your children (and I am very aware that there are no words of comfort for this grief), it will help to consider concretely what would happen to them. Yes, of course, they would be terribly sad, but think about who would continue to care for them, who else loves them, how you can prepare any legal or financial documents that will protect them.

This is also a useful strategy when we fear getting sick with COVID-19. What are you most frightened about and are there ways to plan for those unlikely possibilities? For example, a single parent with whom I work has been reassured that his sister will come stay with his daughters if he should need to be hospitalized.

Preparing for the Ebb and Flow of Fears

As time passes, most of us find that the fear diminishes. It is always lurking somewhere, ready to jump out of dark corners, but it attacks less frequently. There is a wonderful saying: Courage is like a muscle. You have to use it to strengthen it. Or, another: Perhaps courage is fear that has said its prayers.

Fear is human. We will sometimes feel it like a wild animal on our backs, claws digging in. At those moments, I remember the words of Audre Lorde: "When I dare to be powerful — to use my strength in the service of my vision, then it becomes less and less important whether I am afraid."