Risk and Safety During COVID-19 and Cancer

This has been a traumatic year for most people around the world. The degree of trauma depends, of course, on your personal circumstances, but the combination of cancer and the pandemic has been a heavy load. For people who must also contend with job loss, economic struggle, heavy childcare obligations since schools have been closed or other family concerns, it has been especially difficult.

Trauma theory includes discussion of risk detection and safety seeking. In our reactions, we do both, and framing coping in these two dimensions can be helpful as we try to better understand and manage our feelings.

Through the years, I have found it helpful to frame cancer treatment and recovery as a kind of PTSD (post-traumatic stress). This has been a closer fit for many people than labeling their reactions as depression or anxiety. Of course, those feelings are present, too, but the over-arching theme is most often recovery from and coping with trauma. Being diagnosed with a potentially life-threatening illness and going through months of difficult treatment is an intense experience, and it is inevitable that our responses are also going to be intense and challenging.

Trauma theory includes discussion of risk detection and safety seeking. In our reactions, we do both, and framing coping in these two dimensions can be helpful as we try to better understand and manage our feelings. Let’s first consider risk detection. When we begin treatment for cancer, we are frightened and contending with situations and treatments that are new in our lives. We are given information about risk as it applies to our diagnosis: statistics, side effects of chemotherapy drugs, surgery, and possible dangers during the months of treatment. For example, we are warned about high fevers and exposure during the times that our counts are low. We may try to improve our diets, reduce our alcohol consumption, exercise more, or lose weight as ways to maybe reduce our risk. During this pandemic, the risks are clearly proclaimed: wear your mask, stay away from crowds, social distance from others, consider isolating from anyone who does not live in your household, wash your hands, etc.

Safety seeking is how to try to manage or even control the risks. In life, it is never possible to completely control our risks and our world, but it is especially impossible during cancer treatment and during this pandemic. One of the very hardest things for many people going through active cancer treatment is having to acknowledge their lack of control. We feel almost completely at the mercy of the drugs we are taking, the clinicians who are caring for us, and the physical and emotional cyclones that batter us. There are the big things, like whether we will survive the illness, and the small ones, like having someone else make scan appointments for us at what is a most inconvenient time. This year, everyone in the world has had a similar experience as we recognize that we cannot keep ourselves and those we love completely safe unless we never leave the house—and, even then, there could be small risks from tiny exposures to a delivery person or a necessary repairman.

Safety seeking during cancer treatment translates to how we decide to live our best possible lives in spite of chemotherapy or radiation. We may choose to limit our activities and to pass up events that we ordinarily enjoy. During COVID-19, our choices are similar, but greater. We likely opt not to go to restaurants or the gym, even in places where they are open, and we see our friends outside and masked. Making these choices gives us some sense of safety and control even while we have to continue to contend with our risk. As I have said in other blogs, there are a lot of similarities between living with cancer and living with this pandemic. We have had practice, and the rest of the world has learned what we already knew. Adding the concepts of risk detection and safety seeking to your vocabulary and your thinking is another helpful tool to enable us to adapt to these times.