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For Any Cancer Diagnosis

Q. How can a cancer survivor deal with fear of recurrence?

A.

Many feelings can come up once cancer treatment ends. On the one hand, it is a time of hope and relief, but it can also be a time of fear and anxiety. Fear of recurrence is not at all uncommon for cancer survivors and you are not alone. Take control of the things you are able to. Everyone has their own way of coping, but here are a few practical suggestions:

  • Take care of yourself by making healthy choices which may include increasing physical activity and adjusting your diet. Engage in activities such as yoga, meditation, or other relaxation techniques.
  • Seek out support. Speaking with others in a support group can help relieve anxiety.
  • Explore spiritual connections. Read our fact sheet, Strengthening the Spirit.
  • Stay active in your follow-up care by asking specific questions.

Questions to ask your doctor about recurrence:

  • What is the likelihood that my cancer may return?
  • Are there any steps I can take to keep it from returning?
  • How can I know if it’s back? Are there things I should I look for?
  • What tests will I have that could detect a recurrence? How often should I be tested?

Our publications, Communicating With Your Health Care Team and Doctor Can We Talk?, offer practical suggestions that will prepare you for your doctor appointments.

Other resources include:

Finally, expressing your feelings to a counselor one-on-one in a nurturing environment can be helpful. The process of openly coping with emotions helps many people feel less anxious. You may also join a post-treatment support group to learn how others cope with fear of recurrence.

Q. I'm a cancer survivor and am wondering if I should seek counseling now that my treatment has ended?

A.

The decision to pursue counseling is always very personal. As a post-treatment cancer survivor, you may be dealing with concerns that are different than those you had at the time of your initial diagnosis. The post-treatment phase may be a time to reevaluate purpose, direction, and priorities. We know that many cancer survivors have fears of recurrence and other anxieties that friends and loved ones may not fully understand. Speaking with a counselor can help.

CancerCare offers a number of ways to get support including counseling and support groups. A support group provides a safe place for people coping with similar issues to share and learn from each other. Many people find the opportunity to relate to others in this way enormously helpful and powerful.

You may also want to listen to our Connect Education Workshop, Managing the Stress of Survivorship.

Going forward, keep in mind that taking care of yourself emotionally is equally as important as looking after your physical needs.

Q. Since I've been diagnosed, I've been anxious and sometimes feel overwhelmed by my thoughts, which I can't seem to "turn off." Are there any ways I can help myself to feel more calm?

A.

Anxiety is a natural emotional experience for eveyone. When someone has to cope with a cancer diagnosis, anxiety (or worry) can increase, intruding on an individual’s ability to regain a sense of calm, clear his or her thoughts and feel more control over the issue at hand. Chronic anxiety can lead to fatigue and depression over time, so it is important to find techniques that can offer relief from the stress of cancer, even if just for short periods of time.

When confronted with crisis, our bodies trigger a “fight or flight” response. Part of this physical response is rapid, shallow breathing, which increases blood flow through the heart and puts extra oxygen into our bodies. A person under chronic stress will continue to take shorter, more shallow breaths, which will in increase stress and create a continual state of anxiety.

Here’s a simple breathing exercise that can help calm you:

  • Sitting down, place one hand on your chest and the other over your navel.
  • Take three breaths and observe your breathing. For most people, the chest area tends to rise more than the abdomen.
  • Now, take in a deep breath and extend your abdomen. Picture your lungs as long, narrow balloons, filling up from the end to the front; and from the bottom to the top.
  • Hold the breath and silently count to five; then, exhale loudly.
  • Do this for three breaths and then sit quietly for a moment. If you feel lightheaded, hold the next breath for a shorter time. Most people find there is a calming feeling that follows.

The beauty of this exercise is you can do it anywhere, anytime. The goal is to reduce stress by returning yourself to a natural state of breathing.

You can find more relaxation techniques in CancerCare’s fact sheet, Relaxation Techniques and Mind/Body Practices: How They Can Help You Cope With Cancer.

Q. One of the toughest times I have is when I go to bed at night. After I turn off the lights and am in the dark, my thoughts go immediately to my cancer and possibly dying from it and all the things I should do in preparation. Any suggestions?

A.

Anxiety is very common among cancer patients. For some it occurs when they wake up, and for others, as they try to go to sleep. You mention three concerns which trigger anxiety as you’re trying to fall asleep. The first is turning off the lights, the second is the fear of dying, and the third is wanting to have your affairs in order.

The dark can be an especially scary place for people facing a life threatening illness. Absence of light is a metaphor of the darkness of unknowing. Try changing your bedtime routine – relax into your pillow with the light on. Like a child who sees monsters in the dark, turning on the light, even dimly, can provide comfort and a sense of control, allowing you to relax and fall asleep.

Your second concern, fear of dying, triggers a “fight or flight” reflex, hardwired into all of us for survival. Using mindful meditation, focus on your breath while non-judgmentally looking at your thoughts when your mind wanders, especially thoughts of worry. When you feel anxious, gently bring your focus back to your breath. Breath, specifically oxygen, is life, which fuels us, and aims to keep us in balance. Anxiety makes us take short breaths depriving our body and mind of oxygen and making us more anxious. When anxiety is high, take a deep breath, hold it for a comfortable amount of time, then release it, and repeat. You can do this for a few minutes or until you fall gently to sleep. You might also try listening to a pre-recorded guided imagery exercise, if you have difficulty meditating on your own.

Finally, thinking about unfinished business, especially if there is a perceived timeline, often makes people anxious. Putting one’s affairs in order does not mean giving up on life, it simply means taking care of, and continuing to invest in our lives. With the worry of cancer it can be hard to focus on individual tasks, thereby increasing one’s anxiety. Try writing down the things you need to take care of, and then prioritize them. Use creative visualization, by imagining yourself doing and finishing each task, and enjoying a sense of accomplishment as each task is completed. These visualizations can serve as a first step and increasing the likelihood of completion, which in turn can free you of the worry that is keeping you awake at bedtime.

To learn more about reducing anxiety, please read our fact sheet, Relaxation Techniques and Mind/Body Practices.

Q. My treatments for cancer aren't always easy. More and more, I am thinking negative thoughts, which only increases my anxiety. What can I do to calm my mind and help make my treatment sessions go more smoothly?

A.

We’ve all heard the saying, “We are what we eat.” No one disputes that since it’s apparent the food we put into our mouths replenishes cells and becomes our physical bodies. Less commonly heard is, “We are what we think.” This is because it is much less apparent what direct impact our thoughts play in our well being. Unlike food, which can be quantified and controlled, our thoughts are affected by external sources often outside our control including people, places and things. Now, the growing field of psychoneuroimmunology (PNI) shows that the mind and body are constantly communicating, back and forth.

If negative thoughts come up for you in managing your cancer, guided imagery exercises can help you counter them with positive thoughts, so the body can be more relaxed. One imagery exercise is called Creative Visualization, which is used in sports psychology, business and other areas where people confront challenges. It’s a simple technique that uses your imagination to envision an event as you would like it to happen.

Before receiving a chemotherapy treatment, you might take time to quietly sit and visualize how you would ideally like treatment to go. It helps to think about details such as what clothing you’re wearing, how the weather feels, or where you’ll be sitting or lying when you get your treatment.

During your treatment, you can continue to visualize the chemotherapy (or radiation or surgery) as it travels through your body and “confronts” the cancer cells. Use your imagination: employ super heroes (yourself or others), magic wands, or loved ones providing comfort, hope and strength to defeat the cancer. This technique can ease the mind’s tendency to worry and help you focus on “rallying” healthy cells and the immune system to defeat disease.

If you have difficulty coming up with your own Creative Visualization exercise, it might be easier to listen to a pre-recorded Creative Visualization exercise. You can find a large number of CDs and audiobooks on this subject by doing a search (using keywords “guided imagery” or “creative visualization”) at Amazon.com. Also, a good book on the topic is Creative Visualization: Use the Power of Your Imagination to Create What You Want in Your Life, by Shakti Gawain (New World Library Publishers).

For Breast Cancer

Q. I've just started treatment for breast cancer and I need to talk about my fears and concerns with the people who are closest to me. But my family just says, "Oh, you'll be fine" and to stay positive. How I can I get them to listen?

A.

A diagnosis of cancer is a little like throwing a stone in the water; the ripples extend well beyond where the stone lands. Just as you are trying to deal with treatment and the concerns that go along with it, so, too, is your family. They may be anxious about how to help you and afraid they may upset you if they talk about your feelings or theirs. Much has been written about the need to remain “positive” for the person with cancer and family members are often concerned that if they express negative thoughts or concerns it will make the illness worse.

We’ve developed information to help address some of these communication challenges that may arise. Coping with Cancer: Tools to Help You Live and Caregiving for Your Loved One With Cancer are Connect® booklets that might be helpful to you and your family members. Our fact sheet, “What Can I Say to a Newly Diagnosed Loved One?” may also help your family members talk with you about your diagnosis. Another good resource is The Breast Cancer Companion (Avon Books, New York) by Kathy LaTour; several chapters deal with opening communication.

You might also try to set aside time to have a family meeting and allow each member an opportunity to talk about their concerns. For example, family members might meet to read aloud letters they have written about their own fears and emotions, as a way to begin the discussion.

Remember, not all families can respond in ways that will be helpful. A support group might be useful to you as a way to connect with others who understand how you are feeling. CancerCare offers groups in-person, over the telephone, or online. You can also contact us at 1-800-813-HOPE (4673) and speak with an oncology social worker.

For Lung Cancer

Q. I'm in remission after having chemotherapy and radiation for small cell lung cancer. I've recently started having a shortness of breath when I'm at rest (doesn't seem to happen at work). Is there anything I can do?

A.

The shortness of breath, or dyspnea, you are experiencing can be uncomfortable and frightening. The more you struggle for air, the harder your lungs work to get oxygen, and the more distressed you feel. It is extremely important to consult a medical professional to find out what might be setting this cycle in motion. Possible causes could be:

  • a side effect of chemotherapy or radiation (which may reduce lung capacity)
  • anemia, meaning your lungs don’t have enough red blood cells to deliver oxygen throughout your body
  • a non-cancer lung condition, like asthma, COPD, or an allergy
  • anxiety caused by fears of recurrence, the lasting emotional effects of having had cancer, or other types of stress

Contact the American Lung Association (1-800-LUNGUSA) for information on other possible causes of dyspnea. Depending on its source, a doctor may prescribe a steroidal or anti-anxiety medication, supplements, oxygen, or special exercises. The Lung Cancer Alliance has a very helpful video demonstration of breathing techniques to relieve dyspnea. Progressive relaxation, meditation, and guided imagery can all help reduce stress and anxiety. CancerCare has several Connect Education Workshops that address stress management in cancer survivors including Fear of Recurrence and Late Effects: Living with Uncertainty and Managing the Stress of Survivorship.

To prepare for your doctor’s appointment, keep a record of your breathing problems, with these questions in mind:

  • When do you experience shortness of breath?
  • When does it feel worst?
  • How long does each episode last?
  • What is going on around you before, during, and after each episode?
  • Does anything make it feel better?

Take your record with you to your appointment. It is very important that a medical professional review your symptoms, especially if you’re also feeling faint and dizzy, if your heart is pounding, or if it’s difficult to breathe even at rest.

CancerCare has information on creating a survivorship care plan that can be used to personalize your post-treatment needs and communicate them to your health care provider.

Don’t be afraid to advocate for yourself so that your medical, emotional, and practical needs are addressed, and your quality of life is maximized.

For Ovarian Cancer

Q. I was diagnosed a few years ago with ovarian cancer and have finished my treatment, but now I'm afraid of recurrence. Is this normal?

A.

After a diagnosis of ovarian cancer, a woman can feel vulnerable and experience a lot of uncertainty. The emotional, social and physical experience of having ovarian cancer can be overwhelming and living with this experience often leaves one with a fear of this happening again.

While your fears are typical, at times they many vary. For example, around the time of your check-up, blood tests, or when a milestones or anniversary is approaching you may feel sad, irritable, or anxious. Allowing yourself to acknowledge and accept your feelings is the first step. Developing ways to manage these feelings is extremely important and a way to be kind to yourself. An important act of kindness to yourself is to live in the now and find ways to balance your fear of recurrence with enjoying your life, and the hope for continued wellness.

Ways to manage fear of recurrence:

  • Get support. Many women find comfort in a support group. Share your feelings and learn how others are coping with challenging and common fears, which can provide you with a community of strength and understanding. You can also speak with a CancerCare oncology social worker about your concerns.
  • Take good care of yourself. Get enough sleep and reduce stress. Find things to do that are comforting such as meditation, yoga class, writing in a journal, or spending time with your pet. We all have activities we find soothing and it is important to develop these and do them when you need to.
  • Communicate. Share your feelings with the people who are important to you. Let them know how you are, and what they can do to help. Set limits if you need to by deciding what you can commit to and what you can do another day.

Find additional information through the Lance Armstrong Foundation and Cancer.Net.