May 10, 2017

Coping With Anxiety at the End of Cancer Treatment

A cancer diagnosis and treatment understandably brings about fear and worry. So patients should feel ecstatic when they have finished treatment, right?

Not so, says UW Carbone Cancer Center psychologist Lori DuBenske, PhD. “Often patients have this expectation that the end of treatment will bring celebration and relief,” she said. “But for many people, this transition is actually more difficult because you don’t have this structure and path and perceived safety net that comes with receiving treatment.”

Tips for Coping With the End of Cancer Treatment

Here, DuBenske discusses some tips for coping with grief and anxiety for those patients who have completed treatment but still require follow-up scans and appointments.

Anxiety at This Transition Time is Perfectly Normal

During treatment, there’s a structure and a plan that often helps patients feel something is being done about their cancer. Losing structure after treatment has ended can lead to uncertainty. If you are fearful or don’t feel relief, it’s normal. Don’t add to your worry by worrying that you’re not doing it right!

Be as Specific as Possible

If you are feeling fear or anxiety, be as specific as possible in identifying what the fear is. It’s better to say, for example, “I’m afraid that if the cancer comes back, there won’t be a treatment available and I will suffer with pain,” than to say “I’m afraid the cancer will come back.” The more specific you can be in identifying exactly what you fear, the easier it is to identify the appropriate way to address this fear, either by taking specific action (such as getting information or making a plan) or addressing the specific emotions (such as getting support or managing disturbing thoughts).

Ask What You Can Do

Ask yourself, "Can you do anything to address the specific fear head on?" If yes, then do it. In the face of cancer survivorship, there is minimal opportunity to do something to directly reduce the uncertainty of cancer recurrence. Sometimes, just getting information can be a good step in coping with uncertainty and to reduce anxiety. Using the previous example, that there won’t be a treatment available if the cancer returns and you will suffer with pain, you can talk to your doctor to get more information. Learning what options would be available and how pain would be managed can reduce your fear.

Look for a Healthy Way to Cope

If you can’t directly address the specific fear, then there are still healthy ways to cope. Most uncertainty and worry at this time does fall into the “there’s nothing I can do about it” category. This is when emotion-focused positive coping strategies can help. Emotion-focused coping includes changing thoughts that trigger difficult feelings, getting support and talking about feelings and taking actions that produce calm (such as exercise or relaxation).

For example, you may fear that there is no way you could emotionally or physically handle treatment again if you have a recurrence. Fear often comes from imagining the worst-case scenario or underestimating one’s own ability to cope with it. It can help to imagine a time before your diagnosis, and how you might have felt if someone told you what you would have to go through. Would you feel the same way? Yet, you can see that you got through it. You may just need a reminder that these fears are not true to your experience.

Additionally, it may help to talk about your fears and get validation for those fears. Find support from someone who will listen to your fears rather than dismiss them with quick reassurance like “everything will be fine.” Support can come from a friend, family member, a cancer support group, or professional counselor or therapist.

Identify When or Why You are More Anxious

You likely don’t feel anxiety at the same level all the time. If you can identify when or why you are more anxious, then you can better prepare to cope with it. For example, most people learned they had cancer through scans or doctors’ appointments, so it makes sense that anxiety levels rise prior to scans or follow-up appointments, with fear it could happen again. A sense of dread or nervousness is normal.

Keeping your mind off the upcoming clinic visit through social activities, work or other enjoyable activities can help. Keeping to yourself or avoiding activities can increase time spent thinking about your worries and make it worse.

Relaxation techniques such as deep breathing or guided imagery can help you sleep at night or ease anxiety in the waiting room.

If the worry is difficult to manage or interfering with your life, you may benefit from working with a therapist to learn coping techniques or talking with your doctor, about whether use of anti-anxiety medication would be appropriate at these times.

Consider Seeing a Therapist

If you have ever thought, "I wonder if I should get help for my anxiety?" then you may benefit from seeing a therapist. If you feel your fears and worries are intrusive to your life – for example, you’re unable to sleep, focus on work or enjoy activities as usual – then you may benefit from seeing a behavioral health specialist.

In most cases, a patient can self-refer for psychology services. For services at the UW Carbone Cancer Center, call the Cancer Clinic Scheduling line at (608) 265-1700, or look for psychology services in your area. Please note that it is your responsibility to check with your health insurance carrier before a visit to determine what benefits and coverage your policy allows.

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