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TLDR: Fear of cancer recurrence is a normal and common part of survivorship. However, it’s important to be able to recognize when the fear of cancer returning is causing unhealthy mental or physical challenges in your life or impacting your relationships. There are many evidence-based strategies that have been shown to reduce anxiety and fear around cancer recurrence. There are also medications that some people find helpful. Finally, there are things you can do to minimize your lifetime risk of cancer, which may help you feel empowered and less fearful.
While a cancer diagnosis often causes a range of mental health challenges, the fear that cancer will return after treatment (FCR) is one of the most common shared experiences in the survivorship community. This looks different from person to person: for example, some people may experience anxiety only around scans ("scanxiety") or lab tests, while others may find that FCR impacts their day-to-day quality of life. For some, FCR can be part of a more complex set of symptoms related to PTSD, generalized anxiety, or depression.
The trouble that many people find in addressing FCR is that their concerns aren’t irrational: they are rooted in a real and specific memory of what it feels like to be diagnosed with cancer, and a fear of possibly going through that experience again.
In her book about life as a leukemia survivor, Suleika Jaouad writes, “To learn to swim in the ocean of not knowing - this is my constant work”. As cancer survivors, learning to tackle fear of recurrence means adapting to a life with uncertainty.
Symptoms of FCR
So: if FCR is a normal phenomenon, what are the signs that you might need additional support? Here are a few things to watch out for:
- Sleep disturbances due to FCR
- Difficulty with planning the future due to FCR
- Constant worry about physical symptoms
- Loss of interest in activities or interests
- Using substances such as drugs or alcohol to deal with worry caused by FCR
Regardless of how much you feel FCR is impacting your life, it’s always a good idea to check in with a mental health professional to discuss your survivorship coping strategies. The good news is if FCR is a live issue for you, there are a number of therapeutic approaches that have been proven effective in reducing someone’s fears and helping them feel more in control of their emotional response to life as a survivor.
Tools for managing FCR
Psycho-oncology is a clinical specialty that addresses the unique issues that exist at the intersection of mental health and cancer. There are certain therapists that are trained specifically in the challenges of survivorship and who may use a number of therapeutic approaches. Cognitive Behavioral Therapy (CBT) is a structured, goal-oriented type of therapy that has been shown in studies to help people tackle FCR. Similarly, incorporating mindfulness skills into your daily routine has also been shown to decrease anxiety, depression, and improve quality of life. There are also specific medications for anxiety and depression that have been shown to improve quality of life for cancer survivors who are experiencing high levels of FCR.
Some people find that incorporating proactive steps to reduce their risk of recurrence or secondary cancers can help to manage FCR, including following screening/monitoring guidelines recommended by their care team. It’s important to know that the scientific evidence around lifestyle modifications is evolving (and fortunately there are a lot of great studies coming out!), but there are some basic guidelines that you can follow. Avoiding things we know are harmful like excessive alcohol, cigarettes, and other harmful substances is important for everyone, but even more so for cancer survivors. There is also data on the importance of exercise among cancer survivors and how movement can be protective and improve quality of life.
In summary: there are a number of ways to tackle anxiety and fear around cancer recurring including targeted therapy, medications, or being proactive about prevention. You might benefit from incorporating some of these elements specifically around dates that are challenging (upcoming scans, cancerversaries, visits to oncology), or even on a day to day basis.
If you have found other strategies effective, we would love to hear from you!
This article was developed by the VivorCare clinical team