cancer

Living with the Fear of Cancer Recurrence

stephm2506/stock.adobe.com

stephm2506/stock.adobe.com

In my last post, I talked about the complex feelings of cancer diagnosis and treatment. I wanted a separate post to specifically target the fear around cancer recurrence.

Whether you’re still going through cancer treatment or it has been years since you were treated, the fear of cancer coming back is very real. You’re attuned to every ache and pain in your body and instead of thinking that these discomforts stem from sore muscles or the beginning of a cold, you think cancer. Perhaps you secure message your doctor’s office for reassurance or you talk yourself down from feeling anxious. Nonetheless, the thought of cancer is ever looming.

Anxiety about cancer recurrence is normal

While most cancer patients who initially reported depression at the time of diagnosis experienced little to no depressive symptoms 10-years post treatment, the anxiety stemming from cancer is still there. After all, to have a cancer history is to face realities that cannot be fully changed or influenced. Sure, you might decide to eat healthier, stay physically active, manage stress better and maintain supportive relationships around you. While these are all good lifestyle habits to have and nurture, nothing you do can guarantee a cancer-free future.

What to do with healthy anxiety

First of all, if you feel something unusual during a breast exam (and the best time to do a breast exam is at day seven of your menstrual cycle), please do contact your oncology clinic. Similarly, if your body is exhibiting symptoms you don’t recognize or common symptoms are lingering, it is wise to seek medical advice. It is important to listen to your body and care for it; otherwise to ignore these symptoms is to deny that something is wrong. Burying your head in the sand only increases the likelihood of you getting your ass kicked.

What is constant anxiety

There is a difference between caring for your body and smothering it. You know your anxiety is in the driver’s seat when you’re constantly thinking about cancer, Googling every body discomfort known to man, and seeing your providers above and beyond normal follow-up appointments. You might be very rigid about the lifestyle choices you make. For example, you can’t miss a day at the gym, there is little to no flexibility in your dietary choices (unrelated to allergies), or you get easily agitated when you perceive that others are critical of how you’re managing your cancer. In other words, your world evolves around your cancer.

What to do with constant anxiety

Your body responds with anxiety when there’s a perceived threat. After all, cancer was and still is a huge threat to your existence. Doesn’t it make sense that you be constantly watchful of it? Knowing that, it’s important to realize that fear is your friend, not your foe. It is there to protect you; to preserve you. The key here is to befriend your body and to acknowledge your fear while putting it in the passenger seat.

Anxiety management techniques

What to do with your thoughts

Just because you think something does not mean it’s happening or that it’s true. Try it: think of a pot of gold. Think super, uber hard. What happened? Did you get rich from conjuring up images of gold? If you did, please come to my office and have those same thoughts. Okay, so you know I’m being facetious here. What I mean is that when your mind thinks something, that’s all it’s doing: a string of words came and went. You can entertain these words and attach a lot of meaning to them, or you can let them come and let them go.

Put simply, thoughts are either helpful or unhelpful. Helpful thoughts can be, "How do I make the most of what I have?" or "These things are meaningful to me and I'm going to do them!" When these thoughts come, listen to them and act accordingly. These thoughts are serving you. 

On the other hand, with thoughts like, "I can't enjoy my life because of my cancer!" or "Cancer is just going to come back; I know it!" acknowledge them and let them go. Like the pot of gold, just because you think it does not mean anything. In learning to have a different relationship with your thoughts, you’re essentially saying, “I hear you thoughts and I won’t be minding you so much. Here, why don’t you sit in the back? I’m still the one driving.”

What to do with your feelings

Similarly, when feelings of anxiety come, let them be there. Don’t push them away; they will only come back stronger. Acknowledge them; sit with them; talk to someone about them. While these feelings are scary, you can make space for them. What do they feel like? Does your heart pound? Do you get sweaty palms? Is your stomach churning? Know that these sensations will pass. As you ride through the waves of these feelings and body sensations, you can still be in the driver's seat, making the most out of life. 

Staying present

The fear of cancer recurrence has you looking into the future. It is thus hard to focus on the present and what’s going on right now. What have you been missing out on? Is it the changing colors of the leaves? Conversations with your loved ones where you’re only half listening? Finished a meal and you don't remember what you ate? When you find your mind focused repeatedly on your worries, acknowledge your mind, and come back to the present moment. Right now is the only moment you can do something about. Don’t miss out.

Need more?

Often times it helps to have someone come alongside you as you learn how to put cancer in the passenger seat. At the very least, because you’ll still have follow-up diagnostic tests and exams, you know the thoughts of cancer recurring are not going away. However, it doesn’t have to dictate your life. Let me know how I can help!


Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That could also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not thinking about work, she loves spending time with her hubby, eating good food and more recently, watching Harry Potter. 

“I was Diagnosed with Breast Cancer. What am I to Feel?”

Laurin Rinder/stock.adobe.com

Laurin Rinder/stock.adobe.com

October is Breast Cancer Awareness Month. I’m putting on hold my blog post on trauma to address the emotional needs facing breast cancer patients. Granted, cancer patients often talk about their experience of cancer to be traumatic, even though many do not meet full criteria of Post-traumatic Stress Disorder.

To hear that, “You’ve got cancer” is enough to unravel any brave soul. The urgency of the news leaves little room for reflection, for contemplation. You’re scheduled with the surgeon, followed by the radiation oncologist and likely the oncologist. Some medical facilities fit all three appointments into a four-hour meeting; others schedule them one at a time. Either way, your head is full and it’s hard to digest information about the stage, tumor size and grade, if it’s hormone dependent and whatever else you’re supposed to know.

All this knowledge; all these next steps, but how are you feelin’?

Facing a loss

Being diagnosed and treated for breast cancer is to face your own mortality. Your vision for what your life would be like is called into question. You thought you would live to hike the Annapurna Circuit, see your kids graduate and hold your grandkids in your arms. All these plans are now up in the air. Even if you were told the type of cancer you have is highly treatable, you’re starting to envision a very different future.

The pendulum through the messiness of grief

Being diagnosed with cancer or other chronic illness is to grieve a loss. Sure, you’re used to your body having some aches and pains, but you’re definitely not as healthy as you had thought. Thus, it makes sense that women going through breast cancer would face different stages of grief in no linear fashion.

Denial

Also known as non-acceptance, denial happens because you’re in shock and overwhelmed by the news of cancer. “Were those really my test results? Did the doctor make a mistake?” You might weep and you might also feel numb. You might wake up in the middle of the night wondering if it was all a dream. It is common for you to feel out of touch with the rest of the world because quite frankly, you would much prefer a life without cancer, thank you very much.

Bargaining

Your mind races through choices that could have detoured cancer. “What if I had lived a healthier lifestyle? What if I had gotten a second opinion? What if I had reconciled that relationship rather than let it eat at me all these years?” There are no answers to these questions but it doesn’t stop you from asking them. Conscious or not, when you consider how you could’ve affected the outcome, it’s a way to take back the control you feel like you’ve lost. Similarly, you might bargain with God or a higher power to give you another chance at a life without cancer. Or, at least not now, though there really isn’t a good time.

Depression

While not all breast cancer patients meet criteria for clinical depression, sadness is very much a part of the grieving process. When you think about how your body is sick, the possible side effects of treatment and how cancer might affect your quality and quantity of life, you understandably would feel sad. Women have often talked about treatment leaving them feeling “disfigured” or “damaged.” This might lead to feelings of shame and negative self-worth and the tendency to isolate and push people away.

Anger

“Why is this happening? Why me? What have I done to deserve this?” are some of the questions that breast cancer patients might ask. Implied in these questions is a sense of unjust, that this shouldn’t be happening. Sometimes, you might feel anger towards yourself, if you think you could’ve somehow prevented cancer. Other times, you might be angry at God or a higher power from “allowing it to happen,” or at your healthcare providers for not doing more to help. Unfortunately, your loved ones might get the blunt of your anger, simply because they’re the closest to you.

Acceptance

If denial is synonymous with non-acceptance, then acceptance is to face the reality of what is: “You have cancer.” It’s hard to read those words and to face them head on, but to keep on denying that fact is to say, “Cancer has you.” To accept something does not mean you have to like it, or that you approve of it; it only means you’re not fighting the reality of cancer diagnosis, treatment and prognosis. You’re more willing to look it in the eye, and say, “Okay, let’s do this.”

The actual stages of grief

The five stages of grief originally coined by Elisabeth Kübler-Ross is actually in the order of denial, anger, bargaining, depression and acceptance. I mixed up the order to show that there really isn’t a right or wrong way to go through grief because mourning a loss is meant to be messy.

You could be accepting the side effects of chemo one moment and then be very angry that you missed the toilet and barfed all over the floor the next. You could have a good cry and feel at peace, and the next crying episode could make you very angry at God. You might want to cancel your MRI and be in denial about what your doctors would want to say to you and the next day, invite a friend to come along to your imaging appointment.

It’s okay

The Kübler-Ross model likely does not encompass the emotional complexity of your cancer journey. Nonetheless, your cancer experience is your experience. It is okay to feel the way you do; all of your feelings are valid and normal. Allow yourself to go to these places; it’s a part of the healing process.

If you need help navigating through the messiness of these feelings, I’m here.


Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That could also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not thinking about work, she loves spending time with her hubby, eating good food and more recently, watching Harry Potter. 

You've Got Cancer? What shouldn't I do?

Wanna make someone feel worse when they've cancer? Here's how:

tai111/stock.adobe.com

tai111/stock.adobe.com

  1. Talk even when you don't know what to say - Years ago when my friend's wife was diagnosed with leukemia, his buddy didn't know what to say, so he said this: “Man, at least you get to marry another woman...”

  2. Begin your sentences with “At least” - If you want to minimize one's experience with cancer (or anything for that matter) and remind them how much better they have it compared to people in Syria, the words, “at least” is the way to go.

  3. Tell them you understand when you really don't - A patient has taught me I can only guess or imagine what it's like to be in their shoes; to say that I understand when I've never been can be a real put off.

  4. Share about your aunt's cancer story, and your grandma's... - Not to say there isn't a time and place to share cancer experiences, but just because you have a story to tell does not mean the one with the cancer wants to hear it. It helps to ask first.

  5. Expect that things are back to normal post-treatment – Meal delivery is over, hair is growing back, party pics made it on FB, life's back to normal, right? Cancer brings a new normal. While it might not be your job to constantly remind the other of their cancer, just know that this is only the beginning of the journey.

Here's an earlier post on what to do instead

And if you need help navigating through all this, give me a call!

You've Got Cancer? What can I Do?

WavebreakMediaMicro/stock.adobe.com

WavebreakMediaMicro/stock.adobe.com

Ever wonder how to approach a friend, a loved one when they are first diagnosed with cancer and going through treatment? Here's my first post on what to do. What not to do will come later...

  1. Do nothing – Gotcha! Sometimes there isn't anything to do but to simply be with that person.

  2. Validate – Let them know that it must be very hard for them... You can't imagine... This really sucks!

  3. Offer company – Sometimes in our not knowing what to do, we disappear. Offer your presence, hear them out, hang out.

  4. Talk about something else – Cancer can be all consuming. While it might be important to give cancer its spotlight, let's also move onto something else.

  5. Offer help – What can you do? What can be helpful? Want a ride to an appointment? Oil change? Go to a ball game? 

  6. Set up long-term help – It's hard to ask for ongoing help, let alone when you're emotionally overloaded. Assuming you know your friend, you can set up meal delivery, house cleaning, and baby sitting, email treatment updates, etc. 

  7. Bring comfort - Cancer treatment is unnerving for the human body, in more ways than one. Find out what will bring comfort to your loved one and do it! Is it a particular type of food for the foodie, flowers for the visually stimulated, or a card for the, um, card person?! 

  8. Use humor - Break up the monotony! A friend recently told me this was the funniest thing she had said to her while going through treatment: “Well, you're the healthiest looking sick person I've ever seen!” Sure, be sensitive, but know that cancer patients need to laugh too.

  9. Touch - Cancer can make your loved one feel like their body is damaged. Don't be afraid to offer touch. 

Help need walking your loved one through cancer? I'm here!

Lessons from Cancer?

Unsplash/canva.com

Unsplash/canva.com

I was recently asked to comment on whether there might be any positives to the cancer experience. As a Medical Family Therapist with a special interest in working with those touched by cancer, I quickly put on my thinking cap...

Cancer sucks AND it can also a great teacher. It can force you to reconsider your life and what you're living for and why. It can make you realize you do have a choice beyond the auto-pilot of daily living and that pace is yours to set. It can help you question your own mortality and those around you and hopefully, guide you to better the elements of relationships that are within your control. Cancer can also pull together communities to support you and connect you with those you didn't know well, while deepening existing relationships. That said, cancer also puts you on the receiving end such that you might, perhaps for the first time, learn to receive rather than give.

Let me know if you'd want more!

Do you have Stress-Resilient Habits?

Morgan Sessions/unsplash.com

Morgan Sessions/unsplash.com

John Preston, PsyD, ABPP did a training on “The Habits of Stress-Resilient People” last month. Putting my two cents in the mix, you can develop stress-resiliency by:

  1. acknowledging that pain and suffering are a part of life, rather than an exception - if you live long enough, and sometimes, you don't even have to live that long, you know that crap will hit the fan

  2. choosing to be with uncomfortable feelings - as unpleasant as they might be, difficult feelings will be there. Feel them rather than hide from them; they do come and go

  3. having a good cry – according to biochemist and “tear expert” Dr. William Frey, tears contain stress hormones that are excreted from the body through crying

  4. taking things in, moment-by-moment - fight the tendency to operate on auto-pilot

  5. recirculating moments of joy – everyday, train your brain to notice the things that have gone well that day

  6. focusing on doing what works – do what is most effective in the moment, rather than dwelling on what's fair, unfair, should, should not, etc

  7. living a valued life – What matters to you? What do you want to live for? Doing those things will bring you vitality and meaning even when life gets tough

Thoughts? Would love to hear them! Need help developing these habits? I'm here!