Do You Have a Question About Mental Health & Cancer– Strong In Cancer — A New Column From SurvivorNet with Dr. Marianna Strongin

I’m a stage 4 lung cancer patient and have been in treatment for six years. It has been traumatic to say the least — two major surgeries, chemotherapy, radiation and immunotherapy. About 18 months ago I received my first clean scan that revealed no evidence of disease. My family and I were ecstatic, and I’ve since had a few more clean scans. But I’m crippled by anxiety about my cancer returning, so much so that I can barely enjoy the fact that I’m currently cancer free. There’s just a persistent sense of dread and doom that gets increasingly worse as I near my next scan.

Dr. Strongin: You are absolutely right. The diagnosis of cancer, along with the arduous treatment that goes along with it are absolutely traumatic and have a profound impact on our psyche. A traumatic event is an incident that causes physical, emotional, spiritual, and psychological harm, and cancer often affects most of those things. And so, therefore, it is categorized as a trauma. Now because of this psychological breakdown, we have to treat it with enormous compassion and patience. So let’s look at why your mind can’t celebrate the clean bill of health and may even cause you to feel more dysregulated. For the last 18 months you have lived in a prolonged state of distress. When a threat is no longer present, your mind can’t help but find ways to look for unexpected or unknown threats, such as possible relapse.

The diagnosis was an unexpected threat, and now your mind wants to prevent it from happening again. A traumatized mind is super aware of all the triggers that could lead to a similar traumatic event, and therefore that mind is never at rest. A future scan is just that threat that can cause you to feel dysregulated all over again. There’s actually a term called scanxiety, which is the anxiety cancer survivors experience every time they go for a scan. In addition, you also have adapted to worrying about your health and your future in your everyday thoughts, and it would be impossible for you to simply let those go. You have made room for them, and now we have to work really hard to replace those thoughts with more self-soothing, validating, calming thoughts. Now let’s take a closer look at the actual worry your mind has learned to create.

So anxiety lives in the future and consists of questions we ask ourselves. In order to tackle it, we must calm ourselves, both physically and emotionally in the present. Some people feel their worry thoughts in their bodies, for example, increased heart rate, stomach pain, and some people even experience pain in the very place that they have their cancer. So we first must begin by soothing it physically, putting your hand on it, giving it attention and beginning to soothe it by reassuring it in the present. I love self statements. Like, “I am safe.” “I am strong.” After we calm our own body, it’s important to then calm our thoughts. Give your anxious questions, answers like “I will be okay”; “I have always managed to find a way and I always will.” “At this moment, I am safe.” “At this moment, I am healthy.”

In order to orient ourselves to the present rather than the future, we must train ourselves to be more present. Exercise is another way to let those thoughts go and to really focus on your physical body in the moment. Lastly, we must remember that nobody can tell the future, but cancer makes us fearful of the future. It robs us of how we think about time. This is something a cancer survivor must learn to tolerate while also using it to orient and enjoy the present. Nobody can control the future, but a traumatized mind has to refocus and reframe in order to enjoy the present.

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I’ve been battling prostate cancer on and off for years. I’ve had ups, and I’ve had downs and generally have a very good support system of family and friends. The exception is my only sister. She rarely checks in on me, rarely if ever talks to me about my cancer battle and seems to just basically want to act like there’s nothing wrong with me. It seems like a classic case of avoidance, but nonetheless it upsets me as we used to be very close. I guess you could say the cancer has sort of put a wedge in between us, and I don’t know how to work around it.

Dr. Strongin: Everyone handles their diagnosis differently. I have had patients who keep the entire journey private, only sharing it with me, and others who document their entire treatment and recovery on social media. Similarly, loved ones react and support others in a variety of ways that make them most comfortable. It sounds like you and your sister are both engaging in an avoidance dance. She is avoiding asking about your cancer, and you are avoiding talking about your feelings in regards to how little she’s following up with your cancer. In order to create a new dance, one of you has to step out of this routine. Sounds like you are already taking the lead by writing in this question. I suggest you share how you feel and express your cancer recovery needs to your sister. I have a feeling you are both dancing this dance as a way to prevent hurting one another. And sometimes it takes a new routine to realize the old one was no longer gratifying.

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