breast cancersurvivors

According to the National Comprehensive Cancer Network (NCCN), an individual is considered a cancer survivor from the time of diagnosis through the rest of his or her life. This includes before, during and after treatment. While this definition acknowledges that a person living with cancer is surviving it in the moment, individuals may or may not identify with this definition. Working as a psychologist in oncology, I have met many patients for whom this definition of survivorship does not work. Sometimes a person with cancer will wait until treatment is completed to consider him or herself to be in survivorship. Because the challenges may be different while in treatment and after, for this article we will discuss survivorship after active treatment—what you might experience and what you can do to work through the unique psychological or physical challenges of the transition into post-treatment life.

Completing active treatment for cancer is something to celebrate! Treatment involving frequent visits to the doctor, bloodwork, poking and prodding can be exhausting, so getting to the end is exciting, and a milestone to really enjoy.

The journey, though, doesn’t end there, as much as you may want to exclaim, “Woohoo, it’s over!” Post-treatment life brings with it follow-up care and, for some survivors, some unexpected challenges.

As you are no longer being watched or poked and prodded as frequently as you were during treatment, fear or worry might creep in. In addition, during treatment some individuals build strong relationships with their medical teams, and no longer seeing those people regularly might feel like a loss. If you are feeling this way, you are not alone.

There are physical challenges in recovery from treatment, too. It’s common to expect to “bounce back” after treatment ends, but this is often not the case. The most common post-treatment physical symptoms are fatigue and “chemo brain,” a term some patients use to describe such changes in cognitive functioning as memory loss, lowered attention and difficulty thinking clearly that occur after chemotherapy. Experiencing these symptoms for longer than one anticipates following treatment can be emotionally taxing. Setting realistic expectations with your doctor can help to relieve some of the emotional distress.

Another common experience after treatment is “scanxiety” — the anxiety and worry that accompany the time before undergoing or receiving the results of a medical examination. Although this is not a medical term, it is a very real experience for the majority of cancer survivors. Symptoms of scanxiety are: anxiety, fear, irritability, insomnia, intense worry and rumination, thinking about worst-case scenarios, avoidance and cancelling or rescheduling scans. It’s OK if you experience this! Recognizing the root cause of your emotions is the first step to managing them.

Luckily, there is a variety of strategies for coping with the stressors of cancer survivorship. Reaching out to a therapist who is specialized in oncology or health psychology to address this adjustment can be very beneficial. Your medical doctor may also have suggestions. Here are some ways patients overcome scanxiety:

  • Cognitive Behavioral Therapy (CBT) – For survivors with anxiety, therapists can suggest strategies for relaxation and managing unhelpful or unrealistic thoughts.
  • Online or in-person support groups – Support groups offer connections to others who are familiar with what you’re going through. It can be therapeutic to talk to and hear from others who have been there.
  • Mindfulness – The opposite of “auto pilot,” mindfulness means focusing on one thing at a time. It is a focus on acknowledging and accepting feelings, thoughts, sensations and emotions in the present moment. Siteman Cancer Center offers mindfulness classes for Siteman patients and their caregivers.
  • Medication – Work with your doctor to decide if medication is needed. Numerous medications are now available for sleep, anxiety and depression. Often, the combination of medication and one of the therapeutic interventions mentioned above are most helpful in addressing such distress.
  • Distraction – When you know you have a scan approaching, try some short-term stress management — save favorite TV shows to catch up on, plan mornings at the gym, read magazines, plan coffee with a friend, call a family member to catch up. Plan healthy activities ahead of time to keep your mind off your worries.
  • Journaling – Writing about your thoughts and concerns may help to release pent-up emotions and to increase self-awareness.

Author: Jessica Vanderlan, PhD, Siteman Cancer Center

Photo: Getty Images