Fear of Recurrence
Topics covered on this page:
Why might I experience fear of cancer recurrence after cancer treatment?
The goal of cancer treatment is to kill or remove all the cancer cells in the body. Unfortunately, it isn’t always possible to do that. Some cancer cells may get left behind. While you are undergoing cancer treatment, you know that something is being done to get rid of the cancer. Once treatment is over you may feel like you have no protection against the cancer. It is natural to worry that the protection is gone, and fear that the cancer could return. When cancer comes back after treatment is finished and you have been cancer-free, it is known as a recurrence.
People can experience a range of emotions after treatment. Understanding your feelings—both positive and negative—can help you manage them. Positive feelings include relief that treatment is over, excitement about the future, a deepened sense of closeness to loved ones, and a desire to get the most out of life. On the negative side, people may feel worry, sorrow, and confusion about what the next stage of their life will bring.
How does it affect me?
Many people describe their feelings after cancer treatment as one of the most emotional periods of their lives. While they had expected strong emotions during their treatment, they were surprised by the flood of emotions after it ended.
Many people blame themselves if their cancer comes back. They may believe that it was due to missing a doctor’s appointment, putting off important tests, or not making healthy lifestyle choices. Don’t make this mistake! Cancer can come back even if you do everything right. Don’t drain your energy by blaming yourself. Instead, focus your energy on figuring out how to deal with your situation.
Will it get better?
In the early days after treatment ends, you may think that any symptom you feel—even a runny nose or feeling a little unwell—could mean that the cancer has come back. But as time goes by, most people find this fear fades.
Everyone reacts in his or her own way but, eventually it will become easier to deal with your emotions and fears. There are some things that you can do to help ease your fears, and they are discussed below.
When should I get help for my fear of recurrence?
How high is your level of fear? One way to measure the level of your fear is with an assessment tool. You can find a helpful tool in Chapter 3 of Looking Forward under Fear of recurrent measurement.
Everyone deals with fear of recurrence in their own way. For some, it comes on as a reaction to a trigger, such as the anniversary of the original diagnosis; for others it is a constant source of anxiety. (To see more about anxiety, see Anxiety). When fear begins to take control of your mind and keeps you from living your best life, discuss your concerns with your healthcare team.
What can I do to help manage my fear of recurrence?
It isn’t possible to know for sure whether your cancer will come back, but there are steps you can take to manage your fear of recurrence. Here are some tips that can help.
Finding ways to relax can help your mind and body. These easy relaxation strategies can be done anywhere!
- Even a few minutes of deep breathing can help your body relax. Try breathing exercises such as slow, deep, counted breathing.
- Progressive muscle relaxation. This involves tensing and relaxing a muscle, or groups of muscles, one at a time.
- Guided imagery or visualization. Imagine being in a place that makes you feel calm in real life. You can use a recording to guide your visualization or find help from a trained instructor.
- Massage therapy. Use a certified massage therapist who has experience working with cancer patients.
- Mindfulness meditation. This can help you adapt to stress and anxiety and let go of worries.
- For more information see Relaxation strategies.
Challenging your thoughts of worry and fear can be helpful to change your perspective. This technique involves becoming aware of any unhelpful or negative thoughts that you replay or say to yourself. Once you become aware of these thoughts, you can challenge them by assessing whether or not it is an accurate or true thought. Follow these steps to practice challenging your self-talk.
- Pay attention to your feelings: what has triggered your negative feelings?
- Pay attention to your thoughts (self-talk): ask yourself, is there proof that this is an accurate thought?
- Challenge the unhelpful self-talk by asking yourself:
- Could this thought be overly negative or exaggerated?
- Does this thought undermine how well I may be able to cope or solve the problem?
- What would I say to my best friend if they shared this same thought with me about themselves?
- Replace your self-talk: Be realistic and replace the unhelpful thought with a more realistic one. You do not need to be overly positive, rather be more realistic.
Here is an example of challenging one’s self-talk:
Thought: “I am putting so many demands on my wife and she must be fed up”
Challenge: “Perhaps this is not exactly how she feels since she hasn’t told me so. If my best friend expressed this thought, I would say that it is normal to feel a bit overwhelmed but he is doing as much as he can to support his wife emotionally.’”
Replacement self-talk: “My wife has not mentioned she is fed up. I am still helping out and doing the tasks I can. I will talk to her about how I feel and ask her how she feels so that we both feel supported.”
Consider how much energy goes into the negative and unhelpful thoughts that won’t go away. You can take this emotional energy and use it towards completing smaller doable tasks. This can help you feel better as you accomplish simple tasks and it can act as a distraction from your worries. You can make a list of simple tasks around the home. Do not put pressure on yourself to do everything on your list – do the tasks that help take your mind off of your worries. Here are examples of tasks to consider:
- Reorganize your closet
- Fold some laundry
- Fix a knob on a drawer
- Clean one room or area in your house
Mental tasks are activities that keep your brain busy for a short while so that you can be distracted from worry and stress. Distraction does not solve the problem nor remove all your worries but it can be a helpful strategy to shift your focus to something else for a while. Examples of mental tasks are:
- Counting your breaths
- Doing mental arithmetic such as multiplication tables or counting back from 100 by 3s or 7s
- Working on a crossword puzzle or sudoku
- Reading a book
A short term but effective way to deal with worry is to delay it for a later time in the day. This technique can help you feel more in control as you choose not to focus on a worry until that chosen time when you will devote time to it.
- Pick a time when you will ‘get your worrying done’ and try to stick to this as much as possible. When worrying thoughts come up during the day, remind yourself that you can delay thinking about them and that you have a designated time for when you will deal with these concerns.
- You can write your thoughts down and tell yourself that you will come back to them later. It is also important to let go of these worrying thoughts as much as possible once the designated time is up. Use the hour you have chosen to try and come up with solutions and ways to deal with your concerns. You may feel that some things are still unresolved but try not to focus on these until your next worry period.
What help do I need to worry less?
It can be very helpful to write your thoughts and feelings down on paper to keep track of them. Some people find that it is easier to let go of worrying thoughts once they’ve written them down. Journaling can be a relaxing exercise if you enjoy writing. Keep in mind that your journal is only for you and will not be judged or graded so you can feel free to list all your stressors in paragraphs, bullet point form, or with drawings. The important thing is to have a healthy outlet where you can express your emotions.
You can make a list of activities or hobbies that you are interested in and give some of these a try. This can be relaxing as it distracts you from your present thoughts and allows you to return to your daily activities with a refreshed mind and a more realistic outlook. These activities and hobbies are things you can do alone or with your loved ones. It can remind you that you can still enjoy life and that not every moment needs to be focused on worrying or problem-solving. Choose activities or outlets you can use to express your emotions. These can include:
- Playing a sport
- Playing an instrument or listening to music
- Going out for a walk
- Listening to a podcast
- Trying out a new skill or joining a class to learn a new skill
- Reading a book
Where can I find help?
- Don’t be afraid to lean on your family and friends. People are often happy to help, but may not know where to start. Give yourself permission to ask for and accept help. You may be afraid that you will burden your family or friends. If this is a concern you have, talk to them and ask them how they feel and if what you are asking of them is too much. Sometimes we think we are a burden to others when in reality we are not. The simplest way to know if you are asking too much of someone is to ask.
- Ask your family and friends to write down what help they can offer. This will make it easier for them and for you to know what you can ask of them. It can be easier for you to reach out for help if you know exactly who to ask and what you can ask of them – be it help with getting groceries, going to an appointment, or doing small tasks at home.
- Your emotional wellbeing and mental health are important aspects of your general health. Consider asking your doctor for a referral to a psychosocial professional such as a psychologist, psychiatrist, or social worker to help you with the challenges you are facing. They can be verry helpful in discovering ways to manage your worries and anxiety during this time and they can teach you skills that will help you manage these feelings in the future.
- Counseling services may also be provided by a spiritual care worker, or some nurses in your treatment center. Ask your healthcare team for recommendations and more information.
- Support groups can provide information and resources for people going through similar experiences. These can be in person, via phone, or online. You can learn about other coping strategies by talking to others who have had a similar experience to yours. Your healthcare team can suggest possible groups for you.
- Fondation Québécoise du cancer: Call the Info-cancer hotline (1 800 363-0063). This hotline is for both patients and their loved ones to have a confidential conversation with a nurse who can direct you where to go to meet your needs.
What can I do to look after myself?
Looking after yourself will make you feel better in general and will free up more energy to tackle the challenges you face. Start with the basics:
Good nutrition will help your body feel better and stay strong as you go through treatment.
- You might need more energy or calories during treatment to maintain your body weight.
- Drink plenty of liquids to prevent dehydration, especially when you are unable to eat.
- Protein can help your body heal and maintain a healthy immune system. It is found in fish, poultry, eggs, nuts, dried beans, lean red meat.
- Check with your healthcare team to find out if there any foods or beverages that you should avoid.
- For further information see Looking after yourself.
Exercise can help strengthen your body and help you clear your mind as you undergo cancer treatments.
- Choose an activity you like to do either alone or with a family member or friend.
- Walking, light stretching, or breathing exercises can help your body and mind feel better.
- In general, light exercise can be done while you are undergoing treatment but check with your healthcare provider before starting a new exercise routine.
- For further information see Looking after yourself.
A good night’s sleep can help your body and mind feel better.
- Try to keep a regular bedtime routine and minimize distractions before going to bed. For example, turn off your electronics and choose a quiet place to sleep.
- Avoid drinking caffeine or alcohol close to bedtime.
- Try relaxation strategies before you go to bed or listen to soothing music.
Available services
For services available in Quebec to help you deal with cancer-related burden, check out the services below.
The Quebec Cancer Foundation supports people with cancer and their loved ones throughout Quebec, through services suited to their needs and daily concerns.
Services offered for burden
Several services and activities offered by the Quebec Cancer Foundation can be useful to help you manage your burden including psychological support such as guided meditation, art therapy, and telephone peer-matching. Other services such as wellness workshops, yoga and massage therapy are also featured.
The Quebec Cancer Foundation also has many documentary resources on the subject. Via the Info-cancer library, their documentalists specialized in oncology can guide you in your search for information and give you suggested readings.
Contact
1-800-561-0063
The mission of the Quebec Breast Cancer Foundation is to promote the well-being of cancer patients and their families through research, innovation, support and awareness.
It is committed to offering a range of services, including a hotline for information and resources adapted to the needs of people living with cancer.
Services offered for burden
Psychosocial support and family counselling: The Quebec Breast Cancer Foundation offers a psychosocial support service to support and accompany people affected by breast cancer and their families during and after treatment.
You can also share your experience with others who have been there on our online communities:
Parlons cancer du sein Facebook group
Club stade 4 Facebook group
Service locators
Below is a list of organizations that can help identify local support services for you and those that support you. The quality of the services has not been verified by e-IMPAQc. Before using these services, verify with your healthcare practitioner.
The Regroupement des Organisations Communautaires en Oncologie (ROCO) offers a service locator resource specific to the province of Quebec. It lists support resources available by region.
Contact
514-506-3503
The Quebec Cancer Foundation offers a resources directory of community, association and public resources by region or postal code.
The foundation also has a document lending service. Their materials (books, web resources, online articles, webcasts) cover a wide range of topics related to cancer. It is free to borrow and materials are sent by mail or email anywhere in Quebec.
Contact
1-800-363-0063 (Monday to Friday, 9 AM to 5 PM EST)
Resources
You can find more information on managing feelings of worry, uncertainty, and stress in the resources below.
Canadian Cancer Society – Coping with anxiety and stress
Acknowledgement of sources
The content of this document has been adapted from the following sources:
- American Cancer Society. Can I Do Anything to Prevent Cancer Recurrence?
- American Cancer Society. Coping with Cancer Recurrence
- Canadian Cancer Society. Worrying that cancer will come back
- Cancer Council. Living Well After Cancer
- Cancercure. Coping With the Fear of Recurrence
- Livestrong. Emotions After Cancer Treatment
- Looking Forward. Chapter 3, Section 5
- Mayo Clinic. Cancer survivors: Managing your emotions after cancer treatment
For services available in Quebec to help you deal with cancer-related anxiety, check out the services below.
Healthcare professional endorsement
The content of this document has been reviewed and approved by a team of healthcare professionals and clinical experts.
Disclaimer
Please note that this fact sheet is not intended as a substitute for consultation with a healthcare professional. Rather, it was designed to complement interventions by your treating team. If you have questions about your health, or any medical issue, you should contact a healthcare professional right away. You should not delay seeking medical advice, or disregard professional medical advice, because of information in this fact sheet. Before beginning any health treatment, always consult your doctor. All care has been taken to ensure that the information contained in this document is accurate at the time of publication. e-IMPAQc is not responsible for any injury or damage to persons or property arising out of, or related to, any use of the fact sheet, or because of any errors or omissions.
Reproduction and copyright
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