Dr Mark Winwood, Director of Psychological Services for AXA PPP healthcare
It’s an unfortunate truth that many of us will experience cancer in some capacity – be it first-hand as a patient or while supporting a loved one through their diagnosis and treatment. Cancer Research UK predicts that one in two of us will develop cancer in our lifetime but, thanks to advances in medical care, the rate of survival in the UK has doubled over the last 40 years and around half of cancer patients survive for ten or more years.* It is therefore important to appreciate that cancer can have lasting psychological effects extending beyond treatment and into remission.
Fear of recurrence
During periods of active treatment, remission is often perceived as the light at the end of the tunnel – a positive, final stage that’s cause for celebration. Therefore, reaching remission can be a great relief for a cancer patient, their family and friends. It can inspire a renewed excitement for the future, gratitude for life, desire to achieve new goals and deepened closeness to loved ones. But it may not be so simple. In reality, the risk remains that the cancer will return. There’s also the potential loss of the support network that’s been established during their treatment. Add to this the emotional impact of transition back to ‘everyday life’ after weeks, months or even years of treatment. So, before you celebrate a loved one entering remission, it’s important to appreciate what they may be going through emotionally and psychologically. Cancer can become an integral part of an individual’s identity so, if you wish to talk to them about how they’re feeling, gently encourage them to open up. Their response should help to give you a better understanding of the, at times conflicting and seemingly paradoxical, emotions they’re experiencing.
For some people the niggling fear that cancer may return never leaves and they continue to live harbouring considerable uncertainty about the future. While anxiety levels tend to be high during episodes of active treatment, they can also persist into remission – especially when scans (with their seeming ‘moment of truth’ certainty) become less frequent or are even stopped altogether. In these circumstances, some people will worry that the cancer could return and not be spotted until it’s too late. Others may worry that it will come back because they are no longer receiving active treatment.
The anniversary of a significant event such as the date of diagnosis or completion of treatment can be a trigger for renewed concern. It may be worthwhile considering follow-up care when this occurs – for example, a visit to their GP may suffice to allay their concerns. Breast Cancer Care UK states that the frequency of follow-up depends on the individual’s needs and the arrangements provided by the hospital where they were treated.** Follow-up appointments, which involve a physical examination, with the purpose of detecting recurrence or the spread of cancer to other parts of the body, are also a valuable opportunity for patients to ask questions and raise any concerns about suspect symptoms.***
Impact on emotions and mental health
Lingering fear of the cancer returning can lead to mental health issues. And, given the relatively high likelihood of developing cancer in one’s lifetime and the fact that, on average, one in four people will experience mental ill health every year, it's unsurprising that the two often occur together. For some people, anxiety may not strike until years after completing their cancer treatment, leaving them struggling to comprehend and deal with their low mood and feelings. In instances such as these, it can be helpful to have someone trusted to talk to to share their concerns. This could be a family member or friend, colleague, a fellow patient or their family doctor.
The after-effects of cancer treatment can also trigger anxiety. Chemotherapy, for example, can change a person’s physical appearance, from hair loss to weight gain, which can in turn adversely affect their self-esteem. They can even trigger feelings of fear and anxiety about the way that other people perceive them. Reflecting on the changes, patients can experience a deep sense of loss and or sorrow and, should this persist or become overwhelming, it may lead to anxiety or depression, which may require psychological support and or medical treatment.
Guilt is another complex emotion that cancer survivors may experience. Some may feel their own personal actions and choices were responsible for causing their cancer. Others may feel remorse that they have survived while others have not. Guilt is often a closely guarded emotion but acknowledging it can be an important first step to addressing and overcoming it.
Anger is also another emotion commonly connected with cancer. Intensity can vary from frustration to rage. Lengthy spells in hospital for treatment can allow plenty of time for reflection and opportunities to become angry at having the disease – particularly towards how the condition has affected them and their loved ones. And, following treatment, they may have new physical, emotional or financial challenges to deal with. While, for many, anger is a normal part of the emotional response to a significant challenge or change, some may need professional support to help them to overcome it – through confidential counselling, for example.
Cancer survivors may also experience emotional numbness. After the stresses and strains of treatment, they may feel resigned and unable to take on anything more. Some try to protect themselves by withdrawing and shutting down their feelings or adopting an indifferent attitude to life, perhaps in hope that, if the cancer does return, they’ll know what to do.
Unfortunately, there is still considerable stigma around discussing cancer so it remains a difficult conversation to have. Cancer survivors often feel they must be strong for their family and may, therefore, be reluctant to share their feelings. Equally, family members can feel pressure to put on a brave face, leaving them without an outlet to share their own feelings and frustrations.
How can you help?
Cancer survivors can experience a myriad of emotions following completion of their active treatment. If they are close to you, you may recognise changes in their character or personality. Others may change in ways that are subtler and harder to discern. Whatever the case, try to reassure them they are not alone and that there is plenty of support out there to help them – long after their treatment is over.
Photo by Ken Treloar