CANCER AND ANXIETY
Anxiety ( blog) and iheart)
Hi DR Ryan here, medical oncologist AND PROFESSOR AND RETIRED COLONEL AND CANCER SURVIVOR and this is when tumor is the rumor and cancer is the answer.
I am sure you are familiar with our opening song from chariots of fire. A man has a plan and in a day it is crushed…… so it is when you have been told you have cancer ,thoughts of loss of control, soul sucking anxiety, what about your family and the list goes on as it hits you like a ton of bricks.
He rose above it in the film and so you to will be a hero ………I have seen no exception no matter how afraid you are, and that is what we are going to talk about today …your attitude when first diagnosed and through your course of therapy.. What about ANXIETY
. We will take our time so feel free to write in your questions or comments at www.w4cs.com and i will try to get to them
Anxiety and fear
it is anxiety that is the killer, NOT FEAR. We humans suffer most when not knowing all that needs known, especially when there is so much to fear. I choose, as do many dictionaries and as have countless great religious leaders and philosophers, to define anxiety as fear of the unknown.
I frequently relate a parable to my patients on this crucial subject. Let us travel back in time to the clan of the proverbial cave man. In one cave, somewhat safe from the elements and huddled about a fire, is a family fraught with anxiety towards the savage carnivores outside. These beasts only know this clan as prey. The clan shrinks under the weight of this knowledge, convinced that the predators will most assuredly find and devour them. The clan huddles all the closer, shaken by every foreign sound and every dimming of the fire. They dare not move. They are not ready to battle for their next meal or to survive. That is the primordial example of paralysis by analysis– as old as man is. That is anxiety.
in the hillside just to the east, another clan of warriors huddle. They know well the dangers that lurk and are ready to pounce as the fire dims and the sounds draw near. Fearful of what they know, and armed, they set forth into what will now be the known. History has shown us that this clan survives. That is the liberating power of fear inciting action.
Both anxiety and fear evoke the same visceral and pressing emotional urgings. However, for the first clan, the unknown fuels their feelings. That is anxiety and that is the end of that clan. However, the second clan knows that the bigger enemy is anxiety, fear of the unknown. It is fear of anxiety that drives them to action. Anxiety is the road to paralysis. Fear can ignite action without guarantee of success, but action nevertheless.
anxiety disorders in patients and their relationship to the quality of life have been the subject of legions of studies in the medical literature. Their conclusion is universal. Anxiety is as much a killer as is living in constant bodily pain. What is life worth, one wonders, when the icy soul sucking grip of the never and forever lie holds you tight to its bosom. This lie screams into your psyche saying, “it will never change and it will forever be the same”.
anxiety is not abnormal and may in fact be an emotion that leads to a positive outcome. Nonetheless, it is almost the kiss of death when it too easily evolves into the loosely defined term morbid anxiety causing panic, irrationality and paralysis. There is little doubt that morbid anxiety has negative consequences in many regards for the cancer patient as well as their family.
Granted, some malignancies with a less ominous prognosis will not elicit as much morbid anxiety. Once again, the key is that the patient knows that the prognosis is less ominous. It is knowledge that is the oncologists’ first and most precious gift to the patient. It is knowledge that the patient and family must demand. Knowledge delivered through teaching that must be thorough, comprehensible, and empathetic. The flow of information must never stop. Physicians must teach patients how to deal with family, friends, sources on the internet, the staging procedures and their meaning, the treatment and the value of second opinions. Patients must learn well that they will not be alone, that thousands have handled this and that others were no less anxious and no braver.
physicians must speak to their patients of the odds of cure, remission and durability of remission. They must not shy away from discussing spirituality, life’s goals, and the effects of treatment on normal bodily function. Common anxiety-laden patient questions, as “what functions or abilities will I lose” as well as “what will I keep” are essential front burner issues. Discussions must be frank regarding the specter that pain, nausea and vomiting often represent to patients. Moreover, physicians will find the more empathetic time spent the greater the patient’s trust and quality of life.
Patients need to know if research studies hold out a realistic promise. Oncologists must explain the amazing armamentarium of medications they have, the psychological assistance patients will be given and potentially, the beautiful role which hospice may play. Most of all, patients must be put in charge by being given repeated slow but thorough helpings of knowledge. That is the key to killing anxiety. Caretakers must indeed take great care to embrace the god given, hero-making emotion of fear, break the paralyzing bonds of anxiety and guide patients and families onward to face the future.
Remember it’s ok to tell someone you are not ok
Lets summarize the overview of anxiety
For example , mindfulness practice during chemotherapy can reduce the blunting of neuroendocrine profiles typically observed in cancer patients, according to a study published in cancer.
Other issues are what some have called scanziety and also the issue of telephone messages.
Scanxiety refers to the fear and worry associated with imaging, both before and after a test is performed, and lasts until the test results are communicated to the patient. As described by cancer survivor Bruce Feiler in a time magazine column, “scans are like revolving doors, emotional roulette wheels that spin us around for a few days and spit us out the other side. Land on red, we’re in for another trip to cancerland; land on black, we have a few more months of freedom.” The root of this anxiety is related to the uncertainty of the test results and the amount of time that elapses between when the test is performed and the results known. Not surprisingly, most patients report an escalation of anxiety that correlates with longer wait times.
In an ideal world, scanxiety could be alleviated by immediate test results. However, test results also need someone qualified to interpret them and explain their implications. When scans show no evidence of disease, or a blood test is within normal limits, the phone calls are easy to make. It’s a different story when the scans or tests are abnormal or indicate disease progression. In these cases, face-to-face conversations about treatment options are usually best.
“phone tag” frustration
So, what can healthcare providers do to reduce scanxiety? Some oncology practices schedule patients for a clinic visit on the same day a scan or test is performed or results known. Of course, this approach only works when there is collaboration between the imaging or laboratory department and oncology providers. “the test results are not back yet” are words no patient wants to hear on a follow-up visit.
Patients who have scans and tests performed in their hometowns need to be informed that test results may or may not be available on the same day. These patients should be instructed to call their oncology providers to obtain results rather than wait for a call with the results.
Every oncology facility should have procedures that reduce the likelihood that patients will “fall through the cracks” and not be followed up. This can happen when return calls to patients go unanswered. The resulting “phone tag” is frustrating for patients and healthcare providers alike.
After-hours calls are particularly challenging, as they are often placed or received via personal cell phones. One option is to block or hide personal cell phone numbers; however, patients may ignore or decline these calls since the callers are not identified. Another option is the doximity dialer, an app that allows healthcare providers to call patients without revealing their personal cell phone numbers. Patients see an office or clinic number instead. The app allows healthcare providers to call patients at any US number, choose the caller id that appears, and send return calls to an office or clinic.
The app can be downloaded for iphone at the app store and for android devices at google play.
What else can be done to reduce scanxiety? Cognitive-behavioral therapy may be helpful in dealing with the thoughts that are at the root of the anxiety. This helps by examining possible outcomes. This leads to a reduction in all or nothing, and catastrophic thinking, which in turn reduces anxiety. The bottom line is that there are a number of strategies to help patients reduce scanxiety and cope with its effects . Being diagnosed with cancer is hard enough; we need to do all we can do to make the journey less stressful. –
The physical changes regarding patient;s anxiety are measurable David s. Black, phd, mph, from university of southern California in los Angeles, and colleagues assigned 57 English- or Spanish-speaking colorectal cancer patients to either mindfulness, attention-control, or resting exposure at the start of chemotherapy. Four saliva samples were collected at the start of chemotherapy and at 20-minute intervals during the first 60 minutes of chemotherapy. Self-reported biobehavioral assessments after chemotherapy included distress, fatigue, and mindfulness
Analysis showed a relative increase in cortisol reactivity in the mindfulness group, more than twice as many patients in the mindfulness group displayed a cortisol rise, compared to controls (69 versus 34 percent; Mindfulness scores were inversely correlated with fatigue and distress scores “implications include support for the use of mindfulness practice in integrative oncology,” the authors wrote.
Let’s go back to Yoga
Researchers have put yoga to the scientific test for years, and the results so far have been impressive. The practice has been shown to lower risk for heart disease, type 2 diabetes, depression and hypertension and anxiety.
But yoga can also help those who are already ill feel better. A new study suggests that doing yoga twice a week may improve quality of life for men being treated for prostate cancer and may help reduce the side effects of radiation, which include fatigue, sexual dysfunction and urinary incontinence.
So again if you have any of these tell your doctor, there is help
- Difficulty concentrating and making decisions
- Heart palpitations, sweating, shaking
- Shortness of breath, feeling faint
- Numbness or tingling in the hands or feet
- Heightened sense of alertness
- Anticipating feeling anxious or a persistent worry
- Feelings of guilt, worthlessness, and/or helplessness
- Feeling of unreality or detachment from oneself
- Fear of dying or losing control
- Irritability, restlessness
- Dry mouth
- Muscle tension
- Sleep difficulties
- Cold or sweaty hands
- Loss of interest in activities or hobbies once pleasurable
- Withdrawal from normal activities and friends (avoidance)
- Appetite change or weight change (usually loss)
- Persistent aches or pains, headaches, cramps, or digestive problems
Lets also give a non scholarly but becoming so, nod to smoked cannabis, the psychoactive form in alleviating anxiety- there are some early trials in the 80’s mostly about control of nauseas and vomiting where it was no better than what was then the standard and inferior to what we have now with exceptions existing on a case by case basis. It being a class 1 drug highly controlled by the FDA has made scholarly work hard but there is a growing body of evidence that supports a possible role in alleviating anxiety, besides improving mood , appetite and pain as well as anticipatory nauseas Mostly we are left with it being no better than standard of care but there are some powerful small studies and of course individual anecdotes. Remember ,anecdote does not equal antidote
None of the above is true for any other herbal substance despite what you think or may have heard
Remember anecdote does not equal antidote
Seeing cancer through a sibling’s eyes: what we don’t know can hurt them an article summarized from the ONS
Family-centered care is crucial to the care of children with cancer, whose disease and treatment are both life-threatening and often prolonged over the course of several years, through survivorship or until death. Family-centered care recognizes the stark reality that cancer is disruptive to the family system. And can cause great anxiety in many family members with children being no exception While acknowledging the value of family-centered care to the ill child and parents in clinical practice, we may overlook other family members who would also benefit from family-centered care, most notably the healthy siblings of the child with cancer.
Indeed, healthy siblings have described wanting more information about their ill brother or sister and the illness; parents have described wanting guidance on how to best meet the needs of the siblings when one child has advanced cancer and to do so across the spectrum of life-threatening illness.
Challenges associated with a cancer diagnosis, treatment, and adaptation impact the entire family. Recent research has demonstrated that families experience altered family function and may face an accumulation of risk for mental health and severe emotional problems including anxiety over the course of illness,
other research reports that the experience of cancer increases family cohesion and family resilience. So it can bond as well as break- it is a case by case , family member by family member SITUATION even within the same family
Through the sibling’s eyes
Perceptions of the impact of cancer on the family often come from the parental perspective. BUT NOT ALWAYS. Each member of a family will assess the impact of the illness differently
Some experience feelings of jealousy, neglect, and bitterness. But almost all experience anxiety. Parents may spend less time emotionally and literally with the healthy child
When a child is diagnosed with cancer, the whole family is disrupted and anxiety initially runs rampant and delayed anxiety after a siblings death is all too common.
The nurse’s role
It starts with awareness. Nurses can promote a broadened scope of family-centered care and recognition of sibling needs in advanced disease and other times of turmoil. In doing so, they may mitigate some negative effects of strained or limited communication. Oncology nurses directly impact families through communication and can model open, compassionate, developmentally appropriate communication with siblings. Moreover, coaching and teaching are inherent to nursing care of families. Thus, oncology nurses role can be 2-fold: communicating with siblings across settings to increase their comfort or to provide education and
coaching to parents in discussing sensitive, emotional topics related to the illness.
Teaching parents to keep lines of communication open across the various fronts on which they parent all their children can diminish anxiety.
Although there are many methodological flaws in the following report it stresses the mind body connection which is never to be ignored.
However we are not saying the diagnosis of anxiety or for that matter, depression causes cancer in all , most or a significant minority nor does it mean you will get cancer if you have those diagnoses . Nonetheless, anxiety does have measurable effects on the immune system and that weaves a complex web
So what did they find in England in a study which I remind you has many limitations.
A BMJ article addressed how depression and psychological distress can increase the chances of dying from cancer. The study revealed a 32 percent cancer risk due to anxiety and depression. Of course something called multivariant analysis biases this dramatically as stated… just having anxiety of unrevealed duration and severity does not cause cancer in 30 percent of people…. but this is interesting. The authors are clear to point out that Cause and effect are not established clearly.
The study stresses that the correlation between anxiety, depression, and cancer cannot be treated as evidence. In some cases, people with undiagnosed cancer can get anxious and stressed due to the changes happening in their body despite being aware of their sickness.
An expansion of part of this observation must follow
Up to one in ten people will battle anxiety or depression at some point, and this makes people more likely to smoke and drink, and less likely to take exercise and maintain a good diet. But even accounting for this, anxious and depressed people seem to die in greater numbers from cancer
PERHAPS THIS SHOWS that their unhappiness damages the body’s defense systems against the disease. The chicken and egg argument is self apparent however
Some suggest damages in DNA repair in the severely stressed patient but little good data supports this. What we do know is stress can also put people off from attending screenings which could spot cancer early, or prevent them seeking proper treatment when they do fall ill.
People who are anxious often stop looking after themselves and this could lead to poor diet and lack of exercise both proven to have a role in cancer cause
AGAIN THE LEAD AUTHOR STATES THE flaws are too deep in the English study to walk away thinking if you are depressed or anxious you will get cancer
Finally what about the internet in all this. Rather than recite every nuance and nonsense ( not all is nonsense) that DR Google spouts….. All the following key phrases will take you to links that are self explanatory and say pretty much the same thing as what we have covered here
So, anxiety is soul sucking, it has many forms and presentations, it is harmful and it is treatable in cancer patients and families by MANY approaches
This show will be posted both in script form on www.w4cs.com blog and the book blog reachable through the book web site www.whentumoristherumorandcanceristheanswer.com and the audio will be here as well as on iheart radio in a few days
I urge you to reread and listen critically to what has been said and note what has NOT been said regarding the connection between cancer and anxiety, especially regarding cause and complementary and alternative medicine
Now, as I promised in the first show I would, along the way, read stories I have published independently as well as in the book of actual patients with names changed , to at times illustrate a point. The past few shows have been about attitude- both up and down and what works, Here is a tale of my first and only encounter with a leprechaun…I think you will all get the point
A Leprechauns’ Laser Light Of Life
As I made rounds, lilting laughter punctuated a rag tag vocal ensemble’s singing of “Danny Boy”. It ebbed and flowed from the oncology ward lounge, warmly filling a sterile hallway; but not my heart. It was the twentieth St. Patrick’s Day since small cell lung cancer riddled and devoured my son of Hell’s Kitchen, World War II veteran, tough Irish dad. Although he died during the dreary wet frozen rains of a New England fall, he was etched into my heart’s memory owing to one very magical St. Patrick’s Day.
As I did every St Patrick’s since his death, I was reminiscing a time when I, a newly minted, wet behind everything medical student and a 2nd Lt in the USAF in the Health Professions Scholarship Program, visited my dad at work as General Electric’s chief labor relations negotiator in Manhattan. The day ended at a midtown Irish bar with me accompanying him on the tavern’s beer soaked upright as he crooned “Danny Boy”. You could feel the century old pub wood weep as a sonorous tenor voice I never knew he had lifted hearts, minds and glasses. Mutually uninhibited but not inebriated, father and son were in tune.
So here I was decades later on another St Patrick’s Day rounding on the Oncology ward, tired and tied to a bittersweet memory. Regaining focus for the duties of the day, I began to thumb through the chart rack. Suddenly, intruding through the funk was the unmistakable sound of a Buck Rogers’s ray gun. It was right behind my left ear, magically mixing with leprechaun like chortling and giggles.
I spun on my heels and was bowled over by the impish grin and theatrical posturing of my toy toting assailant. Hopping and toe dancing as light as a shamrock blown by faerie breath and half naked in hospital regalia with toy cosmic carbine in hand, retired USAF Chief Master Sergeant “O’Reilly” squealed, “Ah-eee, Gotcha Doc”!
O’Reilly had whistled and skipped to an easy truce with his sleepy follicular Non Hodgkin’s lymphoma for sixteen years prior to this admission. His blarney charmed the beast called anxiety. His acceptance of the capriciousness of a life filled with the Damocles Sword of a strong probability of an aggressive transformation of his disease was like a therapeutic balm of Gilead for not only himself, but so many patients he befriended and bolstered.
His checkups were always a happy routine rife with fabulous tale spinning, unabashed limerick singing and other sound medical practices. Clinic visits from the sage retired chief leprechaun of the USAF always ended with a pat on my head, a wink at the nurses and his trademark squeezing off of a couple laser beams of magic from the now infamous toy gun at whomever he thought needed it most. It never hurt, it often helped and more than once, it seemed more powerful than my prescription pad. An emeritus professor of mirth and mentorship, O’Reilly was one of the wisest men I knew.
Shortly before this final admission, the limber leprechaun interrupted plans to visit family in Ireland because, as he said, “Me shillelagh’s telling me something ain’t right”. A thorough history and physical revealed nothing. The complete blood count showed a slight drop in his usually robust hemoglobin and his platelet count had fallen considerably. So did my heart when review of the peripheral blood smear suggested what an immediate bone marrow examination confirmed; myelopthisis. His lymphoma had transformed aggressively and was exploding into banshee like furor. It was replacing his bone marrow. Further staging showed broad lymph node, boney, spleen and meningeal dissemination. An incredibly bright man, he fully understood the limits of therapy and the grave prognosis. Typically unafraid and more concerned for his family, he was annoyed at the change in travel plans. He sprightly assured me, “I have a few things yet to do, so let’s have a go at it.”
We did. After a rocky course consisting of intensive systemic and intrathecal brain chemotherapy, massive transfusions and considerable assistance from colony stimulating factors to support his white blood cell count and fight infection and erythropoietin to help him make blood, this knobby kneed leprechaun of a man was zapping my dour spirits. Bald and beaming and headed towards a major clinical response, he was working his magic on this very special St Patrick’s Day.
That was his family in the lounge warming the ward with lilts of laughter. Spying my doleful drudge as I began ward rounds, he left the comfort of family and friends to fire a laser beam of life my way. Clearly unfazed by the enormous odds of a rapid and refractory to treatment recurrence of his cancer, he often grandly showcased his plastic phaser quipping something to the effect of, “If it comes back, we’ll zap me cancer with this thing; it’s better than those poisons, eh?”
O’Reilly was one of the gifts clinical oncologists can garner in decades of clinical practice, if they are open to receive them. He was one of those wonderful “doctor-patients” put in our path to minister magical wisdoms just when we oncologists need those most. Being touched by such patients’ special zest, zeal and wisdoms is one of those easy medicines to swallow. Souls such as these are precious jewels in the growing treasure chest of a clinicians experience and the luster of the clinical pearls they impart are often both illuminating and transformative. So it was with O’Reilly
Unbeknownst to me, he had more things than fighting his cancer on his agenda. He had taken particular notice of one of my young clinic nurses. She was a seemingly emotionally cold and somewhat intense Second Lieutenant nurse that was “too young to act such a tough nut and too talented not to try and crack”, according to O’Reilly. She had requested transfer to the inpatient Oncology service. This coincidentally put her on the ward and in O’Reilly’s service and sights when the aggressive transformation of his lymphoma occurred. Both I and the senior nursing staff were concerned for her, believing her far more fragile than her implacable demeanor might suggest, but our “tough nut” showed no signs of trouble and sadly, few signs of warmth even when O’Reilly’s improbable clinical remission occurred.
Shortly after that St Patrick’s Day, the probable occurred. O’Reilly was readmitted with signs and symptoms of a rapid recurrence. He was quick to grasp his situation, calmly and confidently summarizing my lengthy delivering of sad news to a family unwilling to believe the unacceptable, saying gently to all, “It’s been a great run, so now, soon, I’ll be with sod and saints”. In his final days of a rapidly progressing malignancy that would not be denied, he had three simple requests; some intimate uninterrupted time with the Mrs., a steady supply of Guinness Stout and “one last shot at some unfinished business”. Curiously, and without any explanation offered, he decreed that the “tough nut” young nurse be assigned to his care and furthermore she was to be the only medical staff he wanted in his room; no one else, no exceptions. Somewhat bewildered but always admiring of his wisdom, the charge nurse and I warily agreed. On hearing his request, the young lieutenant almost condescendingly agreed seemingly fashioning it as some sort of dramatic last wish. After all, she thoughtlessly quipped, it was “probably (her) turn anyway”. She would be in his service having no idea how true that would prove.
I was shaken upon news of his passing the next morning. However, deeply appreciative of O’Reilly’s gifts, I was both concerned and curious as to the impact, if any, his passing had on the young “ tough nut” nurse. No worries. I no sooner strode onto the ward than she ran up to me glowing, seemingly transformed and weightless, her eyes brimming with tears of joy. Reaching into her pocket she produced our leprechauns’ little laser gun. Smiling, she told how he called her to his room, eschewing all others. She bubbled joyously of how they chatted for hours about secret things, special things about love and the rich life. She was bursting with the pride and surprise as one who had been picked above all others as something special and lovable. Tugging at my white coat like the impatient exuberant child she then was, she announced triumphantly that she was the last target he leveled a final salvo of saving love at. He then bequeathed his other worldly potion in a pistol to her, assuring her that, “I can go now. You’ll know when to use it and when it’s time to pass it on.”
Death is not always so kind, so graceful in its gifts. When we healers and helpers are absorbed in our sorrows, perhaps lost in the fog of sadness over the limits of our skills or other concerns, we may also be most vulnerable to the laser beams of life from those who by all rights should be sorrowful, yet are not.
This is Dr Kevin Ryan author of the book when tumor is the rumor and cancer is the answer, a comprehensive text for newly diagnosed patients and their families signing off radio www.w4cs.com the cancer support radio program
See you Next Tuesday at noon PST when we will look at depression and cancer
Now for any questions