Anxiety and depression inevitably accompany cancer. Most people have periods of intense worry or fear, often right after diagnosis (note: read yesterday's blog), before scans, hearing about others whose cancer has progressed. Most people also find ways to manage it.
Yesterday I met with two women who were particularly anxious and not managing so well. One was wondering whether she could ever be less fearful and, if not, whether life was tenable in her current state. She expressed thoughts about "maybe it would be easier just to get this over with", but denied any active thoughts or plans of suicide. The second woman isn't sleeping, describing many worries and fears overwhelming her in the darkness. The first woman may need medication, and I referred her to the psychopharm who works with our group (after, of course, doing a careful suicide assessment and deciding, with her, that she is not at risk). The second woman will benefit from talking about her worries and, possibly, meditation.
These two conversations stimulated my thinking about this topic, and I thought I would share an edited version of a column that I wrote last year for Cancer Today.
Anxiety inevitably accompanies cancer. It is predictably intense right after diagnosis, when preparing for surgery or chemotherapy or radiation, when treatment ends, and if cancer recurs or progresses. Anxiety is a normal response to these difficult circumstances, and can usually be managed without medical interventions. There are times when medications will help, and you should talk with your doctor if:
• You are unable to sustain your normal routines or obligations due to anxiety
• You are unable to sleep through the night, and awaken in the dark to find your mind and heart racing
• You often can’t control the worry
• You are having panic attacks.
There are a number of strategies that can help you manage these feelings. First, remind yourself that sometimes feeling worried or frightened is an appropriate response to a serious illness. As a little time passes, you almost certainly will feel better. Everyone describes the first weeks after diagnosis or of learning about a recurrence to be the most difficult, and then everyone finds ways to manage. Your life will go on.
Here are some tips to help during the hard times:
• Stop for a moment and take a deep breath. Even better, take several and pay attention to your breaths. Feel your body relax.
• Starting with your toes, mentally name your body parts and move upwards. With each stop, consciously relax.
• If you can’t concentrate, move the body. Get up and do something, anything. A short walk is best, but even moving around the room will help.
• Identify those times that are sure to be anxiety-provoking. For most people, that means beginning a new treatment or going for scans or appointments. Consider asking someone to accompany you and give her directions on what will help. Do you want her to bring snacks or sit quietly or rub your feet during chemo? Admitting that you are scared and asking for help is therapeutic in and of itself.
• Try to be specific about your fears. For example, if you are beginning chemotherapy, are you frightened about the needle stick or possible side effects or the drugs themselves? Once you know the trigger, you can usually find a solution or way to ease it. Make the worry smaller; try not to let it grow large and vague.
• Make a plan. If you are scared about the results of a scan, talk with your doctor about how and when you will hear them. Do not leave this to chance; you do not want to wonder whether the lack of a phone call is good or bad news. Decide if you want a phone call, no matter what the results, or if you want to wait for your next appointment. Be clear about your needs.
• Ask for help and ask specifically. Your family and friends want to be useful, and helping you feel less anxious is a wonderful goal. Most people feel much better when they talk about what is worrying them.
• Make sure to take good care of yourself. This means trying to eat a balanced diet, getting enough sleep, keeping up a mild to moderate exercise routine, and staying hydrated. Your mood will be better if you are physically feeling as well as possible, and it is reassuring to take control of the things that you can control.
• Be gentle with yourself. If this is a bad day, have a treat or take a nap or just remind yourself that tomorrow will be better.