WA News Feature Articles Conquering Cancer Fears
Conquering Cancer Fears
Written by Jan Hallam
Thursday, 24 August 2017


 

24082017---Turner-Jane-Prof Aug17.2016

Prof Jane Turner is a Queensland based psychiatrist who has been working in the area of psycho-oncology for more than 25 years. She’s had a lot of difficult conversations with cancer patients about their fear of the disease recurring and she’s also found some constructive ways to make those conversations meaningful and effective.

Jane, who will be in Perth speaking with GPs later in September for St John of God Subiaco Hospital’s Health and Medical Research Week, said the issue of cancer recurrence is an area gaining more traction and attention in clinical and research circles.

“About 40% of people after cancer treatment have a debilitating fear that it will come back and this is not just people who have early cancer treated. Even people with metastatic cancer worry that it will progress further,” she said.

“We don’t exactly know why some people have this problem more than others but what is important is that it doesn’t seem to go away on its own.”

Anxiety post-cancer treatment, and its ‘successfulness’, is a natural response for patients and their families alike but treating it needs a different clinical approach.

Cancer fear is rational

“CBT is a widely accepted treatment for anxiety and it is very helpful if people’s feelings and fears are irrational but it doesn’t work so well with cancer patients. Even if a patient is cancer free it can recur, that’s a reality. We have some of the best cancer survival rates in the world but no one can guarantee, so, to some extent, the fear of recurrence is rational.”

However, this anxiety can lead to a lower quality of life.

“These patients often get stuck in their anxiety. They may drink too much or become sedentary and when you ask them about these lifestyle things, they say, ‘what’s the point the cancer will come back’. You find them withdrawing from relationships.”

“We have just completed a study which paid a lot of attention to this. It drew on the third wave of therapies – medi-cognitive therapies – acknowledging that the thoughts are not the problem, they are in fact reasonable, but there needs to be new ways of dealing with them.”

“An intervention called Conquer Fear has been developed that consists of five face-to-face sessions. The first step is to help the person understand why they have come to this point.”

“We don’t have data to back this up, but I have been a psychiatrist in this area for 25 years and there are events that shape your world view. If you’re nine and your mother dies of breast cancer and you get breast cancer, it doesn’t matter if people tell you that you have a great prognosis, you will still worry that you will die.”

Cancer and bad luck

“The other aspect is information and misinterpretation. If there was a delay in diagnosis or there were complications, you can understand why that person might think the cancer will come back, ‘because I’m so unlucky with everything else’.”

“By helping people understand their past experiences of loss and grief, they are able to see the logic of their feelings and that is liberating for them.”

The next step is for people to embrace living rather than just surviving.

“In the sessions we talk about values and goals. ‘OK, I’ve survived this, but what do I want for myself.’ The program uses components from acceptance and commitment therapy, which, when I first heard about it, I thought sounded like ‘just suck it up’ but, in fact, it is good common sense.”

“It gives people the chance to decide: ‘what can I change about this situation?’.  Rather than squander resources endlessly, a person can choose to disengage. I use a car analogy. Cancer is an unwanted passenger in the backseat. I can focus on that unwanted passenger and risk an accident or I can keep an eye on it in the rear-view mirror but keep on driving.”

These scenarios will be familiar to many GPs and Jane says GPs are often in the hot seat because they have at their fingertips the tools that can help patients’ anxieties bloom.

“People seek reassurance from GPs who may be pressured to do unnecessary tests. If someone says they are worried, a good response is ‘Yes, you would be worried. How much is it interfering with your life?’ GPs can correct misconceptions and alleviate aggrieved behaviours.”

“GPs have a role in helping patients get to grips with their new normal and help them tolerate it. Cancer leaves scars, both physical and emotional, and they can both heal. However, if you scratch them hard enough, the scars will bleed. Anxiety is that scratching.”

“Being angry and upset are reasonable and rational thoughts. We just have to help those who can’t move beyond them.”

ED: See; www.sjog.org.au/researchweek