Moving Beyond the Fear of Cancer Recurrence

By Dr. Doreen Wiggins for Yoga Medicine®.

Working as a breast cancer surgeon often leads me into the most feared and intimate moments when I say the words, “the biopsy shows that you have breast cancer.” I purposely chose the word “intimate” because being in that moment with the patient will forever change her inner landscape in relation to herself, her “body home,” and her future. This encounter will be the first opportunity to intercede on her behalf to hold space for these words.

In the moments of speaking about a potential life-threatening diagnosis, neuroception is unconsciously employed, meaning that the patient’s neural circuits are wired to seek cue on the seriousness of the diagnosis within moments of our interaction.¹ The impact from our meeting can leave long lasting imprints on the patient’s perceived outcome. I am aware of this potential and therefore, I share bad news with a patient-centered intent. Sensing how she is absorbing and processing the news, I break down terminology and speak clearly because I know that the foreign language of cancer can quickly lead to destinations such as surgery, radiation, and medical appointments discussing adjuvant treatments. She will undergo bodily changes, emotional adaptations, and mental constructs that now include the possibility of facing mortality.

The Start of a Winding Journey

A cancer diagnosis is the beginning of an unknown journey with no clear endpoint that can create fear, uncertainty, anxiety, and stress. Once cancer treatment has been completed, there is no guarantee of a wholly successful treatment that can lead patients into the territory of fear of cancer recurrence (FCR). FCR is a haunting emotion, thought, or preoccupying consequence of facing an illness with an unsure outcome. “FCR causes significant psychological distress and can manifest along different points of survivorship. It is most commonly begins at diagnosis or at key stress phases which include treatment adjustments, bodily changes, additional screening or testing, and even at the completion of cancer therapy. The never-ending concern that cancer can return is an insidiously haunting prospect.”²

Moderate to severe FCR, estimated to affect 49% of survivors, is described as experiencing frequent thoughts about cancer (greater than once/week) and FCR in the absence of triggers.³ Rumination and perceived negative thoughts about cancer recurrence can lead to a heightened stress response within the body, which can influence neuroendocrine function and immune functioning through the sympathetic nervous system.

Roughly 7% of people diagnosed with cancer will have debilitating FCR, whose beliefs become conviction that the cancer will return leading to suffering and death, with constant intrusion of thoughts and fears, and can interfere with daily functioning causing significant distress.⁴ These beliefs can lead to hyper vigilance with bodily symptoms leading to over estimation of risk, fearfully presenting as a sign of cancer recurrence, or even oppositional behavior like the avoidance of follow-up screening even if a suspicious physical change is apparent. They are constantly living in a sympathetic “fight or flight” mode, not allowing parasympathetic healing to occur.

On the other hand, mild FCR may inspire cancer patients to create positive lifestyle changes to improve health, find purpose and meaning. This can spur a patient to cultivate compassion for others, strengthen social relationships, better health maintenance and self advocacy – all of which contributes to an enhanced wellbeing and increased rates of long-term survival.

A Shift in Realization for Improved Outcome

There are currently 17 million cancer survivors in the United States.⁶ As cancer diagnoses increase in numbers and individualized treatments have helped prolong life after diagnosis, continuing wellbeing through survivorship will be key. It is important for healthcare providers to share empathy with patients regarding the life changes with a cancer diagnosis. There is a great and often missed opportunity to create change with a cancer diagnosis—a shift in realization that the fragility of life and health can inspire self-reflection, life purpose, and meaning.

Research has demonstrated that cancer survivors who seek out mind-body practices, such as yoga, find relief from their disease-related concerns and often forge a sense of autonomy over their personal health.⁷ Similarly, research on meditative movement practices, such as yoga and tai chi, demonstrate that cancer patients cultivate an ability to foster feelings of self-agency, coping with uncertainty, and developing trust in their body which translates into a sense of safety within oneself.⁸ Connection by grounding and landing in the body through yoga and meditative movements can foster a sense of oneness and awareness of a greater purpose.

Conclusions from a Breast Cancer Surgeon

As cancer is an unwelcomed intruder within the body, it often promotes deep seated fears regarding future suffering and possible mortality. Working as a breast cancer surgeon, it is an honor to have the trust of my patients to be their surgeon. However, I know that true healing occurs by feeling safe within oneself, and if that is harnessed, can lead to growth and an enriched future ahead. There is opportunity within great adversity for personal growth, and as a yoga teacher myself, I believe that holding space for the body to find sanctuary has deep value for healing. I have observed my cancers patients set deep intentions, and allow for feelings and sensation to arise through awareness and breath. This seems to help them to calm emotions and work through discomfort which allows for connection and trust to build within. As a breast cancer surgeon, yoga teacher, and the observer, I have great hope for my patients who use yoga and breathwork to harness the body’s wisdom to true healing.

References:

1. Colletti, Michelle. “Neuroception: A Subconscious System for Detecting Threat and Safety.” Elite Learning, 2 Oct. 2019, www.elitecme.com/resourcecenter/rehabilitationtherapy/neuroception-a-subconscious-system-for detecting-threat-and-safety/.

2, 3, 4, 5. Sharpe L., Curran L., Butow P., Thewes B. “Fear of cancer recurrence and death anxiety.” Psychooncology, November 2018. https://www.ncbi.nlm.nih.gov/pubmed/29843188

6. Sampson, David. “Cancer Survivors Predicted to Number over 22 Million in U.S. by 2030.” Cancer Pressroom, 11 June, 2019. http://pressroom.cancer.org/SurvivorshipStats2019

7, 8. Reijmen E., Vannucci L., De Couck M., DeGrève J., Gidron Y. “Therapeutic potential of the vagus nerve in cancer.” Psychooncology, October 2018. https://www.ncbi.nlm.nih.gov/pubmed/3007753