Number 4 Cancer Recurrence and Intense Psychological Distress

The plan is for me to write a series of blogs about cancer. You will read this small paragraph every time you read one of these blogs because it is an explanation and a disclaimer. First of all, why should I do this and what qualifies me to do so? The answer to the second question is that I am a cancer immunologist with a PhD from the University of Pennsylvania and have 30-years experience in not only research, but also in the experiences of cancer patients. I have published numerous articles and a book about immunity to cancer and have two other books about my experiences with research and cancer patients as well as a fictional account of the final cure for the disease. However, none of this experience allows me to give advice or otherwise tell people what to do if they have cancer. I can be viewed as a participant/observer who will be relaying current and past observations about this world called “cancer”, which many people do not understand. That’s the answer to the first question, which is why I should do this. The first step in overcoming anything is to understand it first. With that being said, here they are:

Number 4 Cancer Recurrence and Intense Psychological Distress

The recovery phase from cancer is like no other type of recovery from other diseases because of the unpredictability of cancer. Recovery from most illnesses require a period of physical healing, but over time the patient usually returns to normal and can get back to every-day life. However, there are unfortunately several aspects related to cancer recovery that are unique to cancer itself. Of course there is a period of physical healing because more often than not the treatments for cancer do disrupt the normal function of the body. Another unfortunate aspect to the healing process has to do with the psychological adjustments patients must make during this time. The common definition of being cured of cancer is to be disease free for 5 years. However during and after that period the patient must psychologically deal with the fact that the cancer may come back. This is called “recurrence” and is the source of much fear and anxiety for many recovering cancer patients. This emotional condition begins immediately after the “cancer free” diagnosis and is very intense within the first year. Many patients report that over time the fear and anxiety becomes less intense. However, there are several, what would be called “triggers” that reignite severe bouts of this condition. The first and most frightening would be the appearance of the same symptoms from the initial diagnosis. Other events that may occur years after being cancer free that may induce these emotional responses are the anniversary of the diagnosis, surgery, or the day the treatment ended.

There is another stage of psychological stress that many recovering patients have to endure that in effect, draws in all of the previous emotional problems that began after the initial diagnosis. This stage appears when the patient actually does have a recurrence of their cancer. Many people who’ve never actually experienced having cancer, and then have been cured of it, only have a vague or second-hand view of what occurs during the first five or 6 years after a cancer-free diagnosis. Basically their lives change because of the after-effects of having cancer. Many of these are psychological, but quite of few of them have to do with financial, social, or family-related issues. At the time of diagnosis and just prior to treatment, the patient must make decisions based on the information gathered from the physician and other outside sources. It was found that there are four methods associated with this decision-making process and they are: information seeking, information processing, ruminating, and advice following. It was determined that the patients who made exclusive use the first two strategies (information seeking and information processing) were more likely to cope with the stress of a life-threatening cancer than those who used the advice-following strategy alone. The reason why this information is important is because when the patient experiences a recurrence of their disease the first thing they think about is this period of decision-making prior to treatment. They often blame themselves for not making the proper decision. This entails feelings of guilt because apparently they feel as though the have failed their family, friends, and physician. After these initial psychological events occur, all of the other emotional stresses associated with the diagnosis come to the surface of the patients mind. It is apparent that at almost every stage of cancer there are psychological stresses that have the ability to not only contribute to a poor quality of life, but also interfere with the biological process of recovery from cancer. These issues are dealt with in the field of psycho-oncology and are of critical importance to the overall outcome of a cancer diagnosis. As far as recurrence is concerned, much more research must be done to efficiently use psychological/psychiatric intervention in order to address the massive psychological disturbance caused by the recurrence of cancer.