I just finished treatment for gynecological cancer, but I am worried about recurrence...

Most cancer patients look forward to completing treatment as quickly as possible, as these treatments may cause them great physical, psychological and emotional trauma. If they can complete treatment as soon as possible, they can return to normal life as soon as possible. However, some people may find that they still need to face a series of challenges in their lives after completing cancer treatment. This is also true for patients with gynecological tumors. According to a population-based study conducted by NCCR, in China, the 5-year relative survival rate of cervical cancer is 45.4% overall, the 5-year relative survival rate of endometrial cancer is 55.1% overall, and the 5-year relative survival rate of ovarian cancer is 38.9% overall. Due to the high 5-year survival rate relative to other tumors, many women need long-term follow-up in primary care institutions.

In the description of cancer, disease recurrence is one of the most frightening and stressful moments. Despite having completed treatment, as survivors of the disease, patients are always faced with the possibility of recurrence. Fear of recurrence (also fear of disease progression) is a unique feature of cancer treatment (fear of cancer recurrence, FCR), which is defined as "fear, worry, or concern about cancer recurrence or progression" and is one of the most commonly mentioned concerns by cancer survivors. It is an adaptive response rather than an unrealistic or neurotic fear. Mild or transient FCR is normal and can motivate appropriate health behaviors, and excessive worry about recurrence can lead to severe emotional distress. Pathological FCR often manifests as persistent anxiety, excessive physical examinations and/or seeking medical reassurance, avoiding things related to cancer, producing intrusive thoughts and images about recurrence, and difficulty planning for the future. On average, 49% of cancer survivors and up to 70% of patients prone to recurrence are affected by moderate to severe FCR, and about 7% of patients are at risk of disability.

It’s normal to feel fear or anxiety about your cancer coming back. Feeling sick or visiting the doctor can bring back a host of unpleasant memories of when you were first diagnosed with cancer. It’s not enough to just know how common this worry is; people often describe it as “excruciating” or “powerless,” and it can be accompanied by physical symptoms, such as nausea and insomnia, and mental or emotional manifestations, such as irritability and difficulty concentrating. Fear of a recurrence can be unsettling and shake your confidence in returning to a normal life.

So, as a patient, what methods are there to deal with such emotions?

Acknowledge and express your fears and anxieties

Being open about your feelings and expressing them has helped many people feel less anxious. People have found that when they express strong feelings, such as anger or sadness, those feelings are more likely to go away. Some people talk to family and friends, while others seek help from a counselor. Of course, if you don't want to talk about your illness with others, you don't have to express it. You can sort out your feelings by thinking about and writing about them. Although it is important not to let cancer control your life, it is not easy to do so. Finding a way to express your feelings can help.

Talk to your primary care physician to stay informed and schedule regular checkups

You should understand the disease you have, know what you can do now to help your recovery, know your current physical condition and possible situations. Those who know more about their own disease and treatment are more likely to follow the treatment plan and reduce anxiety about the unknown.

Discover areas of your life where you have choice and control

For example, choose a healthy lifestyle, maintain meaningful relationships with others, and avoid focusing on things that are unpredictable or uncontrollable.

Make a plan for yourself

Try to be as active as possible in activities that you enjoy, that help you find your purpose, and that you benefit greatly from.

Remember

Today is the tomorrow you worried about yesterday

Many of the things we worry about never happen, and these worries are sometimes unnecessary.

Improving mental health after cancer treatment is just as important as improving physical health. As you work to improve your physical health, make sure you also improve your mental health. Excessive worry about recurrence can have a serious impact on your life. Remember that the experience of being diagnosed, fighting the disease, and surviving cancer provides some emotional, psychological, and even spiritual growth that can inspire you to maintain a more fulfilling and meaningful lifestyle.

References

1. Zeng H, Zheng R, Guo Y, Zhang S, Zou X, Wang N, Zhang L, Tang J, Chen J, Wei K, Huang S, Wang J, Yu L, Zhao D, Song G, Chen J, Shen Y, Yang X, Gu X, Jin F, Li Q, Li Y, Ge H, Zhu F, Dong J, Guo G, Wu M, Du L, Sun X, He Y, Coleman MP, Baade P, Chen W, Yu XQ. Cancer survival in China, 2003-2005: a population-based study. Int J Cancer. 2015 Apr 15;136(8):1921-30. doi: 10.1002/ijc.29227. Epub 2014 Oct 3. PMID: 25242378.

2. Koch, L., Jansen, L., Brenner, H., & Arndt, V. (2013). Fear of recurrence and disease progression in long-term (≥5 years) cancer survivors—a systematic review of quantitative studies. Psychooncology, 22, 1–11.

3. Lang-Rollin I, Berberich G. Psycho-oncology. Dialogues Clin Neurosci. 2018;20(1):13-22. doi:10.31887/DCNS.2018.20.1/ilangrollin）

Author: Wang Yun and Wang Yang from Shanghai Jiao Tong University School of Medicine Mental Health Center

About the Author

Wang Yun

Chief Physician of Shanghai Mental Health Center, Master. Has been engaged in clinical diagnosis and treatment of psychiatric diseases and teaching of medical students for a long time.

Expertise: Clinical diagnosis and treatment of depression and anxiety disorders, neurosis, schizophrenia, and consultation on general psychological issues such as study, work, marriage, etc. Excellent teaching teacher of Shanghai Medical College, Fudan University in 2019. Secretary of CSNP Chinese Depression Researchers Alliance, the first author has published more than ten papers in domestic and foreign journals.

About the Author

Wang Yang

He currently works at the Mental Health Center affiliated to Shanghai Jiao Tong University School of Medicine.

Research direction: Pathological mechanism of obsessive-compulsive disorder and optimization of treatment options

Funded by Shanghai Science and Technology Commission's Science Popularization Project

(Project No.: 20DZ2311100)