Scanxiety: Understanding Survivor Anxiety and Fear of Cancer Recurrence

He Calls It Scanxiety

As his scan appointment approaches, Dr Lewis starts to think more and more about what the image might show. The phenomenon of scanxiety comes to life. He thinks of his abdomen as being “like a black box” until he looks inside with whatever imaging. His imagination starts to get the best of him, and he begins to fear the worst. Afterward, he experiences an enormous sense of relief when the scan comes back showing that his condition is stable.

He describes his situation as “more than ironic” that on the first day of his oncology training he developed the abdominal pain that eventually revealed his MEN1 status. He had already committed to treating cancer but certainly did not realize how personal it was going to be. He saw his entire training through the dual lens of being a physician and a patient, and he believes it made him sensitive to some of the psychological stressors of cancer care.

Follow-up Anxiety

Another time patients get anxious is when they arrive at the end of treatment after active chemotherapy. At that point, he “releases” them into surveillance where, as their oncologist, he will see them every few months or every year.

This phase has its own apprehension associated with it. Patients have been in one rhythm doing something active and now are switching into a mode that feels much more passive. Some patients confide in him that they are afraid to be seen any less frequently. A phenomenon he finds fascinating. It is almost as though the patients have been held captive; he opens the door for them to leave but they’re afraid to go. Dr Lewis suggested there must be a tremendous amount of psychology to be explored in that situation.

No Routine Follow-ups

Dr Lewis believes becoming complacent and allowing a routine follow-up to be simply another visit on the schedule is easy for any oncology provider. Therefore, he always reminds himself that there are no routine follow-ups for cancer patients. Many times there are real feelings of fear and even borderline PTSD associated with returning to the place where they underwent treatment.

The oncology nurse has to be sensitive to that apprehension and be able to help mitigate patients’ anxiety. Sometimes the best treatment for that is pharmacologic, and Dr Lewis offers his patients a low-dose anxiolytic around the time of their follow-up scan. This can really be helpful, particularly if someone needs to lie still in an MRI machine. But this oncologist-patient knows the worry about recurrence never dissipates entirely.