Fear of cancer recurrence: Mind-body tools offer hope

Every year, there are more adults who have been diagnosed with cancer at some point in their lives. All of them face the uncertainty and fear that follow cancer treatments. Research shows that fear of cancer recurrence interferes with emotional and physical well-being. And it also suggests that mind-body tools can help people who have been treated for cancer regain control.

A growing number of cancer survivors

Over the past 50 years, the number of adults who have completed primary treatment for cancer has grown steadily. By 2024, an estimated 19 million will be living in the United States, a tribute to rapidly evolving options for diagnosis and treatment. There is a critical need to support survivors as they navigate the uncertainty of post-cancer life. Indeed, if you ask patients, health care providers, and researchers, you'll find that even the often used term "cancer survivor" has different definitions and connotations.

When treatment is over, this doesn't mean worries are over — not even among people in remission with no evidence of disease. After active treatment concludes, cancer survivors find themselves facing a new, unforeseen challenge: persistent fear and distress regarding their health and future. Survivors may continue to worry about disease recurrence for years after treatment ends. What's more, their worries often persist at levels equal to that experienced at the time of diagnosis. In fact, 30% to 70% of cancer survivors report moderate to high levels of fear of cancer recurrence, or FCR.

Which worries crop up most often?

After cancer treatment, people confront prognostic uncertainty about their survival. They may struggle with long-term symptoms from their cancer. They must undergo ongoing medical tests and surveillance. Their treatments may have lasting consequences, such as infertility or cognitive difficulties. Uncertainty, the fear of consequences for loved ones that stem from their illness, and social role changes further contribute to the complexity of FCR.

What triggers fear of cancer recurrence?

If you've experienced FCR, you know cues in your social environment can be a trigger: follow-up appointments, public health campaigns, and new diagnoses among family and friends. Physical symptoms, such as pain and fatigue due to cancer treatments, aging, or other factors may also prompt you to worry that cancer has recurred.

How do people respond to these fears?

Unfortunately, distinct patterns of maladaptive behavior can emerge. On one end of the spectrum is reassurance-seeking behavior. People seek extra visits with their oncologists, request additional screenings, engage in overtreatment, or excessively examine their bodies for signs of recurrence. Cancer survivors may also cope with FCR through avoidance. They may skip or delay follow-up visits, engage in substance use, or hide out through patterns of sedentary behavior and social isolation.

How can mind-body tools help?

Mind-body techniques, such as cognitive behavioral skills, mindfulness meditation, and yoga help cancer survivors take control of persistent FCR. A systematic review and meta-analysis of 19 randomized control trials showed that mind-body techniques had small-to-medium effects in easing FCR. The most rigorously tested tools are:

• Cognitive behavioral skills, such as setting aside "worry time," and learning to recognize and reframe fears
• Meditation techniques, such as seated meditation and meditative movement like yoga or tai chi
• Relaxation techniques, such as deep breathing and guided imagery
• Expressive art therapies, such as dance therapy.

Follow-up assessments showed that the benefits lasted as long as two years after the baseline assessment.

Certain common themes were emphasized in many of the trials included in the review. For example, participants were asked to recognize the harm of appraising ambiguous or unpredictable changes in their bodies as threatening. Indeed, research suggests that physical symptoms such as pain, fatigue, and gastrointestinal symptoms trigger fear in cancer survivors. This heightens stress, which can then aggravate physical symptoms.

Another common theme highlights the benefits of focusing on the present moment, which can help survivors reframe their relationship to uncertainty. Using mindfulness meditation and cognitive behavioral skills, people can curb both reassurance-seeking and avoidance behaviors. They learn ways to let go of thoughts and judgements, tolerate waves of uncertainty, and develop an appreciation for impermanence, particularly regarding physical symptoms.

The bottom line

Mind-body interventions offer a promising solution to managing FCR if you struggle with fear and worry after cancer treatment. If you are struggling with these worries, ask your cancer care team, primary care provider, or therapist if there are mind-body training options available to you. Taming the fear of cancer recurrence through such techniques can help you take control of your emotional and physical well-being.

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