Fear of Cancer Recurrence

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer answers with
00:08 --> 00:10your host doctor Anees Chagpar.
00:10 --> 00:12Yale Cancer Answers features the
00:12 --> 00:14latest information on cancer care by
00:14 --> 00:16welcoming oncologists and specialists
00:16 --> 00:18who are on the forefront of the
00:18 --> 00:20battle to fight cancer. This week,
00:20 --> 00:22it's a conversation about cancer
00:22 --> 00:24survivorship with licensed clinical
00:24 --> 00:25social worker Angela Khairallah.
00:25 --> 00:28Dr Chagpar is a professor of surgical
00:28 --> 00:30oncology at the Yale School of Medicine.
00:31 --> 00:33Angela, maybe we can start off by you
00:33 --> 00:35telling us a little bit more about
00:35 --> 00:37yourself and what it is you do.
00:37 --> 00:40I'm a licensed clinical social worker
00:40 --> 00:43and currently I work in the Smilow Breast
00:43 --> 00:46Center as well as the Smilow Cancer
00:46 --> 00:49Center Survivorship Clinic and in part of
00:49 --> 00:52my role I meet with patients and I
00:52 --> 00:55spend time just getting to know them,
00:55 --> 00:58checking in, see how they're doing.
00:58 --> 01:00You know, I really like to find out how
01:00 --> 01:02patients are doing on an emotional level.
01:02 --> 01:05Particularly with regards to their diagnosis,
01:05 --> 01:08how they're coping and managing
01:08 --> 01:09throughout treatment.
01:09 --> 01:11As well as into, you know,
01:11 --> 01:13survivorship and when I meet with patients,
01:13 --> 01:16you know what I'd like to talk to
01:16 --> 01:18them about is that you know when
01:18 --> 01:20you're diagnosed with cancer,
01:20 --> 01:22it can affect all aspects of your life.
01:22 --> 01:24It can affect it socially,
01:24 --> 01:26emotionally, spiritually, financially,
01:26 --> 01:28and even sexually,
01:28 --> 01:31and it's really not uncommon that
01:31 --> 01:33when patients are diagnosed with
01:33 --> 01:35cancer and are going through treatment
01:35 --> 01:37that they might develop some anxiety
01:37 --> 01:40and some depression as a result.
01:40 --> 01:42Of what they're going through, and so it's.
01:42 --> 01:45It's not uncommon for that to impact
01:45 --> 01:47them shortly after their diagnosis,
01:47 --> 01:49as well as throughout treatment.
01:49 --> 01:50But on the other end,
01:50 --> 01:52when I meet with patients in
01:52 --> 01:54the cancer survivorship clinic,
01:54 --> 01:57I often see it at that point as well.
01:57 --> 01:58You know,
01:58 --> 01:59I I can't tell you how many
01:59 --> 02:01patients will share with me.
02:01 --> 02:03You know, I did fine. I was strong.
02:03 --> 02:05I fought this thing.
02:05 --> 02:08I didn't cry at all the whole through,
02:08 --> 02:09throughout all of my treatment.
02:09 --> 02:11And now that everything's done
02:11 --> 02:12and everything's behind me.
02:12 --> 02:14Now I'm starting to feel overwhelmed.
02:14 --> 02:17I'm starting to get anxious and worried,
02:17 --> 02:18and you know,
02:18 --> 02:19really,
02:19 --> 02:21it's just about listening and
02:21 --> 02:22validating and normalizing their
02:22 --> 02:25feelings that you know that what
02:25 --> 02:26they're going through is normal
02:26 --> 02:28and actually is quite common.
02:28 --> 02:29You know,
02:29 --> 02:31it's it's pretty often that I meet with
02:31 --> 02:33patients in the cancer survivorship
02:33 --> 02:36clinic and they are experiencing you know,
02:36 --> 02:38those fears and those worries
02:38 --> 02:41that the cancer could come back
02:41 --> 02:43and and even occur or reoccur.
02:43 --> 02:45And so while I'm meeting with patients,
02:45 --> 02:48I complete a full psychosocial assessment.
02:48 --> 02:50Ask them a variety of questions to
02:50 --> 02:52get to know them better and see
02:52 --> 02:55how I might be able to best help
02:55 --> 02:56them throughout this whole process.
02:57 --> 02:58Yeah, you know,
02:58 --> 03:00cancer is one of these things that
03:01 --> 03:03it really does strike the fear of.
03:03 --> 03:05Of God and everything else in you.
03:05 --> 03:08I mean it. It is one of those
03:08 --> 03:10things that doesn't, you know,
03:10 --> 03:13take time to schedule on your calendar.
03:13 --> 03:18It comes oftentimes out of the blue and.
03:18 --> 03:21And it really does have just
03:21 --> 03:24tremendous fear associated with it,
03:24 --> 03:27so you know and and from what
03:27 --> 03:29you're you're telling me,
03:29 --> 03:30and from what I've experienced
03:30 --> 03:31as a clinician as well,
03:31 --> 03:33is that this is something that
03:33 --> 03:35never completely goes away.
03:35 --> 03:38So let's kind of walk through the
03:38 --> 03:40journey of of a cancer patient
03:40 --> 03:41when they're first diagnosed.
03:42 --> 03:44Is that when you first meet them and.
03:44 --> 03:46And how do you kind of,
03:46 --> 03:49aside from telling them that you know
03:49 --> 03:50when you're diagnosed with cancer?
03:50 --> 03:52It does tend to be a little
03:52 --> 03:54bit of a scary experience.
03:54 --> 03:57How do you kind of help
03:57 --> 03:59them to overcome that fear?
03:59 --> 04:02Or deal with it or manage it.
04:02 --> 04:04Or kind of not put their life on
04:04 --> 04:07hold and somehow continue to put 1
04:07 --> 04:10foot in front of the other as they
04:10 --> 04:12try to deal with this diagnosis,
04:12 --> 04:13right?
04:13 --> 04:13So I think
04:13 --> 04:16that yes I do meet a number of patients
04:16 --> 04:19who are diagnosed at the beginning
04:19 --> 04:22of treatment and I I really think
04:22 --> 04:25it's about talking to patients and
04:25 --> 04:27really understanding where they're
04:27 --> 04:29coming from validating their feelings.
04:29 --> 04:30Normalizing that,
04:30 --> 04:33what they're going through is very
04:33 --> 04:36similar to what many others go through,
04:36 --> 04:38and those fears those worries that those
04:38 --> 04:41concerns that they are having those are real.
04:41 --> 04:44And many people also experience that,
04:44 --> 04:47I think just being there to provide them
04:47 --> 04:50with support as they go through the process,
04:50 --> 04:52you know and really helping them
04:52 --> 04:54understand that a side effect of
04:54 --> 04:57going through cancer and treatment is,
04:57 --> 04:59you know, experiencing some anxiety.
04:59 --> 05:01Some worries, some fears,
05:01 --> 05:03sadness as a result of what
05:03 --> 05:05they're going through.
05:05 --> 05:06And from my standpoint,
05:06 --> 05:09I like to assess and make sure that
05:09 --> 05:12those worries those fears those sadness.
05:12 --> 05:15Isn't impacting somebody's quality of life,
05:15 --> 05:15you know,
05:15 --> 05:17and I'd like to educate them and
05:17 --> 05:19explain that it's OK to have a day
05:19 --> 05:21once in a while when you're sad or
05:21 --> 05:22where you're worried or scared.
05:22 --> 05:23You know,
05:23 --> 05:25it's OK that you might be feeling
05:25 --> 05:26anxious and and you lost a night
05:26 --> 05:28of sleep or two over this,
05:28 --> 05:30but when you're noticing that those worries,
05:30 --> 05:32those fears that sadness it goes on for
05:32 --> 05:35several days on to several weeks at a time,
05:35 --> 05:37you really do need to make sure
05:37 --> 05:39that you're letting your team know.
05:39 --> 05:41Let your medical oncologist or your
05:41 --> 05:43surgeon know, asked to speak with.
05:43 --> 05:45A social worker who would be associated
05:45 --> 05:47with your clinic and then they can
05:47 --> 05:50further assess is their need for
05:50 --> 05:51additional support and services.
05:51 --> 05:53If I do identify that a patient would
05:53 --> 05:55benefit from additional support and services,
05:55 --> 05:58I frequently refer out to providers
05:58 --> 06:01in the Community who can provide,
06:01 --> 06:01you know,
06:01 --> 06:03mental health counseling and support.
06:03 --> 06:05I'll often encourage patients to
06:05 --> 06:08attend a local Cancer Support group in
06:08 --> 06:10that area to provide additional layer
06:10 --> 06:13one of the other things that I will.
06:13 --> 06:16Do is you know I talked to patients
06:16 --> 06:18about one of one of the helpful
06:18 --> 06:20interventions for people that are
06:20 --> 06:22experiencing anxiety and depression
06:22 --> 06:24is meeting with a professional who
06:24 --> 06:27specializes in cognitive behavioral
06:27 --> 06:28interventions.
06:28 --> 06:30You know, talk to patients about you.
06:30 --> 06:32Know the connections between their thoughts,
06:32 --> 06:34their feelings and their behaviors,
06:34 --> 06:37as well as what truly is and what
06:37 --> 06:39isn't in their control.
06:39 --> 06:41As a result of everything that
06:41 --> 06:42you're going through.
06:42 --> 06:44You know when someone is
06:44 --> 06:45initially diagnosed with cancer,
06:45 --> 06:47it truly does feel like it's
06:47 --> 06:49completely out of their control.
06:49 --> 06:51And what lies at the core of our
06:51 --> 06:53fears and our worries often are
06:53 --> 06:55things that feel like they're out of
06:55 --> 06:57their control or out of our control.
06:57 --> 07:00And so I will talk to patients about
07:00 --> 07:03how can you bring back control over
07:03 --> 07:05something that feels so out of control
07:05 --> 07:08in your life and help them identify
07:08 --> 07:11strategies to help them move forward.
07:11 --> 07:13I also like to encourage
07:13 --> 07:14patients to make sure that
07:14 --> 07:16they have an adequate
07:16 --> 07:17support system around them.
07:17 --> 07:19We do know that by having family and
07:19 --> 07:22friends and neighbors and a medical
07:22 --> 07:24team that surrounds you through this
07:24 --> 07:26process helps you in the long run.
07:27 --> 07:29And and that's so important,
07:29 --> 07:32and I think one of the things that you
07:32 --> 07:35know for cancer patients as well As for
07:35 --> 07:37people going through whatever ailment
07:37 --> 07:40you may be going through thinking
07:40 --> 07:42about what is within your control
07:42 --> 07:45and what is not within your control.
07:45 --> 07:48And you know the fact that.
07:51 --> 07:54There are things that you can do that
07:54 --> 07:57are constructive that are within your
07:57 --> 08:00control that can kind of empower you,
08:00 --> 08:03and in so doing reduce your fears.
08:03 --> 08:05So can we talk a little bit more
08:05 --> 08:07about some of those strategies?
08:07 --> 08:10What kinds of things would you talk to a
08:10 --> 08:12patient about that that are within their
08:12 --> 08:14control that might reduce their anxiety,
08:15 --> 08:17right? Well, first and foremost,
08:17 --> 08:21I would encourage patients to.
08:21 --> 08:22Think about you know,
08:22 --> 08:24think about what is in their control
08:24 --> 08:26and some of the things that patients
08:26 --> 08:28have identified when I've worked
08:28 --> 08:30with them are things like, well,
08:30 --> 08:32I have control whether or not I
08:32 --> 08:35choose to even treat this cancer.
08:35 --> 08:37I have control whether or not I choose
08:37 --> 08:39to go to my appointments or follow
08:39 --> 08:41up with my scans or get my blood
08:41 --> 08:43work so that that's a choice that
08:43 --> 08:45they have that is in their control.
08:45 --> 08:47But what we also know,
08:47 --> 08:48and one of the things I educate
08:48 --> 08:51patients about, is that you.
08:51 --> 08:55You have control over well what we do
08:55 --> 08:57know is that if we're getting adequate sleep,
08:57 --> 09:00you know adequate hydration.
09:00 --> 09:03Making healthy food choices, you know,
09:03 --> 09:06exercising or walking as much as we can.
09:06 --> 09:08Those are all things that
09:08 --> 09:09help us feel better.
09:09 --> 09:11Those are things that help with worry.
09:11 --> 09:13Those are things that help
09:13 --> 09:14with sadness and depression,
09:14 --> 09:16and those are things that we do have,
09:16 --> 09:18you know, control over,
09:18 --> 09:19and so I will encourage
09:19 --> 09:21them to just think about.
09:21 --> 09:23Or kind of reframe.
09:23 --> 09:25You know how they're thinking about
09:25 --> 09:27something also thinking about?
09:27 --> 09:29You know trying to take this
09:29 --> 09:32whole process one step at a time.
09:32 --> 09:34I have patients who often feel
09:34 --> 09:36completely overwhelmed by all of
09:36 --> 09:38the things that they are asked to.
09:38 --> 09:40Do you know this appointment?
09:40 --> 09:41That appointment surgery?
09:41 --> 09:43Dealing with this side effect,
09:43 --> 09:44that side effect,
09:44 --> 09:46it's just sometimes can feel so
09:46 --> 09:48so daunting and overwhelming.
09:48 --> 09:50I'll encourage them to try to
09:50 --> 09:53take it one day at a time or even
09:53 --> 09:55one hour at a time to try to move
09:55 --> 09:57forward in in accomplishing the
09:57 --> 09:59things that they need to accomplish.
10:00 --> 10:03Yeah, that's such such good advice.
10:03 --> 10:05I mean, I think when we think back
10:05 --> 10:06to what you were talking about
10:06 --> 10:08in terms of what you can control,
10:08 --> 10:10you may not be able to control
10:10 --> 10:13the fact that you got cancer.
10:13 --> 10:14That that is.
10:14 --> 10:19A historical fact for cancer patients
10:19 --> 10:22that they can't go back in time and change,
10:22 --> 10:24but what they can change is what
10:24 --> 10:25they do moving forward.
10:25 --> 10:27So going to your appointments,
10:27 --> 10:29choosing to get treated.
10:29 --> 10:34And at least those are things that you
10:34 --> 10:37are doing to help overcome this cancer.
10:37 --> 10:39You can't control whether or
10:39 --> 10:41not you're cancer will respond,
10:41 --> 10:44but you can control whether or not
10:44 --> 10:46you talk to your medical oncologist.
10:46 --> 10:48And you know.
10:48 --> 10:50Surround yourself with a team
10:50 --> 10:52who can treat the cancer,
10:52 --> 10:54no matter whether it chooses to
10:54 --> 10:56respond to one therapy or not.
10:56 --> 10:59You know the other thing that I
10:59 --> 11:02think is overwhelming for a lot of
11:02 --> 11:05patients is that it's not just the
11:05 --> 11:08cancer which is scary in and of itself.
11:08 --> 11:11Many patients are are looking at
11:11 --> 11:13their cancer diagnosis and kind
11:13 --> 11:15of looking in the mirror and
11:15 --> 11:17evaluating their own mortality,
11:17 --> 11:20which they may not have done in
11:20 --> 11:22a while. But at the same
11:22 --> 11:24time, there's also other fears
11:24 --> 11:26and you kind of alluded to this
11:26 --> 11:28at the top of the show as well.
11:28 --> 11:31You know fears about well.
11:31 --> 11:32Are my friends still going
11:32 --> 11:33to be there for me?
11:33 --> 11:36Is my is my spouse still gonna love me?
11:36 --> 11:40Am I still going to be able to have
11:40 --> 11:42a sexual relationship and am I going
11:42 --> 11:46to be able to afford all of these
11:46 --> 11:48medical bills that are piling up?
11:48 --> 11:50And oh, by the way,
11:50 --> 11:51how am I going to communicate
11:51 --> 11:53this diagnosis to my children?
11:53 --> 11:55Are they going to be scared?
11:55 --> 11:58Are they going to be diagnosed with cancer?
11:58 --> 12:01And so the snowball kind of.
12:01 --> 12:05Spins sometimes out of control with.
12:05 --> 12:06It's not just.
12:06 --> 12:09A disease it's not just a cancer,
12:09 --> 12:12it's all of these other things that
12:12 --> 12:15then kind of add complexity to what
12:15 --> 12:18is already a harrowing experience.
12:18 --> 12:20So can you kind of break that down
12:20 --> 12:22for us and and give us some advice
12:22 --> 12:24that you might give patients in
12:24 --> 12:25trying to manage all of these
12:25 --> 12:27other aspects of cancer that
12:27 --> 12:29they may be facing as well.
12:29 --> 12:31That might be adding to their anxiety.
12:32 --> 12:37So I think that encouraging and talking
12:37 --> 12:41to patients that this is the one time in
12:41 --> 12:46your life where it's OK to ask for help.
12:46 --> 12:48It's OK to turn to others and
12:48 --> 12:51say I can't do this on my own.
12:51 --> 12:52What do you suggest?
12:52 --> 12:55How do you think I should manage
12:55 --> 12:57and deal with this? You know, I,
12:57 --> 12:59I will often talk to patients and say,
12:59 --> 13:02you know, this is the time in your life
13:02 --> 13:05where it's OK to also be accepting of help.
13:05 --> 13:09So not only ask for it but also be
13:09 --> 13:12accepting of it and so really you know.
13:12 --> 13:14Letting talking to family members,
13:14 --> 13:16talking to your friends, you know.
13:16 --> 13:18Letting your medical team know.
13:18 --> 13:19Also, you know again,
13:19 --> 13:22asking to speak with your social
13:22 --> 13:23worker within your clinic.
13:23 --> 13:26These are all people in your lives
13:26 --> 13:28that are there to help and support you.
13:29 --> 13:31And So what I was about to say
13:31 --> 13:33was I think that there are so
13:33 --> 13:35many resources that people can
13:35 --> 13:37avail themselves of that can help.
13:37 --> 13:38But we need to take a short
13:38 --> 13:40break for a medical minute.
13:40 --> 13:41No worries though.
13:41 --> 13:42When we come back on the
13:42 --> 13:43other side of the break,
13:43 --> 13:45Angela and I are going to take
13:45 --> 13:47a deeper dive into all of the
13:47 --> 13:48resources that can help you if
13:48 --> 13:50you or someone you love is going
13:50 --> 13:52through a cancer diagnosis in
13:52 --> 13:55honor of cancer Survivorship month
13:56 --> 13:58funding for Yale Cancer answers
13:58 --> 13:59comes from smilow cancer.
13:59 --> 14:01Hospital hosting a smilow shares
14:01 --> 14:04cancer survivors series, June 15th.
14:04 --> 14:07Register at Yale, Cancercenter or
14:07 --> 14:10e-mail cancer answers at yale dot edu.
14:12 --> 14:14The American Cancer Society
14:14 --> 14:16estimates that over 200,000 cases
14:16 --> 14:18of Melanoma will be diagnosed
14:18 --> 14:20in the United States this year,
14:20 --> 14:23with over 1000 patients in Connecticut alone.
14:23 --> 14:25While Melanoma accounts for only
14:25 --> 14:27about 1% of skin cancer cases,
14:27 --> 14:30it causes the most skin cancer deaths,
14:30 --> 14:32but when detected early,
14:32 --> 14:35it is easily treated and highly curable.
14:35 --> 14:36Clinical trials are currently
14:36 --> 14:38underway at federally designated
14:38 --> 14:40Comprehensive cancer centers such
14:40 --> 14:42as Yale Cancer Center and Smilow
14:42 --> 14:45Cancer Hospital to test innovative
14:45 --> 14:46new treatments for Melanoma.
14:46 --> 14:49The goal of the specialized programs
14:49 --> 14:51of research excellence and Skin Cancer
14:51 --> 14:53Grant is to better understand the
14:53 --> 14:55biology of skin cancer where the focus
14:55 --> 14:57on discovering targets that will lead
14:57 --> 15:00to improved diagnosis and treatment.
15:00 --> 15:03More information is available at
15:03 --> 15:04yalecancercenter.org you're listening
15:04 --> 15:06to Connecticut Public Radio.
15:08 --> 15:10Welcome back to Yale Cancer Answers.
15:10 --> 15:12This is doctor Anees Chagpar and I'm
15:12 --> 15:15joined tonight by my guest, Angela Khairallah.
15:15 --> 15:17We're talking about cancer survivorship
15:17 --> 15:20and the fear of recurrence and and
15:20 --> 15:22a number of anxieties that cancer
15:23 --> 15:25patients face along this journey
15:25 --> 15:27and we started off by talking about,
15:27 --> 15:29you know things that you can control
15:29 --> 15:31and things that you can't control.
15:31 --> 15:34And the fact that fear is a totally normal
15:34 --> 15:39part of of any cancer patients journey.
15:39 --> 15:40But Angela right.
15:40 --> 15:43Before the break we were starting
15:43 --> 15:45to get into practical advice as
15:45 --> 15:48we started to talk about the fact
15:48 --> 15:51that it's not just, you know,
15:51 --> 15:54the fear of the diagnosis of cancer itself.
15:54 --> 15:57There's also for some patients, a.
15:57 --> 16:00As spiritual kind of fear when they're
16:00 --> 16:03thinking about their mortality and
16:03 --> 16:06what's going to happen when they die.
16:06 --> 16:07For some patients,
16:07 --> 16:10there's also a relationship.
16:10 --> 16:13Fear what's going to happen with
16:13 --> 16:15my relationships with my spouse,
16:15 --> 16:19my friends, sometimes a sexual fear.
16:19 --> 16:23Am I going to be able to have the kind
16:23 --> 16:25of sexual relationship I did before?
16:25 --> 16:27Sometimes there's fears of.
16:27 --> 16:29Employment and the repercussions
16:29 --> 16:33of a cancer diagnosis in terms of
16:33 --> 16:35either employment or insurance.
16:35 --> 16:37Am I going to be able to continue
16:37 --> 16:39my job and my ever going to get
16:39 --> 16:40health insurance again?
16:40 --> 16:43Am I ever going to get life insurance again?
16:43 --> 16:45There's often fears associated
16:45 --> 16:46with children do.
16:46 --> 16:48How do I tell my child about this?
16:48 --> 16:50What are they going to go through?
16:50 --> 16:53What is going to be their emotional tool?
16:53 --> 16:54And, you know,
16:54 --> 16:56could they potentially get cancer
16:56 --> 16:58as well as a fear of?
16:58 --> 17:01And a guilt sometimes of my God.
17:01 --> 17:03Am I doing this to my child?
17:04 --> 17:04And and then.
17:04 --> 17:09And then there's the whole financial fear of.
17:09 --> 17:09Great,
17:09 --> 17:11well I've got this diagnosis
17:11 --> 17:13and I I've chosen to trade it,
17:13 --> 17:14but then that's going to be
17:14 --> 17:16associated with all kinds of
17:16 --> 17:17bills that are going to come in.
17:17 --> 17:20And my gosh now is there
17:20 --> 17:21a fear of bankruptcy?
17:21 --> 17:24And so while people are going
17:24 --> 17:26through that treatment phase even
17:26 --> 17:28before they get to survivorship
17:28 --> 17:31in the whole fear of recurrence,
17:31 --> 17:32which we'll get to.
17:32 --> 17:35Can you talk a little bit more
17:35 --> 17:38about specific strategies that
17:38 --> 17:40people can use in dealing with
17:40 --> 17:42all of these other fears that just
17:42 --> 17:44kind of compound things as as
17:44 --> 17:46they're going through treatment?
17:48 --> 17:50Absolutely, you know,
17:50 --> 17:54I would say there are a variety of
17:54 --> 17:57resources and services within the
17:57 --> 18:00Community that can help with a number
18:00 --> 18:03of the things that you identified.
18:03 --> 18:06Again, I think you know,
18:06 --> 18:08reaching out to your team asking to
18:08 --> 18:10speak with your clinic social worker,
18:10 --> 18:14your clinic social worker should have
18:14 --> 18:18access to and a list of a variety.
18:18 --> 18:21Of resources and services?
18:21 --> 18:23Uh, they would be able to answer
18:23 --> 18:24questions you know related to
18:24 --> 18:25how to apply for disability.
18:25 --> 18:27They'd be able to answer questions
18:27 --> 18:30about applying for FMLA here in the
18:30 --> 18:32state of Connecticut we actually had
18:32 --> 18:34something that started as of January.
18:34 --> 18:36The Connecticut Family Leave Act.
18:36 --> 18:38They'd be able to help address
18:38 --> 18:40any questions or concerns that
18:40 --> 18:41you had related to that.
18:41 --> 18:43Also with cancer,
18:43 --> 18:46depending on what type of cancer you have,
18:46 --> 18:48there is a handful of.
18:48 --> 18:50Financial grants that you can apply
18:50 --> 18:53for while you're in active treatment
18:53 --> 18:55and active treatment is typically
18:55 --> 18:57defined as recently having surgery,
18:57 --> 18:59going through chemotherapy or
18:59 --> 19:02radiation treatment, and they help.
19:02 --> 19:03Not ongoing,
19:03 --> 19:05but kind of a one time thing where
19:05 --> 19:07they they might help a little bit with
19:07 --> 19:08with their mortgage or your rent.
19:08 --> 19:10Or you know your utilities,
19:10 --> 19:12that sort of thing.
19:12 --> 19:12Also,
19:12 --> 19:15depending on what hospital
19:15 --> 19:17you know or center,
19:17 --> 19:19you're being treated at they most likely.
19:19 --> 19:23Will have some kind of program that you
19:23 --> 19:26can apply for that could potentially
19:26 --> 19:28help out with some of the medical
19:28 --> 19:29expenses that you're incurring,
19:29 --> 19:32and you know there's a variety
19:32 --> 19:34of programs available out there
19:34 --> 19:35as well that you could apply
19:35 --> 19:37for that could potentially help
19:37 --> 19:40with the expense of medication,
19:40 --> 19:41like for example.
19:41 --> 19:43Oftentimes drug companies have Co payment
19:43 --> 19:46assistance programs that can help you know,
19:46 --> 19:49provide you with support.
19:49 --> 19:52If I meet with the patient and they're
19:52 --> 19:55expressing concerns related to,
19:55 --> 19:57say, their sexual health,
19:57 --> 20:00you know with regards to their
20:00 --> 20:02relationship with their partners,
20:02 --> 20:02you know.
20:02 --> 20:04Again, depending on where you're treated,
20:04 --> 20:07there are quite possibly could be a
20:07 --> 20:09clinic that specializes in that you know,
20:09 --> 20:11in addressing those sexual
20:11 --> 20:13concerns that you're having,
20:13 --> 20:15you know it's not uncommon.
20:15 --> 20:16For example,
20:16 --> 20:19women who go through breast cancer
20:19 --> 20:21do experience and can experience
20:21 --> 20:23a variety of side effects
20:23 --> 20:25related to their sexual health,
20:25 --> 20:28and so there are resources out there
20:28 --> 20:31that we can refer refer you to if
20:31 --> 20:33somebody expresses concerns related
20:33 --> 20:36to their faith or their spirituality.
20:36 --> 20:37Again,
20:37 --> 20:40there are chaplains or spiritual
20:40 --> 20:43leaders in the community that we can
20:43 --> 20:46help assess and get you connected to.
20:46 --> 20:47So again,
20:47 --> 20:49the social worker quite often
20:49 --> 20:51is the hub of your resource,
20:51 --> 20:54who then can then provide you
20:54 --> 20:55with the different resources
20:55 --> 20:58and things that are available.
20:58 --> 21:00I know in the past when I've had
21:00 --> 21:02patients that have had concerns
21:02 --> 21:03related to their relationship
21:03 --> 21:04and communicating with,
21:04 --> 21:07you know family members and
21:07 --> 21:09friends or their spouses you know,
21:09 --> 21:12particularly at their initial diagnosis,
21:12 --> 21:14that is something that I can
21:14 --> 21:15definitely talk to them about
21:15 --> 21:17and kind of a general rule.
21:17 --> 21:18That I will sometimes say to
21:18 --> 21:20patients they'll say to me, you know,
21:20 --> 21:23I just don't know who should I tell like,
21:23 --> 21:24what should I say?
21:24 --> 21:27How much information should I share?
21:27 --> 21:29And I'll usually say to them,
21:29 --> 21:31my my advice would be to tell those
21:31 --> 21:34people in your life who you're going to
21:34 --> 21:36need to turn to for help and support.
21:36 --> 21:38You know, and I see the range.
21:38 --> 21:41I see people who post it to their
21:41 --> 21:43500 Facebook friends about their
21:43 --> 21:45diagnosis before they even leave
21:45 --> 21:47their initial consultation.
21:47 --> 21:49And then I have people that say to me,
21:49 --> 21:52do I need to even let my my, my, my,
21:52 --> 21:55my children know about my diagnosis
21:55 --> 21:58and so you really do get the whole the
21:58 --> 22:01whole range of questions and concerns.
22:01 --> 22:03And again I encourage patients to
22:03 --> 22:05go back to let those people in your
22:05 --> 22:08life who you feel you're going to
22:08 --> 22:10need to turn to for support and
22:10 --> 22:11help through this process.
22:11 --> 22:13Those should be the ones who
22:13 --> 22:15you who you let know again,
22:15 --> 22:18you know when patients have young.
22:18 --> 22:21Children we you know we have a
22:21 --> 22:23variety of social workers are
22:23 --> 22:25often trained in a model called
22:25 --> 22:26pact and it's called parenting.
22:26 --> 22:28Added challenging time and it's all about
22:28 --> 22:31how to talk to your children based on
22:31 --> 22:33their age and their developmental level.
22:33 --> 22:35So clearly what you would tell like a
22:35 --> 22:37four or five year old would be very
22:37 --> 22:40different than what you would share with,
22:40 --> 22:42say someone who's a teenager
22:42 --> 22:43or in their early 20s.
22:43 --> 22:45And really,
22:45 --> 22:48you know the American Cancer Society.
22:48 --> 22:50Has recommended that really you
22:50 --> 22:53just share a couple of basic things.
22:53 --> 22:56You let them know about your diagnosis.
22:56 --> 22:57You let them know your children,
22:57 --> 23:01know where the cancer is located.
23:01 --> 23:03You share with them what the plan is like.
23:03 --> 23:04For example,
23:04 --> 23:06I'm going to have surgery then
23:06 --> 23:07possibly radiation or I'm going
23:07 --> 23:08to start with chemotherapy.
23:08 --> 23:10And then we're going to go from there.
23:10 --> 23:13And then you also share with your children
23:13 --> 23:15how their life might be impacted.
23:15 --> 23:17During this time.
23:17 --> 23:19I I agree with you, you know.
23:19 --> 23:21Tapping into the resources that are
23:21 --> 23:23available, whether they're financial
23:23 --> 23:25resources or human resources,
23:25 --> 23:26talking to a chaplain,
23:26 --> 23:28talking to a social worker.
23:28 --> 23:30Oftentimes there's also other
23:30 --> 23:32resources that can help.
23:32 --> 23:34Just with you know,
23:34 --> 23:37taking a load off and taking a breath
23:37 --> 23:40and giving yourself permission to to
23:40 --> 23:44breathe and to to get get through this.
23:44 --> 23:46Angela the other, the other area
23:46 --> 23:49where you spend a great deal of time,
23:49 --> 23:50is in survivorship,
23:50 --> 23:51and as you mentioned,
23:51 --> 23:53at the top of the show,
23:53 --> 23:56you know all of this fear and anxiety.
23:56 --> 23:57Many people kind of anticipate
23:57 --> 24:00that there would be fear and
24:00 --> 24:02anxiety associated with the initial
24:02 --> 24:04diagnosis and and even while
24:04 --> 24:06you're going through treatment.
24:06 --> 24:07But even after you've kind
24:07 --> 24:09of gotten through that,
24:09 --> 24:11you've done the surgery and the
24:11 --> 24:14chemo and the radiation and your
24:14 --> 24:16doctors have said congratulations.
24:16 --> 24:18Uh, you know your scans look good.
24:18 --> 24:21We'll just follow you.
24:21 --> 24:22It's reassuring,
24:22 --> 24:24but it's not entirely reassuring.
24:24 --> 24:26So talk to us a little bit
24:26 --> 24:28about the fear of recurrence
24:28 --> 24:30that some patients might have,
24:30 --> 24:34and whether it's justified or not justified,
24:34 --> 24:37and how you approach that as a social
24:37 --> 24:39worker in the survivorship clinic.
24:39 --> 24:41Oh, absolutely, and you know,
24:41 --> 24:44just to to clarify with everyone,
24:44 --> 24:46a fear of cancer recurrence.
24:46 --> 24:48What what? That means?
24:48 --> 24:51It's when a patient has some worry,
24:51 --> 24:54some fear a concern, you know,
24:54 --> 24:56related to the possibility that their
24:56 --> 24:59cancer will come back or or even progress,
24:59 --> 25:02and you know it's important to know
25:02 --> 25:06and understand that this is one of the
25:06 --> 25:07most commonly reported psychological
25:07 --> 25:10issues that are experienced among
25:10 --> 25:12cancer survivors and the majority
25:12 --> 25:15of cancer survivors in research,
25:15 --> 25:16you know, report.
25:16 --> 25:19That this is one of the most significant
25:19 --> 25:22unmet needs in helping them learn how
25:22 --> 25:25to manage fear of cancer recurrence.
25:25 --> 25:28You know, in my work within the
25:28 --> 25:29cancer survivorship clinic,
25:29 --> 25:32I would say that the majority of the
25:32 --> 25:35patients that I meet with do experience
25:35 --> 25:38some level of fear of cancer recurrence.
25:38 --> 25:40Most of them them do.
25:40 --> 25:43And and I always will ask patients
25:43 --> 25:45when I'm meeting with them.
25:45 --> 25:47You know, I will say to them.
25:47 --> 25:49You know one of the most common things
25:49 --> 25:51that cancer survivors experience is
25:51 --> 25:54this fear that the cancer could come
25:54 --> 25:56back and could progress, you know,
25:56 --> 25:58is that something that you are experiencing?
25:58 --> 25:59Is that something that you've
25:59 --> 26:00thought about and again,
26:00 --> 26:02quite often they will.
26:02 --> 26:05They will indicate that they have,
26:05 --> 26:09and it's important to let survivors know
26:09 --> 26:13that this is so common and so normal.
26:13 --> 26:16In fact, it's so common and normal
26:16 --> 26:17that it's surprising.
26:17 --> 26:18To me,
26:18 --> 26:20when somebody says that they don't
26:20 --> 26:22experience some level of this,
26:22 --> 26:24and when I'm meeting with patients
26:24 --> 26:27I really like to get a sense of at
26:27 --> 26:29what level are they experiencing?
26:29 --> 26:30You know this.
26:30 --> 26:31This fear of cancer recurrence,
26:31 --> 26:35so I'll ask a variety of questions.
26:35 --> 26:36You know, you know,
26:36 --> 26:38in the literature it's anywhere
26:38 --> 26:41between 50 and 70% of cancer survivors
26:41 --> 26:44across all cancer subtypes experience
26:44 --> 26:48some level of this fear of cancer.
26:48 --> 26:50Recurrence.
26:50 --> 26:50Also,
26:50 --> 26:53it's important to point out that fear
26:53 --> 26:56of cancer recurrence is not strongly
26:56 --> 26:58linked to someone's prognosis,
26:58 --> 27:00and it may even occur in an individual
27:00 --> 27:02who has a relatively good prognosis.
27:02 --> 27:04So it really doesn't matter what
27:04 --> 27:06kind of cancer you had, the stage,
27:06 --> 27:07the size of your tumor.
27:07 --> 27:09Again, it it can,
27:09 --> 27:11you know it can occur and have
27:11 --> 27:13higher levels regardless of of
27:13 --> 27:16the percentage of whether or not
27:16 --> 27:18the cancer would even come back.
27:18 --> 27:20And you know, it's interesting.
27:20 --> 27:22Because some of the things that I
27:22 --> 27:25like to pay attention to when I'm
27:25 --> 27:27when I'm meeting with survivors.
27:27 --> 27:28You know there are,
27:28 --> 27:30there are things that would make
27:30 --> 27:32somebody maybe more vulnerable for
27:32 --> 27:35developing fear of cancer recurrence.
27:35 --> 27:38For example, if someone is a young adult,
27:38 --> 27:41and when we refer to young adults,
27:41 --> 27:44the adolescent young adult population is
27:44 --> 27:47anyone between the ages of 15 and 39.
27:47 --> 27:48However,
27:48 --> 27:50I work in the adults cancer.
27:50 --> 27:51Community,
27:51 --> 27:54so that's anyone between the ages
27:54 --> 27:55of 18 and 39.
27:55 --> 27:58So if you're a younger cancer survivor,
27:58 --> 28:00if you're female,
28:00 --> 28:03if you have a history of you
28:04 --> 28:08know psychosocial distress at mental health,
28:08 --> 28:09history of anxiety, or depression,
28:09 --> 28:12maybe during our cancer treatment you
28:12 --> 28:15had more severe side effects like pain
28:15 --> 28:18and fatigue or even sleep issues.
28:18 --> 28:19But also if you have
28:19 --> 28:21family members or friends.
28:21 --> 28:23Who have developed cancer gone
28:23 --> 28:25through treatment or sadly have
28:25 --> 28:27even passed away from cancer.
28:27 --> 28:29Those are all things that could
28:29 --> 28:31contribute to making you more
28:31 --> 28:33vulnerable for developing the
28:33 --> 28:35fear of cancer recurrence.
28:35 --> 28:37Angela Khairallah is a licensed
28:37 --> 28:39clinical social worker.
28:39 --> 28:41If you have questions,
28:41 --> 28:43the address is canceranswers@yale.edu
28:43 --> 28:45and past editions of the program
28:45 --> 28:48are available in audio and written
28:48 --> 28:49form at yalecancercenter.org.
28:49 --> 28:51We hope you'll join us next week
28:51 --> 28:53to learn more about the fight against
28:53 --> 28:55cancer here on Connecticut public radio.
28:55 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 28:59provided by Smilow Cancer Hospital.

Information

Fear of Cancer Recurrence with guest Angela Khairallah June 12, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095