ANXIETY AND FEAR IN THE CANCER PATIENT

It is anxiety that is the killer. We humans suffer most when not knowing all that needs known, especially when there is so much to fear. Anxiety is fear of the unknown.
I frequently relate a parable to my patients on this crucial subject. Let us travel back in time to the clan of the proverbial cave man. In one cave, somewhat safe from the elements and huddled about a fire, is a family fraught with anxiety that never leaves…and starves.

In the hillside another clan of warriors huddle. They know well the dangers that lurk and are ready to pounce as the fire dims and the sounds draw near. Fearful of what they know BUT armed with knowledge. They have the greater odds of survival That is the liberating power of fear inciting right action.

In a sense, anxiety is as much a killer as is living in constant bodily pain. What is life worth, one wonders, when the icy soul sucking grip of the never and forever lie holds you tight to its bosom. This lie screams into your psyche saying, “It will never change and it will forever be the same.”

Anxiety is not abnormal and may in fact be an emotion that leads to a positive outcome. Nonetheless, it is almost the kiss of death when it too easily evolves into the loosely defined term morbid anxiety causing panic, irrationality and paralysis.
Granted, some malignancies with a less ominous prognosis will not elicit as much morbid anxiety. The key is that the patient knows that the prognosis is less ominous. It is knowledge that is the oncologists’ first and most precious gift to the patient. It is knowledge that the patient and family must demand; that must be thorough, comprehensible, and empathetic and ongoing.

Physicians must teach patients how to deal with family, friends, sources on the internet, the staging procedures and their meaning, the treatment and the value of second opinions. Patients must learn well that they will not be alone, that thousands have handled this and that others were no less anxious nor braver.

Physicians must speak of the odds of cure, remission and durability of remission. And not shy away from discussing spirituality, life’s goals, and the effects of treatment on normal bodily function. “What functions or abilities will I lose” as well as “what will I keep” are front burner issues as are the specter that pain, nausea and vomiting.

Physicians will find that their empathy impacts the patient’s trust and quality of life. Most of all, patients must be put in charge by being given repeated slow but thorough helpings of knowledge. That is the key to killing anxiety.

Caretakers must indeed take great care to embrace the God given, hero-making emotion of fear, break the paralyzing bonds of anxiety and guide patients and families onward to face the future.

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