After treatment, patients are confronted with a number of issues related to cancer survivorship. Typical issues involve fears about repeated medical follow-up and diagnostic tests. Fear of recurrence is also an ongoing concern that waxes and wanes over time. A number of specific issues can be a source of anxiety. Fears related to returning to work, such as discussing one’s treatment with employees, insurance-related problems, and concerns about discrimination, can cause distress. Fear of screening, follow-up, and risk of second malignancies are ongoing physical threats that are accompanied by anxiety for certain subgroups of patients. Body-image changes, sexual dysfunction, and reproductive issues can also cause anxiety. Posttraumatic stress disorder has been diagnosed in about 3% to 5% of patients who survive cancer and its effects, depending on site and intensity of treatment. In a study of women who were taking tamoxifen for breast cancer, trait anxiety was associated with a higher dropout rate from tamoxifen therapy due to a higher incidence of adverse physiological side effects.[1] (Refer to the PDQ summary on Post-Traumatic Stress Disorder ¹ for more information.) Survivorship programs and resources, including group and individual counseling, can help facilitate adjustment and can address specific concerns. (Refer to the PDQ summary on Transitional Care Planning ² for more information.)

References

1. Cameron LD, Leventhal H, Love RR, et al.: Trait anxiety and tamoxifen effects on bone mineral density and sex hormone- binding globulin. Psychosom Med 64 (4): 612-20, 2002 Jul-Aug.  [PUBMED Abstract]