Survivorship

On Cancer: Coping with “Scanxiety” during and after Cancer Treatment

By Memorial Sloan Kettering  |  Friday, January 18, 2013
Pictured: Laura Liberman
Videos

Memorial Sloan Kettering experts — radiologist and cancer survivor Laura Liberman, psychiatrist Matthew Doolittle, and psychologist Katherine DuHamel — discuss apprehension about scans and procedures, and offer tips to identify and manage “scanxiety.”

(58:00)

After a patient has endured rigorous cancer treatment such as chemotherapy, surgery, radiation therapy, or hormonal therapies, some people might assume that undergoing a follow-up test such as an x-ray, CT scan, or MRI would be an easy, uncomplicated part of the cancer treatment process.

However, the anxiety surrounding having scans – sometimes referred to as “scanxiety” – can be overwhelming for many people.

“The unpredictability of the outcome of a scan can be quite stressful,” says Laura Liberman, a breast imaging expert at Memorial Sloan Kettering and a cancer survivor. “Studies have actually shown that having a follow-up scan can trigger classic symptoms of posttraumatic stress disorder in breast cancer survivors.”

Posttraumatic Stress Disorder in Cancer Patients

Memorial Sloan Kettering psychiatrist Matthew N. Doolittle says that between 4 percent and 22 percent of cancer survivors have a risk of developing posttraumatic stress disorder (PTSD) at some point during their lifetimes.(1)

“People with more-advanced disease, more pain, or those who have suffered other types of trauma are at greater risk for developing PTSD symptoms during or after treatment,” Dr. Doolittle says.

PTSD symptoms such as intrusive thoughts, irritability, and sleeplessness can interfere with quality of life, social functioning, and work. Some symptoms, such as avoiding places or things that are reminders of traumatic events or experiences, may even cause patients to delay medical scans and other critical parts of their cancer treatment or post-treatment plan.

Taking Control

Anxiety about having a medical procedure or an imaging test is completely normal. The key is to be able to take steps to prevent these emotions from taking over your life or affecting the quality of your care.

Cognitive behavioral therapy, which is available to Memorial Sloan Kettering patients through the Department of Psychiatry and Behavioral Sciences, can be an effective technique to help patients cope with anxiety caused by a cancer diagnosis and treatment. This approach focuses on redirecting the way patients think about experiences or things that trigger concern or anxiety. The key is to identify realistic statements that will help them cope with treatment or posttreatment concerns, and to discuss negative thoughts.

“One of my patients found it helpful to remind himself that ‘the past is the past,’ as he went for post-treatment scans and checkups,” says Memorial Sloan Kettering psychologist Katherine N. DuHamel. “Telling yourself that it’s only a matter of time before you relapse and other things that paint a worst-case scenario is not uncommon.”

Dr. DuHamel adds, “Such unhelpful thoughts can be identified during cognitive behavioral therapy and the evidence for, and against, these thoughts can be weighed. Patients are asked questions such as, ‘What else can you tell yourself?’ and ‘How else can the situation be interpreted?’“

Tips for Reducing Stress

Dr. Liberman offers several other tips to reduce stress before having a follow-up scan:

  • Before your appointment, surround yourself with people who will help reassure you and put you at ease.
  • Pretend each appointment is a trip to the airport. That way you will be pleasantly surprised if you don’t have to wait, rather than disappointed if you do.
  • Schedule tests early in the day when possible to reduce waiting time.
  • If you are having a biopsy, ask your doctor about anesthetic (numbing medicine). For some procedures, topical anesthesia (cream or spray) available by prescription that can be applied on the skin before the biopsy may be helpful. 
  • Distract yourself with music or by inviting a loved one to accompany you to your appointment.
  • Try relaxation techniques such as meditation or deep breathing. To learn these techniques, Memorial Sloan Kettering’s Integrative Medicine Service offers classes, a CD on self-hypnosis, and other resources. At-home tools are also available on our website.
  • After the scan, schedule an appointment with your doctor to discuss the test results.

“Knowing you have an appointment to speak with your doctor after the results are available can assuage a lot of anxiety about test results,” Dr. Liberman says.

To learn more, watch a video about managing scanxiety with Drs. Liberman, Doolittle, and DuHamel.

  1. Andrykowski, Michael and Maria Kangas. “Posttraumatic Stress Disorder Associated with Cancer Diagnosis and Treatment.” In Holland, Breitbart, et. al, eds. Psycho-Oncology. New York: Oxford, 2010, p. 353.

Comments

My biggest concern is for all of x-ray and cat scan tests ordered that may not be necessary especially after years of being cancer free. Isn't that risky?

Thank you for your comment! We spoke with Radiation Safety Manager Lawrence Dauer and Vice Chair of Radiology for Quality and Safety Raymond H. Thornton, and here is what they said: We know from our research that many cancer survivors have this question. X-rays, CT scans and other radiology tests that use radiation are commonly obtained after effective cancer treatment in order to verify that a patient¹s response to therapy is lasting. Additionally, early detection of a recurrence offers the potential for early re-treatment. The frequency and duration of follow-up scans are guided by the type and stage of cancer as well as an individual's risk factors. We encourage patients to discuss the anticipated schedule for follow-up imaging with their doctors. When there is a medical indication to have tests like x-rays or CT scans, the potential benefits almost always exceed the small risks that may be associated with the low-level radiation from these tests. In some cases, MRI can substitute for CT scans, eliminating radiation exposure altogether. Ask your doctor if this might be an option for you. If you would like more information, you can call Dr. Dauer at 212-639-7391 or Dr. Thornton at 212-639-2463.

Wow! This came at a good time for me. I had a PET scan yesterday. The night before I had a dream that I was diagnosed with brain cancer and was told that I had a year to live. I have non-hodgkins lymphoma, diagnosed in 2002. I have been in remission for about 10 years. I had chemo and rituxin and now, for about 6 years, rituxin every 6 months with a PET scan. I usually have a little anxiety just before but this time, for some reason, it was stronger. I see my doctor tomorrow. Pray for good results! Thank you! Shirley

Thanks to Carrie at Sloan for pointing out this article to me. I think all cancer patients (or anyone needing to have a scan done) can relate to scanxiety! For 2+ years I've been getting scans and they always seem the worst around the anniversary of my diagnosis. It tends to show up as a blog topic for me all the time! This past December was the all-time WORST I've ever felt. So much so that I decided I needed to start doing things differently and utilizing the resources at Sloan better (acupuncture, pod-cast for self-hypnotism, etc).

Thanks for sharing this information.
Erin

http://melanomaandthecity.blogspot.com/2012/07/scanxiety.html

Does one feel pressure when having a mammogram or does it hurt? I had a mammogram this morning and it hurt. Is that supposed to happen? I think that my tolerance for pain is fairly high, having had two children natural childbirth. The saving grace was that it didn't last too long but why does it hurt? The squeezing pressure was quite severe. I thought the new machines eliminated that.

We spoke with diagnostic radiologist Carol Lee, and she said that for most women, having a mammogram is uncomfortable because of the need for the breast to be squeezed in order to get a good picture. In some women, the mammogram is actually painful, though each picture only takes a few seconds. Even the newer digital machines require compressing the breasts.
There are a number of reasons why the breasts need to be squeezed in order to do the mammogram. First, compression minimizes overlapping tissue that could hide an abnormality. It also evens out the thickness of the breast so the exposure is uniform, so there are no areas that get too much exposure and others that don't get enough. Finally, the thinner the thickness of the breast, the less radiation is needed to produce a clear picture. So, unfortunately, squeezing the breast is necessary, even with the newest equipment.
There a few things that might help. If you still have menstrual cycles and have increased tenderness during parts of the cycle, you can schedule the mammogram for a time when the breasts are least tender, usually the first week of the cycle. You can also try taking acetaminophen or ibuprofen about an hour before the mammogram.

For the first time ever, I had an MRI this year. As a hypnotist, I knew immediately that I had to create a MP3 to alleviate the feeling I had while in the machine. I had also heard that it was bad for others, but I did not understand until I had my own experience. If you think it would be helpful for you, you can download a free copy here http://anewme515.blogspot.com/2013/06/do-better-than-endure-mri-video.html

My wife was diagnosed with breast cancer in january of 2013. It took over 7 weeks for her to start her treatment after the initial diagnosis. During that time, she had many diagnostic tests run and she was always waiting for results. Her levle of anxiety then, as she told me tonight, was far greater than it is while waiting for scans, although she is anxious about getting those results as well. Has any study been done on people during that initial phase to see what kinds of anxiety or what level of anxiety they are having?

I had breast cancer 2.5 years ago and getting scans is still terrifying because I'm afraid they will find something. Of course, realistically you want them to find anything if it's there, because we know it's so much easier to treat if it's caught earlier. But the signifcance of a recurrance isn't lost on me. My last scan I had to get a biopsy on some ultimately benign microcalcifications. Even though this time they told me they were pretty sure they were benign, 95% sure they were benign, it was still terrifying. I'm told this gets easier then longer you go with good scans, but still...

I'm currently waiting to hear back from my doctor after a recent CT scan. It's been 12 days, thought the doctor's office reported they got the images back from the scanning facility 6 days ago (having received the radiologist's report a few days before that).

I went to a new facility, closer to my home, so the scenario is different. However, my doctor has always scheduled an appointment to see him a few days after the scan. Repeated calls to his office still haven't resulted in any information.

I had the Whipple procedure in February 2012 (turned out to be ampullary rather than pancreatic cancer). So this is 27 months or so after the procedure, or around the time that a Stage I cancer that got out might show up on a scan.

Scanxiety might not be entirely related to the patient's approach, but also to callousness from doctors at times.

I'm getting my first scan in a few days after lung cancer treatment with chemo and proton therapy. Strangely the proton did not shringk my tumor beyond a 50% reduction by chemo. So I'm seriously stressed out. Additionally my esopahgus
was seriously damaged as a lymph node was close. There is concern over a possible fistula. Do you do fistula repair at Sloan Kettering?

Dear William, our doctors are skilled in managing the complications of cancer treatment. If you'd like to speak with someone about making an appointment, you can call 800-525-2225 during regular business hours.

I hope it's appropriate for me to ask this question on this site. I've never had cancer, but I'm terrified of getting it due to an article I read on CT scan safety. I had a CT scan of my head/brain in 1988 when I was 36 because of headaches. In 2007, at the age of 55, I had a CT parathyroid series for localization. I had failed surgery previously. This led to 2 more CT scans in 2008 due to an incidental mediastinal cyst finding of chest, abdomen and pelvis before and after contrast. In 2009, I fell down the stairs and had CT scan of my head/brain and then cervical spine in the emergency room because I hit my head. In 2014, I had another CT scan in the emergency room because of severe flank and back pain. My internist frightened me that all these CT scans could cause cancer down the road and then I read that frightening article. All the doctors said the CT scans were needed. Is my internist correct? How much have my chances of cancer been raised? There is a lot of cancer on both sides in my family. Thank you.

Sandra, we are not able to answer individual medical questions on our blog. However, we found a few articles about the safety of CT scans that you might find helpful.

Here: http://www.cancer.gov/cancertopics/factsheet/detection/CT

and here: http://www.mayoclinic.org/tests-procedures/ct-scan/expert-answers/ct-scans/faq-20057860

If you have questions, we recommend you contact the National Cancer Institute's Cancer Information Service at 800-4CANCER.

Thank you for your comment.

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