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

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Managing Anxiety about Medical Scans and Procedures

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.”

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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.