Persistent or recurrent disease.
• Persistent melanoma is a tumour that was not completely removed by treatment. It is found in the surgical scar. Persistent melanoma has not penetrated beneath the epidermis.
• Recurrent melanoma may be of several types. Local recurrence is reappearance of the melanoma in the vicinity of a previously removed melanoma or en route to the regional lymph node basin (intransit metastasis).
• Regional recurrence is melanoma in the lymph nodes near the first melanoma.
• Distant recurrence is spread beyond the regional lymph nodes.
Investigation of persistent and recurrent melanoma begins with a biopsy. After that, additional tests depend on the stage of the disease, as described previously. The stage of the recurrence also determines the type of treatment given and the follow-up schedule. Clinical trial participation is generally offered for recurrence.
FEAR OF RECURRENCE
A complex mix of emotions can often accompany the end of cancer treatment. Some may feel relieved that treatment is over but may feel vulnerable and uncertain about what the future holds. Hearing that they are free of disease upon completing treatment may give rise to a significant level of worry and anxiety that the cancer will come back, or recur. Fear of recurrence is a universal concern of individuals with a cancer diagnosis and is one of the most frequent concerns for those who have completed treatment..
Although the fear of recurrence tends to lessen over time, sudden triggers may revive those feelings. If the fear is characterized by chronic thoughts about recurrence or disease progression that impact your daily functioning and the ability to make plans for the future then it is time to seek help from a professional counsellor or physician.
Recently Dr.Rinat Nissim, Ph.D. C. Psych Psychologist at Princess Margaret Cancer Centre offered some insights into coping with fear of recurrence.
“ So how do you cope with the fear and anxiety? Most often, when we feel anxious, we tend to resist this experience, we tend to be at a tug of war with our anxiety, constantly telling ourselves things such as “It’s silly to be anxious”, or “I should be able to snap out of it” or “anxiety and stress will bring my cancer back.” Pulling harder in this tug of war comes naturally, but the harder you pull, the harder the anxiety pulls, and what this tug of war really does is escalate our anxiety and deplete our resources.
What we need to do sometimes is learn to accept the anxiety; drop the rope and stop the tug of war. Yes, dropping the rope is counterintuitive, yet can be the most productive action. Think about anxiety as a wave in the ocean that is coming at you – You can run from it, but then it’s going to catch up and knock you down. You can try to stand your ground, and resist it, but then it’s still going to knock you down. Or you can dive underneath it and let it wash over you. Accepting your anxiety does not mean you like or agree with your thoughts and feelings, nor does it mean that you’re giving up to them, it is more about observing them and letting them ‘wash over you’ instead of getting tangled up into a bigger knot.”
Be patient with yourself.
For most, it may help to know that fear of recurrence gets better over time. It may never go away altogether but as time passes and the frequency of follow-up appointments lessen, it often becomes much easier to resume a more normal life with reduced anxiety and worry.
Focus on wellness.
Complementary or alternative therapies such as acupuncture, massage, music therapy, and guided meditation can help reduce your anxiety and make you feel more relaxed. Some people also find comfort in spirituality and prayer. There are many programs offered across the country for patients and family members. Be sure to consult your doctor, your local hospital and this website for resources that may be available in your area.
A healthy diet and physical activity also enhance overall well-being. Focusing on things like nutrition and exercise not only helps from a wellness and health perspective, but can also help you feel like you are regaining some control over your life and your health.
Know your triggers.
For some people, fears about their cancer returning is often prompted or triggered by certain things. For example, an upcoming diagnostic scan or hospital visit; the anniversary of your diagnosis or hearing of someone else’s diagnosis – all can stir up anxiety and difficult memories.
Other worries like a physical symptom such as an unusual pain; a cold or headache or a lump or mole you never thought was there before can be a major trigger because those can be legitimate signs of recurrence and can bring on anxiety.
Have a plan.
Having a plan to help cope with the triggers helps to reduce anxiety and make us feel more in control. If you have a follow-up scan, for example, think about how you can best get through the appointment. Plan something that you enjoy or something that will distract you from thinking about it. Meditation or relaxation breathing can help or physical exercise such as a walk in nature can help reduce anxiety. For some, journaling or spending time with a favorite pet can also reduce fears.
Talk about it.
Once treatment ends, family and friends that were great supporters during your cancer treatment may not always understand or realise that the fears and concerns you had during treatment can linger. Don’t be afraid to talk about it and to ask for their ongoing support.
It can also be comforting to talk to others who have gone through the same things you’ve experienced. MNC offers an online patient forum and in-person support groups where you can discuss concerns and exchange insights, as well as a Patient-to-Patient Support Program, which can put you in touch with other cancer survivors to talk about your experiences and share concerns or anxieties you may have. It can be very validating and therapeutic to not only share your own experience but also to help others going through a similar diagnosis.
Consider counseling or medical intervention.
If you are struggling, be open to talk with your doctors about any mental health issues. Social workers, psychologists, and psychiatrists are available to help you understand that fear of recurrence is a normal part of the cancer experience. They can help you develop strategies to cope with your fears and move forward with your life.
Some patient with persistent ongoing fears may be referred for cognitive behavioral therapy (CBT), a form of psychotherapy that has been shown to help reduce anxiety and depression for people with cancer. It combines cognitive therapy — a type of talk therapy that helps identify and change self-destructive thought patterns — with behavioral therapy, which helps people recognize their unhealthy beliefs and behaviors and replace them with positive ones.
When fear of recurrence becomes unmanageable, an anti-anxiety medication can also be useful. Talk with your doctor about what is the most appropriate options for you.
Coping with the fear and anxiety of a cancer diagnosis
RESOURCES & HELPFUL LINKS
Patient Information Sessions
The Melanoma Network of Canada’s Patient Information Sessions are a series of presentations by leading Canadian oncologists, dermatologists, surgeons, psychologists and more on the latest in melanoma treatment options and support services.
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