How to manage cancer "scanxiety"

If you’ve been in and around the cancer community, you’ve heard the term “scanxiety” which sums up the very common worry, nervousness, stress and fear that patients experience in relation to medical tests. While this is an understandable reaction for anyone with cancer experience, it can also feel overwhelming and make it harder to function. 

Fortunately, there are a variety of techniques and resources that can help reduce the impact of scanxiety. Our counselors have put together some strategies you may consider trying below. As always, if you require additional help throughout your diagnosis—be it logistical or emotional support—consider reaching out to a Jasper counselor who can customize a program based on your unique needs. 

What to look for

A big part of a cancer diagnosis is ongoing testing to determine the impact of treatment, the progression (or lack thereof) of disease, and whether or not a recurrence has happened. These tests might include CT scans, MRIs, blood tests and more and provide important information to you and your healthcare team about the state of your diagnosis. For instance, for those in the survivorship phase of their diagnosis, regular testing can uncover a recurrence of cancer.

As expected, the outcome of these tests carries massive implications for the patient—the stakes are high. It doesn’t help that previous testing was what discovered the cancer in the first place. This negative association makes every brush with a lab afterward feel like an emotional roller coaster.

But how does scanxiety manifest itself? In many, it shows up as worry, distraction, and irritability for days to weeks leading up to the test. Other people feel extremely uncomfortable being in the medical office where the tests are performed. To make matters worse, many patients feel stressed, on edge, or fearful in the period after tests, as they wait to find out the results or speak to their doctor about what they mean. 

Fortunately, if you’re experiencing anxiety or worry about your upcoming scans, you’re by far not alone. In fact, it’s so common that the cancer community created the term “scanxiety” as a shorthand to describe the experience. Let’s unpack it a bit further and get into some of the strategies for how to mitigate it.

Noticing anxiety symptoms

Symptoms of anxiety can vary from person to person and from one experience to the next. You might notice them in your emotions and thoughts—like when you’re feeling worried or stressed—but many anxiety symptoms are physical and easily misunderstood or mistaken for other things. 

Here are typical signs of anxiety, which can range from mild to severe:

• Shortness of breath
• Chest tightness
• Pounding heart, raised blood pressure
• Sweating
• Trembling
• Feeling faint, weak, lightheaded, or dizzy
• Worried, fearful, and racing thoughts
• Panic, a sense of dread
• Feeling stressed or on edge
• Trouble falling asleep or staying asleep, nightmares
• An intense urge to escape, run away or hide
• Nausea, upset stomach
• Muscle tension 
• Trouble concentrating
• Inability to relax or enjoy activities
• Irritability 

People with cancer are more likely to have trouble with “scanxiety” if they experienced high levels of anxiety or other very difficult life events before their cancer diagnosis. Again, keep in mind that while anxiety symptoms can be troubling, they are extremely common. Learning to manage and reduce anxiety is a central part of living well for many people with cancer—and many people in general. Your Jasper counselor can be particularly helpful here and can outline short and long term strategies for managing your anxiety. 

One level deeper: Recognizing a panic attack

Depending on the severity of your anxiety and related symptoms, you may be at risk for more complex reactions like a panic attack. A panic attack is an intense experience of anxiety that can involve a combination of the physical and emotional symptoms listed above. A panic attack can come on suddenly, usually peaking within 10 minutes. The symptoms can feel severe and unexplained—it’s not always obvious what’s causing them. This can make the experience very frightening. Panic attacks usually last 20-30 minutes, rarely as long as an hour. They can leave a person feeling emotionally and physically drained and exhausted. 

Panic attacks activate your body’s primitive flight-or-fight response, a biological reaction that prepares you to defend yourself against physical threats or to escape them. In an earlier phase of human history, the fight-or-flight response helped our ancestors quickly switch to survival mode when facing a serious threat, by providing the energy, alertness, and singular focus needed to successfully flee or battle a large predator, for example. Unfortunately, this state is poorly suited to handling most stressful situations in modern life, and can make it harder to deal with them effectively. 

Since the symptoms of panic attacks can be dramatic and scary, people often mistake them for physical health emergencies, like a heart attack. Some people say having a panic attack makes them feel like they are out of control. These kinds of worries can add anxious fuel to the fire and make symptoms worse. Many people who experience panic attacks regularly feel self-conscious about them, fear them happening again and may try to avoid situations that trigger them. 

Panic attacks are physically harmless, but because their symptoms can mimic those of other health issues, it’s smart to get checked out by a health professional if you’re not sure what’s going on. Learning the signs of panic attacks can help you recognize them when they happen, which usually makes the experience less frightening. It also gives you a chance to use techniques to bring your anxiety level down. Breathing exercises, progressive muscle relaxation, and working to redirect your thoughts can be helpful strategies for some people. If you have panic attacks regularly, though, it’s a good idea to see a mental health professional for help, as managing them on your own can be difficult and leaving them untreated can lead to increasing anxiety about future ones occurring. This cycle is possible to break with the help and perspective of a therapist.   

Techniques for managing “scanxiety”

Anxiety in general and “scanxiety” among people with cancer are both very treatable. Managing anxiety well usually involves a combination of techniques and some trial and error until you find what works best for you. Seeing a professional therapist or psychiatrist can be very helpful to assist you in determining what helps you manage your anxiety.

Here are some common strategies for soothing “scanxiety” that many people find helpful - and when to seek out a mental health specialist. 

Practice mindfulness

Mindfulness is paying close attention to your physical and mental experiences in the present moment. This term comes from a type of meditation in which people focus on their breath, as a way to practice the skill of being mindful. During mindfulness meditation, a person will notice thoughts and sensations as they come up, but continually bring their attention back to their breath. 

You don’t have to meditate in order to be mindful. However, mindfulness meditation can be a good way to practice mindfulness so that you can be more mindful in everyday life. (There are many free guides available online for beginners if you’re interested in trying mindfulness meditation. A few we recommend are Insight Timer, Calm and Headspace). Breathing exercises can have a similar effect and have also been shown to help reduce stress and anxiety. (More on breathing exercises, with some easy-to-follow instructions, here).  

Mindfulness can help to reduce anxiety in two ways: by making you more aware of your own mental and physical sensations, which can help you to feel less controlled by them, and by refocusing your attention on the present moment, rather than concerns about the future. (Anxious feelings relate to fear of future negative events, so focusing on the present tends to reduce anxiety).  

Stay engaged with activities when “scanxiety” is likely

One way to help you focus on the present naturally is to plan engaging activities that can distract your mind from turning to anxious thoughts. This can be especially helpful during specific times you know are likely to be stressful, like the day of a scan or test, or during the wait in the medical office. Choose a good book or magazine you know will hold your attention to fill this time, or bring something special, like an art book or poetry, to capture your imagination. Start watching a show you like using headphones in the waiting room. Puzzle books with word searches, crosswords or sudoku can be a good choice, too. Craft hobbies, like knitting, that are portable can also be a great way to keep yourself occupied as well.

If you experience anxiety over an extended period leading up to appointments or tests, plan ahead to stay busy. Schedule activities that you enjoy to help you stay focused on day-to-day life. Ask friends or family to join you. Stay committed to activities you know help you to relax—cooking, riding a bike, playing board games, etc. 

Get outdoors

Spending time in natural environments with lots of green space like parks and forests helps to ease mental health symptoms including stress and anxiety. Walk on a trail, picnic in a park, or spend some time soaking in a beautiful view of water or a sunset. 

Keep a journal

Writing in a journal can be a relaxing ritual and help you process thoughts and feelings so they don’t overwhelm you. Sometimes simply expressing worries can lift a burden. Or writing about the day’s events can help you stay aware of the moments in daily life that you enjoy. 

The health benefits of journaling have been well-documented in scientific studies, which have shown that writing about difficult life events can improve physical and emotional health, lower blood pressure, boost the immune system, and enhance mood and memory. 

Exercise

Exercise is a very effective way to promote overall mental health, including managing stress and reducing anxiety. It can also contribute to healthy eating and sleeping habits. Higher-intensity exercise may be especially helpful for anxiety, but gentler forms of physical activity like walking and yoga have also been shown to have beneficial psychological effects.

Exercise is thought to improve mental health in a number of ways. In general, exercise seems to give people a greater feeling of control over their lives (“self-efficacy”) and improves self-esteem. Researchers think it may also reduce the body’s natural physiological reactions to stress, reducing stress hormone levels and boosting mood through increased blood flow to the brain and the release of feel-good chemicals like endorphins. Studies suggest regular exercise may be even more effective at improving mood than antidepressant medication. 

Whatever your fitness level or experience, there is likely to be some form of exercise that you can add to your routine. Walking is a great option, since it doesn’t require special gear. Gentle yoga can also be a good choice, since you can do it indoors with minimal equipment. Ask someone to join you, if that will help you maintain an exercise routine. If you’re not sure where to start or what’s safe, ask your health care team for guidance. 

Social connection

Positive connections to other people can help ease anxiety, along with having a wealth of other positive effects on mental and physical health. Social interaction can take many different forms: an interesting activity with friends, an intimate conversation with a family member, a cozy evening with a partner, playtime with children. Any activity that makes you feel closer to others is likely to ease worry, improve your mood, and remind you of life’s meaning and joys.

It’s common for people with cancer to feel isolated at times. You might not feel well enough to connect with people in the ways you used to, or you might feel that people without cancer can’t understand or relate to your experiences. These feelings are normal. Sometimes it can be helpful to discuss these feelings directly with family or friends. They might want to support you but feel unsure about how best to do that. They might be worried that talking about cancer or your treatment will upset you too much. You can try saying something like, “Since my cancer diagnosis, it’s been difficult to feel connected to people I care about…” This can be a good way to break the ice and foster helpful conversations. 

It might also be helpful to suggest alternative ways of staying connected. For example, if fatigue makes it hard to participate in activities that you used to do with friends or family, you can suggest a weekly phone or video call or a short visit at your home. 

Support groups

Even if family and friends are supportive, people with cancer often feel isolated from others because of the intense physical and emotional experience of diagnosis and treatment. Talking to others who’ve been through similar things can be a relief and help you feel less alone. Often other people with cancer can share practical wisdom about how to cope with emotions or handle specific challenges that might come up.

There are peer support communities available online as well as ones that meet in person. Ask your treatment team for information about local support groups. 

Give your pets some love

Connection with animals can be just as nourishing as connection with other people. Sometimes spending time with pets can be more relaxing, since they usually don’t make as many demands of us as the other people in other lives, and our connections can be simpler. Tending to the needs of others as people do with pets can help us to feel in control of an important and meaningful part of our lives. And affection from a beloved cat or dog just feels good, too.

If you don’t already have a pet, there are other ways you might be able to connect with animals. Many animal shelters need volunteers to help with walking dogs and fostering animals on a temporary basis. (Just be sure to check with your medical team about any precautions you need to take if your immune system is compromised). You might also ask your care team about animal therapy programs. Research has shown that visits with trained therapy animals can improve the well-being of people with cancer.   

Spirituality

Many people find participating in religion or cultivating their individual spiritual life to be comforting. This can include attending services, using or displaying religious items or artwork, and reading or listening to recordings of religious texts. Whether or not you’re part of a specific religious community, look for ways to engage your spiritual side to soothe worry and anxiety. 

Research has shown spirituality and religion to be helpful for many cancer patients, in managing emotions like depression and anxiety and in improving some aspects of physical health, like symptoms of nausea and pain. If you’re not already connected to a religious or spiritual community, ask your medical team for a referral to chaplains or other forms of spiritual support. You can also research local religious organizations online or ask family and friends for referrals to organizations they participate in. Just keep in mind that religious practice is very personal and you’ll want to find a community that feels right to you. 

Turn to art

Whether it’s music, dance, film, literature, storytelling, comedy or paintings, art can be a rich resource for getting through tough times. You can seek out works of art that relate to what you’re going through or ones that transport you to other people’s worlds. Getting a fresh perspective or having a new experience through art can be energizing and motivating and help us to meet challenges with greater ease. Enjoying art helps us feel connected to others and to the bigger picture in life. 

If you’re already a fan of music, film or another art form, lean into what you love. You might set aside time each day or week just to explore or enjoy these experiences. Another option is to immerse yourself in new art forms. You might visit local galleries or museums, or take advantage of online tours from some of the world’s major art institutions (the Metropolitan Museum of Art, the Guggenheim and the Louvre all offer online experiences). Ask friends, a bookstore clerk or local librarian for advice on good books to check out based on your taste and interests.  

When to talk to a professional

If your anxiety is getting in the way of your ability to function or significantly affecting your quality of life, it’s a good idea to talk to a mental health professional. Individual counseling and medication can be very helpful in reducing anxiety symptoms, including panic attacks. Most mental health professionals will have experience helping people manage anxiety. To find a therapist, you can search the listings in Psychology Today or ask your health insurance company for a list of counselors they cover. Or you can ask your treatment team for a referral to a counselor or psychiatrist experienced in helping cancer patients. 

Keep in mind that although “scanxiety” is normal, that doesn’t mean you should suffer unnecessarily. Don’t hesitate to ask for help if you need it. 

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‍Sources:

Van Maarseveen, M. M. (2005). Schrijven is gezond [Writing is healthy]. Retrieved from https://www.renevanmaarsseveen.nl/wp-content/uploads/overig/Schrijven%20is%20gezond%20(2005).pdf

Neumann, I., & Young, J. D. (2018). The effects of exercise on mental health. Frontiers in Psychiatry, 9, 193. https://doi.org/10.3389/fpsyt.2018.00193

McNeely, M. L., & Irwin, M. R. (2016). The impact of exercise on mental health. Sports Medicine, 46(10), 1293-1313. [invalid URL removed]

Dunn, A. L., Trivedi, M. H., Clark, C. J., & Kamboj, S. K. (2005). Exercise treatment for depression: Efficacy and neurobiological mechanisms. Harvard Review of Psychiatry, 13(1), 18-31. [invalid URL removed]

Schuch, F. B., Vancampfort, D., Rosenbaum, S., Ward, P. B., Stubbs, B., & Rosenblat, J. D. (2016). The effects of exercise on anxiety disorders: A meta-analysis. Journal of Psychiatric Research, 73, 12-19. https://doi.org/10.1016/j.jpsychires.2015.11.013

Kvam, C. J., Raastad, I., & Sletvold, O. (2012). Exercise and mental health. Scandinavian Journal of Medicine & Science in Sports, 22(6), 758-769. [invalid URL removed]

ScienceDaily. (2015, January 13). Exercise boosts brain power, study shows. Retrieved from https://www.sciencedaily.com/releases/2015/01/150113154029.htm