The Emotional Toll

From the Winter 2019 edition of Vanderbilt Medicine Magazine

Living with a disease for a long time can affect more than just physical well-being, a Vanderbilt University Medical Center psychologist cautions.

“Sometimes we see young adults in remission (from cancer) and considered long-term survivors, but they might be having issues with daily life, relationships, obtaining and maintaining gainful employment, and living independently,” said Shari Neul, PhD, assistant professor of Clinical Pediatrics, who works with cancer patients at Vanderbilt-Ingram Cancer Center through the Behavioral Hematology Oncology Program.

Just the threat of a relapse can be very difficult, she said.

“Humans deal with ‘what ifs’ differently,” she said. “Some people and their families are able to say, ‘We will deal with it if it happens,’” she said. “They’re living in the moment. They accept the risk is there but choose to focus on the here and now and do things that are meaningful to them, living life to the fullest. Having battled cancer once does give you a new appreciation of what matters,” Neul said.

But other young adults can find it very difficult to cope with the worry that it could happen again.

“Others really struggle. You see lots of anxieties and worries. There’s always the dreaded ‘what if,’” Neul said. “What if something is wrong with my counts or something comes back on my scans? Some people understandably get stuck on that and there are ways to help them, but it can be very challenging.”

Neul said that she works with young adult cancer survivors, encouraging them to “build a tool box” to combat anxiety. “I tell them there are additional tools they can add, picking and choosing as they need to.”

The tools include a combination of cognitive and behavioral approaches, such as identifying thought processes that can counteract the worry, teaching and practicing relaxation strategies to reduce physical aspects of anxiety (e.g., increased heart rate, rising blood pressure), and engaging in enjoyable activities for healthy forms of distraction to make dealing with worries and fears more bearable. Other strategies such as visual imagery can also be helpful, especially when all you want to do is escape and avoid negative thoughts running through your mind, Neul said.

“You can use all five senses and the imagination — walking through a forest, sitting by a stream — to help calm yourself in the moment or to deal with a short-term stressor (e.g., blood draws, uncomfortable procedure). These imagery exercises are easily adapted to the specific needs and preferences of any individual which can make them highly effective for coping in the moment and reducing the physical sensations associated with anxiety which can contribute to ameliorating some of the pain and discomfort one may experience.”