Dealing With Anxiety
The following suggestions may offer you some help in
dealing with anxiety.
The US National Cancer Institute's Coping pages on
anxiety are located at
http://www.cancer.gov/cancerinfo/pdq/supportivecare/anxiety/patient
and at
http://www.cancer.gov/cancerinfo/pdq/supportivecare/anxiety/healthprofessional
From a patients point of view, the following is offered:
From: Bob Benson
Sent: Wednesday, August 27, 2003 10:06 PM
To: HRPCA Support List
Subject: On dealing with patient anxiety
My latest set of bloodwork numbers did not come out well. I'll be
reporting on these shortly. At the moment, I've quickly moved back into
chemotherapy because the PSA is up to 324. Customarily, I go into a blue
funk each time one of these experiments fail. But--knowing some of my
own reactions--I had put some protective measures into place to avoid
being depressed by a lack of success.
1. My most important tactic is to always have at least 2 backup
treatments defined (complete with doses) to follow the one I'm about to
start. When the present tx fails--and they always do, eventually--I know
what is next, and I don't fret over it. This is the tactic that keeps me
from going crazy with the thought that when I run out of treatments, I
run out of survival.
2. Whenever I agree on a tx regimen, I also insist on putting a time
schedule on it. How long before I know if it works or not? I can live
with failure, better than I can live with uncertainty. Such a time limit
controls the period of anxiety. It also keeps me from stopping a tx too
soon. Further, it keeps me from bugging the doc, except at a
pre-agreed-upon time. Of course I can always change a plan as
necessary.
3. My most anxious moments are experienced the day that I await the test
results. The hospital faxes me the results directly, so this painfully
anxious interim is as short as possible. My wife usually beats me to the
fax machine to see what the numbers are. She worries at least as much as
I do; so these tactics also help here. Doctors and hospitals are just
getting used to sharing test results with patients; so you may have to
do a lot of diplomacy here to emphasize the importance of your having
the results as soon as the doc. I'm not above explaining to the hospital
that it is my decision where to get tests, not the doc's.
4 No news is never good news. I always want to know the facts and the
numbers. You should know ahead of time what the various numbers will
mean. We can help you there. The Handbook of Diagnostic Tests is good
also. Do some "what iffing" up front. What if the PSA goes down a lot? A
little? What if it remains stable? What is stable? What if the PSA goes
up a little? A lot? By the way, asking for facts and numbers does not
include asking for prognoses on length of survival. Don't put the docs
on the spot to make a guess that will always be wrong, unless you agree
to die on his schedule. I believe that only the Lord knows that answer.
I can handle the rest.
5. I think depression and anxiety are very common, perhaps close to
universal with advanced Ca. If you have significant pain and extreme
fatigue or nausea, you may also have depression. The depression that you
have with advanced cancer is mostly a result of physiological changes
(e.g., pain). In this situation, depression usually has nothing to do
with character--so don't expect to just "buck up old fellow." Depression
is recognized most easily and quickly by the spouse. It is reflected in
lack of will to live life as you normally do. If in doubt, ask the doc
for a prescription for an anti-depressant. By taking the
anti-depressant, you will quickly see if it improves your quality of
life.
While this is one approach to fighting off depression and anxiety, there
are probably many more that also will work for you.
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