Dr. Wynn Q&A: Coping with Fears

Question: As a cancer survivor, how can I cope with the fears caused by my disease?

Dr. Wynn: This question reminds me of Helen Keller, who said that "Although the world is full of suffering, it is also full of the overcoming of it."

Making peace with fear is a common concern for survivors. It is also a challenge that may arise repeatedly through all three phases of survivorship, which begins with the acute phase (from time of diagnosis until one year after treatment ends). Next is the extended phase (from the end of the first year after treatment ends until five years following treatment), followed by the permanent phase (from the fifth year out of treatment until end of life from other causes).

Your fears are often specific to your phase of survivorship. Initially, when you receive a diagnosis of cancer, you greatest fears will likely involve death, pain and the unknown — what's going to happen to me and how will this affect my life? Later, as you go through and finish treatment and live as a cancer survivor, you may fear everything from recurrence and abandonment by loved ones, to loss of dignity and the loss of your job or loss of financial security.

Gen. George Patton of World War II fame once said, "Courage is not going into battle unafraid. Courage is going into battle even though you are afraid." Your fear is not a sign of weakness and your challenges are not unique. You can make a plan and make peace with fear.

As a first step, I recommend making a list. Write down everything that you are afraid of. Putting your fears into words can help you put them in perspective. No fear is too outlandish, too foolish, too realistic or too frightening to be listed. Then, set your list aside for several days before going back and reviewing it to see if there is anything that needs to be added, or if there are fears that you can now subtract.

All of the fears on your list are important, even valuable. Each one can tell you about yourself: what your values are, who and what you rely on, what resources you might have, where your faith lies. Each item offers insight into your personal journey through survivorship, and can help you determine your abilities and your limitations.

Next, review your list again, this time asking yourself, "Which of these fears are realistic? Which are giving me good information? Which are scaring me for no good reason?" Some fears tell you to flee. These fears are saying, "You are powerless." Other fears tell you to adapt and make changes. These are saying, "You are in control." Still other fears will tell you, "Stop, listen, get help and think this through." At this point, as you look over your list, ask yourself if you can move any of the fears from one category to another. Are there, for instance, fears that at first make you feel powerless and alone, but could also push you to reach out and get help?

Finally, ask yourself, "Who else needs to see this list?" A close friend, your doctor or nurse, a spouse or other family member, a neighbor? If your fears come from the heart, who do you let into your heart? Let your fears bring you closer to the people who can help. If they are cancer related, bring the list to your medical team. If they are about personal losses, share them with your closest confidantes or reach out to a social worker or mental health professional. This opens up what Helen Keller called "the overcoming."

It's very important to understand — and to remember — that your fears can and will guide you through all three phases of survivorship. They can alert you to your needs, push you to make necessary decisions, and connect you with the people who can help you on your journey. Recognizing your fears, you can make peace with them. Listening to them, you can find yourself and your resources. The next move is up to you!

John Wynn, M.D., is medical director for the Swedish Cancer Institute Department of PsychoOncology. In this role, Dr. Wynn is responsible for developing programs to help patients and families cope with the cancer experience. He also attends to the educational and emotional needs of professionals working in the highly demanding field of cancer care. Board-certified in both internal medicine and psychiatry, Dr. Wynn also has a private practice in psychiatry and organizational consultation.