Fear

I saw a new patient this week who was just diagnosed with breast cancer.  She had a mammogram, her biopsy and found out the news about her having a malignant tumor all in approximately three days. I saw her in my office 48 hours after she had  gotten the bad  news.  I spent over an hour and a half with her and her husband going through the important information regarding her diagnosis. I talked about how the different aspects of her pathology impacted her overall prognosis and talked extensively about treatment.  I would say this initial appointment was very difficult. Despite my best efforts, throughout her appointment, she had this scared and frightened look on her face. By the end of the appointment she seemed better but fear could still be seen in her face and eyes.

Fear is a very strong emotion, an emotion that almost all patients with cancer have to deal with as they face their diagnoses and subsequent treatment. Fear can affect how a patient handles therapy.  Fear can affect whether a patient survives a cancer. Fear can at times paralyze the patient into avoiding therapy, not making necessary decisions and ultimately preventing a patient from choosing the right therapy.

I have another patient that I treat for breast cancer who despite every evidence to suggest that certain treatments should be given, has decided to seek complimentary and alternative therapies.  Despite every indication in her case that these alternative treatments are not effective and her disease is advancing, she continues to cling to their potential help. I believe this is significantly related to the fear that she associates with treatment. It is very possible that her decisions may cost this patient her life.

A recent article from Cure Magazine has a survey about patients fear of treatment. This survey was conducted by Harris Interactive with the help of the National Coalition of Cancer Survivorship and drug company Sanofi-Aventis.  It was released in early 2008 and offers a glimpse of just how widespread and how often fears play role in the patients' treatment.  In this survey, 83% of 326 adult cancer survivors said that they were at least somewhat fearful before they underwent chemotherapy.

After the end of therapy only 38% said their fears had been justified, 62% acknowledged they had many misconceptions before treatment.  Fear of the unknown including worries that therapy will be difficult is normal in many patients.  The fear of therapy may even be more overpowering than the diagnosis. This fear could be harmful because it may interfere with the patient's understanding about the purpose and rationale of the treatments.This may cause the patients to postpone much needed therapy, which is what I feel is happening in my own patient's case.

Below are two are graphs from the article from Cure magazine that I think are illustrative of what most patients face.  The second illustration is also illustrative of what the patients felt about their therapy once they had completed therapy.

Patients and experts agree that good comunication with the physician and other members of the health care team including nurses, social workers, therapists and patient navigators is critical.  The above-mentioned survey found that the patients who doctors make sure they understood the treatment plan have significantly less fear than those who doctor's did not clarify the plan.

I think an additional way in which the patients can battle fear is to seek out support from friends and families and also through support groups. By finding patients who have already been through treatment, patients can get advice from people that have already been through treatment.  We see this very clearly in the treatment of breast cancer where various programs try to match up previously treated patients with breast cancer patients with newly diagnosed breast cancer.  A lot of times knowing and talking to someone who has been through treatment before can relieve some of the fears that the patients have.