Medical appointments after a breast cancer diagnosis can trigger feelings of anxiety and stress. Scans are often among those appointments, causing what is sometimes referred to as ‘scanxiety’.
The anxiety associated with scans can also happen when you have other types of appointments, procedures or conversations with your team. Dr Charlotte Tottman, a clinical psychologist who specialises in psycho-oncology, calls this ‘review anxiety’.
Charlotte provides psychological treatment for cancer-related distress at her private practice in Adelaide. Several years after establishing her practice, she herself was diagnosed with breast cancer. We talked to Charlotte about how people can mentally prepare for medical appointments and manage their ‘review anxiety’.
“The first thing to understand is that it's really normal in the lead-up to scans, bloods, medical reviews or surgery to feel anxious. In fact, it would be weird if you weren't,” Charlotte reassured us.
“It’s about finding the balance between giving it enough attention and thought but not so much that it unnecessarily inflames the anxiety,” she says. “It’s like a Goldilocks sort of amount of attention.”
Charlotte suggests that in the lead-up to appointments you do things that “make you feel light, make you feel joy and offset some of the anxieties”. Those activities will be different for everybody but, Charlotte says, “Any sort of movement and mobility, whether it's formal exercise or not, is a good idea. Getting outside in nature and fresh air can be very good. And not too much time on devices and certainly not ‘Doctor Googling’.”
Charlotte also suggests that you spend time with loved ones and share your vulnerability, to a point: “So, expressing that you might be feeling anxious but not using every social interaction as an opportunity to workshop the anxiety to within an inch of its life, because I think the risk is that you then inflame the anxiety.”
Some ways to help manage stress and anxiety
Two of the techniques that Charlotte talks to people about to help them manage stress and anxiety are:
- the four pillars of coping
- naming feelings
The four pillars of coping
The four pillars of coping are sleep, exercise, nutrition, and activities with purpose and meaning. Charlotte says that while the first three seem straightforward, paying attention to them takes time and energy, and we all have different vulnerabilities. Charlotte recommends that you work out what your own vulnerability is. For example, you may feel ‘off the boil’ if you don’t get enough sleep so you might need to give most of your attention to the sleep pillar.
Charlotte highlights that the fourth pillar, activities with purpose and meaning, is very individual. For some it may be about giving back to the community; for others it’s connecting with the earth and nature, in ways like gardening; or it may be spending time with grandchildren.
“Identify what really fills your cup and make sure that you’re giving those things time and space in your life regularly, but definitely in the lead-up to things like scans, bloods, medical appointments and surgery.”
Name the feeling
Charlotte also encourages people to name what they’re feeling and to say this out loud.
“It sounds weird, and I've certainly had people say, ‘How does saying something out loud make it feel better?’, but it does. That's what happens in therapy – we express our emotions, thoughts and beliefs, and share them. And even if you just hear yourself say it out loud, somehow it does gives us the ability to acknowledge what it is that's going on for us, and to then be able to get a bit of distance from it.
“You can see it. You can step away from it. And that's quite empowering. You can be curious about it, and it can be a ‘thing’ that's separate from you rather than kind of feeling it is just all in you and overwhelming and swamping you.”
What about the day of your appointment?
In the hours and minutes before an appointment, grounding techniques can be helpful, and Charlotte recommends two.
Breathing
“Breathing sounds very lame but it’s incredibly helpful if you're able to take a series of very slow, deep breaths. I usually recommend breathing for the count of four. So, slowly take one deep breath in (1-2-3-4) and then one deep breath out (1-2-3-4).
“You want to be in a position where your shoulders are back, your spine is straight, and your lungs are open. Think about your lungs being like oxygen cylinders when someone goes scuba diving. When we're distressed, we quite often lean over and put our head in our hands, or we might put our hands over our chest. And what that does to your oxygen cylinders is it closes them off and that's not helpful if you're trying to increase the amount of oxygen going into your system.”
This grounding technique will help lower your respiration rate and blood pressure and will help you feel calmer. “And when you're feeling like that,” Charlotte explains, “you'll be better able to think straight because you'll have oxygen flow to your brain, and you'll be able to cope better with whatever you're dealing with.”
Five senses
This simple grounding technique uses your five senses. “The thing about activating or igniting your senses is that it brings you into the present,” says Charlotte, “and if you are in the present, you can't be worrying about the future or ruminating on the past. So, it's a really healthy space for us to be in.”
To help activate your five senses, sit quietly, and ask yourself:
- What can I see?
- What can I hear?
- What can I smell?
- What can I taste?
- What can I feel?
“If you can, say it out loud, even if you're with someone – you can do it together.” says Charlotte. After you’ve done this once, you can keep repeating it in sets of five.
“You can't overdose on it, and it can keep you really nicely in the moment. It's fantastic in the sense that anyone can do it. You can teach your children to do it. You can do it with your partner. And the more you practise it, the easier it comes.”
Charlotte adds, “It doesn't take all of the anxiety away, or change the circumstances or the context that you're in, but it can just mean that you’re just bringing that anxiety off the boil enough that you're able to cope better.”
Read our article with Charlotte about the psychological impacts of a cancer diagnosis and how to cope with ‘triggers’.
This article has been reviewed by Dr Charlotte Tottman, a clinical psychologist who specialises in the treatment of cancer-related distress. Charlotte is an editor for the Cancer Council of Australia and is a member of the Strategic Advisory Group for Breast Cancer Network Australia (BCNA). She is the host of the podcast Upfront About Breast Cancer – What You Don’t Know Until You Do, developed and produced with BCNA.
This content is brought to you in partnership with Eli Lilly Australia and developed independently by the team at Pink Hope in consultation with medical experts.
