Fear of the cancer coming back

Sunday 1 April, 2018

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On this page: Will the cancer come back? | Survival statistics | Fear of getting a different cancer | Checking for signs of a new cancer | Key points


Feeling anxious or frightened about the cancer coming back (recurrence) is a common challenge and one of the greatest concerns for cancer survivors. Most cancer survivors are likely to experience this fear to some degree and it may come and go for many years.

This fear may affect your physical wellbeing, as well as your ability to enjoy life and make plans for the future. Some survivors describe it as a dark cloud or a shadow over their life.

Many people find that their worry is worse at certain times, such as:

  • special occasions (e.g. birthdays or holidays)
  • anniversaries (e.g. the date you were diagnosed, had surgery or finished treatment)
  • before follow-up appointments
  • when other people are diagnosed with cancer
  • when you have symptoms similar to those when you were first diagnosed
  • the death of a friend or family member
  • passing by the hospital where you had treatment, or visiting someone in the same hospital
  • hearing media reports about cancer, new treatments and celebrities with cancer
  • seeing related fundraising campaigns or advertisements (e.g. a graphic cigarette or melanoma warning).
"Once treatment was finished, it was quite daunting. I was fearful that the cancer would come back somewhere. Eight years later, it hasn't come back, which is fantastic." – Pete

Managing the fear of recurrence

  • Focus on what you can control, e.g. being actively involved in your follow-up appointments and making positive changes to your lifestyle.
  • Talk to your specialist about your risk of recurrence and learn more about your type of cancer.
  • Psychological interventions specifically addressing the fear of cancer recurrence have been shown to be effective. Ask your GP for more information or call Cancer Council 13 11 20.
  • Learn to recognise and manage the signs of stress and anxiety, such as a racing heartbeat or sleeplessness. Manage these in a healthy way, e.g. you could try yoga or mindfulness meditation.
  • Speak with a counsellor or psychologist if the fear of recurrence is overwhelming. They may be able to teach you some strategies to help you manage your fears and have a more positive frame of mind.
  • Social support has been found to play a protective role in the fear of recurrence.
  • Joining a support group may help.
  • Consider getting involved in a creative activity. Some people find this helpful in working through their emotions and anxieties.
  • Not all symptoms are a sign of cancer, they may indicate other health problems, e.g. diabetes, arthritis, high blood pressure.
  • Talk to your doctor about how to distinguish normal aches, pain or sickness from cancer symptoms.
  • See your GP if you notice any new symptoms or symptoms that have returned. Don't wait for your next check-up.

Will the cancer come back?

You may wonder how likely it is that the cancer will come back or how long people with the same type of cancer live. Cancer is most likely to recur in the first five years after treatment ends. Generally, the more time that goes by, the less likely it is that the cancer will come back (see Survival statistics below).

The risk of cancer coming back is different for each person and depends on many factors, including the type and stage of cancer, genetic factors, type of treatment and time since treatment. Talk to your doctor about your risk of recurrence.

For information on how to reduce your risk of cancer recurrence, see taking control of your health.

Survival statistics

Many doctors are wary of using the term "cure" because undetected cancer cells can remain in the body after treatment, causing the cancer to return. Instead they may use the term "fiveyear survival rate". Australia has among the best survival rates for cancer in the world.

The five-year survival rate is determined by the percentage of people alive five years after diagnosis. It does not mean you will only survive for five years. For example, about 90 out of 100 people (90%) with breast cancer will be alive five years after they are diagnosed. Many of these people live much longer than five years after diagnosis.

How accurate are the statistics?

Five-year cancer survival rates are a guide only. They generally include everyone with a particular type of cancer, at all stages and grades of the disease. For most cancers, people diagnosed with early-stage disease (small cancer that has not spread) are likely to have a much better outlook than people diagnosed with late-stage/ advanced disease (cancer that has spread to other parts of the body).

Statistics take many years to calculate and are usually slightly out of date. For example, if you were diagnosed with cancer in 2017, the doctor may use survival rates for people diagnosed in 2009 (followed for five years until 2013). With cancer treatments improving all the time, your outcome (prognosis) is likely to be better than it would have been in 2009.

Asking your doctor how your risk has changed at your check-ups can be a good way of learning what the latest statistics are, or how much your risk has reduced since your treatment finished.

Living with advanced cancer

For some people, cancer does come back after treatment. This can be devastating. Treatment for advanced cancer aims to control the cancer for as long as possible. In some cases this may be months or years.

For more information about dealing with the emotional, physical and practical aspects of a cancer recurrence, see Living with Advanced Cancer. Call 13 11 20 or visit your local Cancer Council website.

Fear of getting a different cancer

Some survivors worry about developing a different type of cancer. While this is not common, some people develop a second cancer that may not be related to the first cancer.

See managing the fear of recurrence for some tips that may help you deal with the fear of developing a different cancer.

The following factors may increase your risk of developing another type of cancer:

  • exposure to cigarette smoke or other cancer-causing agents
  • skin damage caused by overexposure to ultraviolet (UV) radiation from the sun or artificial sources such as solariums
  • ageing
  • being born with an inherited gene that increases the chance of developing some cancers (about 5% of cancers)
  • having some forms of cancer treatment, particularly as a child
  • lifestyle factors such as smoking, eating an unhealthy diet, drinking too much alcohol, being overweight, and not getting enough exercise.

Talk to your doctor if you are concerned about any risk factors. See taking control of your health for ways to reduce your cancer risk.

"It helps to focus on what is happening now, what is actually known – not all the possibilities. One step at a time." – Jane

Checking for signs of a new cancer

It's important to know what is normal for you. If you notice any unusual changes in your body or have any concerns, see your GP as soon as possible. Don't wait until your next scheduled check-up.

The main signs and symptoms to look out for include:

  • a lump, sore or ulcer that doesn't heal
  • a mole that bleeds or has changed shape, size or colour
  • a cough or hoarseness that doesn't go away, or a cough that produces blood
  • a change in bowel habits (e.g. diarrhoea or constipation that lasts for more than a few weeks)
  • urinary problems or changes
  • unusual changes in your breasts or testicles
  • abdominal pain or bloating that doesn't go away
  • abnormal bleeding or bruising
  • unexplained changes in your general health, such as weight loss, loss of appetite and loss of energy (fatigue).

To help detect cancer early, free national screening programs are available for breast (women aged 50–74), cervical (women aged 25–74) and bowel (men and women aged 50–74) cancers. For more information, talk to your doctor, call Cancer Council 13 11 20 or visit cancerscreening.gov.au.

"I'm more aware of my own body and the need to get any changes checked out straightaway." – Sam

Key points

  • Many cancer survivors worry that the cancer will come back. This fear can affect both their emotional and physical wellbeing.
  • This concern may be worse at certain times, such as special occasions, followup appointments, and hearing about other people diagnosed with cancer.
  • Many survivors find this fear lessens with time. However, this is not always the case.
  • There are things you can do to help you manage your fear of recurrence and have a more positive frame of mind.
  • The risk of recurrence depends on cancer type and stage, type of treatment and time since treatment.
  • Doctors use five-year survival statistics to refer to the number of people who are alive five years after diagnosis. Many people live much longer than five years after they are diagnosed.
  • For some people, cancer does come back and they will need further treatment.
  • Most people who get cancer only get one type. However, some people will develop another type of cancer.
  • There are ways to reduce your risk of cancer recurrence.
  • People of certain ages can take part in free national screening programs for the early detection of bowel, breast and cervical cancers.
  • If you notice new or concerning symptoms, make an appointment with your doctor.

Reviewed by: Dr Haryana Dhillon, Senior Research Fellow, Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney, NSW; Polly Baldwin, 13 11 20 Consultant, Cancer Council SA; Jessica Barbon, Dietitian, Southern Adelaide Health Network, SA; Dr Anna Burger, Liaison Psychiatrist and Senior Staff Specialist, Psycho-oncology Clinic, Canberra Region Cancer Centre, ACT; Elizabeth Dillon, Social Worker, Peter MacCallum Cancer Centre, VIC; Prof Paul Glare, Chair in Pain Medicine and Director, Pain Management Research Institute, University of Sydney, NSW; Nicole Kinnane, Nurse Coordinator, Gynaecology Services, Peter MacCallum Cancer Centre, VIC; Amanda Piper, Manager, Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, VIC; Kyle Smith, Exercise Medicine Research Institute, Edith Cowan University, WA; Aaron Tan, Consumer; Dr Kate Webber, Medical Oncologist and Research Director, National Centre for Cancer Survivorship, NSW.

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