In my work, I often encounter the idea of 'toxic positivity'—this notion that we always have to be positive and happy. But the reality is that we're not always okay, and that's perfectly acceptable.
Sivan Rotenberg, PhDThe term “fear of recurrence” is used in many ways, but what it really boils down to is the fear, worry, or concern that your cancer might come back or progress. If you've been diagnosed with cancer and find yourself having these thoughts, please know that you're not alone. Dartmouth Cancer Center clinical psychologist Sivan Rotenberg, PhD, says it's something nearly every cancer patient experiences. She offers compassionate advice and practical strategies for how to manage a very common anxiety about cancer returning.
I often hear from people who feel like they should just “get over it” and move on, but it's not that simple. There's no “supposed to.” These thoughts are incredibly common, and it’s important to understand why.
Why does this fear exist?
Our minds are wired to protect us from threats. A cancer diagnosis is a significant threat, so your mind naturally wants to ensure your safety. Those recurring thoughts about cancer are your brain's way of trying to help. This is why it's completely normal to feel increased anxiety before appointments, screenings, or any situation involving your health status. You might notice you're not sleeping well, feeling nervous, or even a bit grumpy. It's a natural response.
I encourage patients to give themselves and their loved ones a little grace during these times. Let your family know what’s coming up and that you might be more irritable or anxious. It can help them understand what you’re going through.
Interestingly, a little bit of anxiety can actually be helpful. A low level of fear of recurrence can motivate us to engage in healthy behaviors, like exercise, and to keep up with crucial follow-up appointments. It's not all bad. However, we need to address it when it becomes overwhelming and starts to interfere with your life.
The pitfalls of toxic positivity
In my work, I often encounter the idea of “toxic positivity”—this notion that we always have to be positive and happy. But the reality is that we're not always okay, and that's perfectly acceptable.
If you're having fearful thoughts, please be compassionate with yourself. There's no right or wrong way to think or feel; all your thoughts and feelings are valid. We can learn to manage them, but they are not a sign of weakness or failure.
Mindfulness: A powerful tool
One incredibly helpful tool for managing fear of recurrence is mindfulness. Mindfulness helps us become more aware of our thoughts. When you can recognize those worry patterns as they start, you have the power to intervene.
All too often, we get caught up in “what if” scenarios, spinning our wheels and disengaging from the present moment. Mindfulness teaches us to observe our experiences without getting swept away by them. As I often tell my patients, it allows you to see what’s happening, rather than being stuck in it. And once you can see it, you can take action.
There are many resources available to help you develop mindfulness skills. You can find apps like Insight Timer or the UCLA Mindfulness app, and numerous helpful websites. The Dartmouth Cancer Center Complementary Care Program also offers mindfulness classes, which I highly recommend. They are free of charge to all current and former patients of Dartmouth Cancer Center, as well as their care partners.
From worrying to problem-solving
Mindfulness helps us get back to living our lives more fully. Our minds are natural problem-solvers. When you notice yourself caught in a loop of “what ifs,” that’s your brain trying to solve a problem. The catch is, your brain doesn’t always realize that the problem might not be something you can address right here and now. We can waste a lot of energy trying to solve something that’s not immediately solvable.
With increased awareness, you can start asking yourself a crucial question: “Is there anything I can actually do about this issue right now?” If the answer is yes, shift into problem-solving mode. If the answer is no, acknowledge and thank your brain's attempt to help, and then gently redirect your focus by reminding yourself that there's nothing you can do about it at this moment. Instead, ask yourself: “What can I do right now to live a rich, full, and meaningful life today?” It’s about bringing yourself back to the present moment as much as possible.
The power of support
Finally, I want to emphasize the importance of support. When people worry about cancer recurrence, they often keep it to themselves, which can lead to feeling isolated. Talking about your fears builds connection and helps you feel seen and understood.
Support can come from loved ones, but sometimes they may not be equipped to provide the emotional support you need. This is where support groups can be incredibly valuable. Going through cancer can feel like being alone on an island, but support groups show you that there are many other islands and boats navigating the same waters. That connection can be incredibly grounding and reduce feelings of isolation.
When to seek professional help
While these strategies are helpful, there are times when professional support is essential. If your worries are so intense that you're struggling to live your life, please reach out to a mental health professional. We can help you develop additional skills and strategies to get unstuck.
Also, be mindful of excessive body checking. While it's important to be aware of your body, spending hours each day monitoring for signs of cancer can consume your time and energy, preventing you from engaging in activities you care about. If you find yourself doing this, it's a good indication that it’s time to seek support.
Finally, if you're constantly in your head, having difficulty connecting with others, or experiencing “presenteeism” (being physically present but mentally absent), please consider reaching out for help. We're here to provide the support you need to navigate this journey.