Helping Patients Minimize Scanxiety

A common problem among cancer survivors is scanxiety: the anxiety elicited by undergoing and waiting for the results. As a Healthy Survivor, I've explored how to minimize scanxiety. in Minimizing Scanxiety" I've shared with clinicians what I've learned.(Oncology Times July 25, 2015)

[Introduction]

Every day you order tons of tests. But you're too busy to think about the results—let alone worry about them—until you see the reports.

Meanwhile, some of the patients whose names are on those reports are worrying mightily, stuck in a Sartre-esque hell of uncertainty with no exit from the waiting, day after day after day after day. Plagued by anxiety, they may try to forget about their pending test results.

But they can't forget... or sleep... or concentrate.Anxiety torques their thinking and emotions. It seeps into their relationships and activities, making mountains out of molehills and spoiling good times, day after day until the end of uncertainty....

[Conclusion]

A fact of survivorship is that patients have to wait for test results. But waiting doesn't have to be a living hell. To minimize patients' scanxiety:

* Discuss when and how patients will learn their results;

* Voice your expectation that the test results will help;

* Reassure patients that you are ready for anything and hoping for the best; and

* Encourage patients to contact you if they feel anxious, so you can discuss further resources and the role of short-term anxiolytics.

The rest of the article Minimizing Scanxiety shares my personal story of dealing with scanxiety.

Comments

[Debby]

Nice that there is a special word for this type of anxiety. The depth of this test depends upon the history of the patient with prior experience having the test taken, use of port, injecting needles, care of nurses, physicians and technicians, outcomes, and rapidity with which the test results are given and explained. Familiarity with the testing procedure may also lessen scanxiety. #FAITH

[kidsandliz]

The pollyanna spin/advice on this may help some. For me, I'd just roll my eyes and say, "You're kidding. Right?" Consistent with what you wrote -- the false reassurances, we will worry about that later, etc. -- I don't find those helpful either. None of those address the actual cause of the patient's fears, although I suspect may address the way the doctor deals with things (s/he can't do anything about anything until results are back, is busy and so won't think about it until they come back), waiting long times to get results sends a message (intended or not) that the doctor either has no clue about how I am emotionally feeling and/or doesn't consider it important/doesn't care.

What works for me is fast knowledge of results. This is anxiety about the unknown. The best cure for that is speed in being given the results, thus making the unknown the known.

Eight and ten day (or more, sometimes much more) delays in getting results is unacceptable. The turnaround should be 1-2 days from the result hitting the doctor's office/electronic record. This is why I get as many tests as possible done at the hospital and not the doctor's office. I ask the technician when they results will be back and get them from medical records. Even if they come back crappy, and they have at times, including 2 of my 3 cancer diagnoses, I'd rather know that than wait.

Some patients may prefer another approach to both the one you recommend and the one that I prefer. There is no one size fits all. For me, and many that I know, speed of getting results back what matters the most to "cure" anxiety. Even if the results suck, at least now you are in a known place and can start moving forward again; the angst of the wait is over.

[Wendy S. Harpham, M.D.]

Dear Kidsandliz,

Thanks so much for your useful comment. I couldn't agree with you more: By far, the most effective step to minimizing patients' scanxiety is minimizing their wait time.

To me, that's a given.

The article addressed the fact that there is necessarily a delay between undergoing the test and getting the results. Not only do the scans have to be compared to prior ones and interpreted, and the test results inputted and transmitted to the doctors' offices, but the oncologists have to have the opportunity to review the results in the context of the patient's case, possibly review the scans personally with the radiologist, and possibly discuss the findings with other doctors before reviewing the results with the patient.

But those steps don't explain the long delays. The challenge for clinicians is that addressing patients' immediate medical needs takes priority over reviewing routine test results.

The article was written with hope of bringing attention to clinicians' role in minimizing scanxiety. I painted a dramatic picture of the distress associated with waiting for results (instead of just saying "it's stressful") and highlighted the responsibility to make every effort to minimize that distress.

I trusted the readers of that article to feel a heightened sense of responsibility to get results to patients as soon as possible and to respond by making any changes that might decrease the wait.

And please understand that the idea that patients worry more about the results than their physicians in no way reflects lack of concern or caring. What it reflects is the disciplined efforts of clinicians to be 100% focused on the patient (or the patients' test results) in front of them, no matter what is happening with the clinicians' other patients or in the clinicians' personal life.

I hope these explanations clarify the intent behind the messages in that essay to clinicians.

Do some offices take longer to get results to patients than necessary? Could some offices do a better job of minimizing the wait? The answers are both "yes." I would like to find ways to optimize the turnaround time in every case.

Thanks again for voicing your reaction and prompting me to focus in the future on ways to minimize the wait time.

With hope,
Wendy