Cancer phobia
Understanding the fear of cancer.
One of the most difficult types of patients that I have encountered are those who do not have cancer but are absolutely convinced that they do.
These patients have an excessive fear that they have cancer and tend to present with a wide-range of symptoms. Cancer-free, they nonetheless carry a real dread of the disease. I call this “cancer phobia”.
Cancer phobia more often affects those who have directly cared for a loved one who suffered marked pain and disability over a protracted period before death.
Easier to prove it is cancer
The tricky thing about tackling this is that it is by far easier to prove that a patient has cancer than it is to certify that he does not.
I recall a middle-aged housewife who complained of many physical symptoms, each of which may indeed possibly be caused by cancer. She had a chronic cough – “Is it lung cancer doctor?”. She also had frequent headaches and insomnia – “Is it a tumour in my brain?” Her list of symptoms ran long.
After taking her history, I thought she was likely to have psychosomatic issues. But the problem is that I could never be certain that none of these symptoms are real.
Fortunately, these “phantom cancer” cases are rare. The large majority of patients who see me have been diagnosed to have cancer or are suspected by my medical colleagues to have cancer. So, anyone who walks into my consultation room is presumed to have cancer until proven otherwise. In contrast, a general practitioner that handles coughs, colds and other common ailments, is less likely to think of cancer as the first diagnosis.
If a patient complains of blood in the stools, the most common diagnosis is haemorrhoids. A general practitioner is likely to offer some topical treatments like Preparation H or suppositories to settle the problem. A colonoscopy is only offered if the problem persists.
However, if the same patient were to be seen by a colorectal surgeon, gastroenterologist or oncologist, he is likely to end up with an endoscopic assessment sooner rather than later. This difference in care is probably related to the mix of cases seen. Specialists tend to see more cancers in their practices and thereby tend to have a lower threshold for comprehensive evaluation. (It is no wonder that the more specialists there are in the community, the higher the overall healthcare cost.)
More investigation
For me, I explore each of the patient’s symptoms and try my best to sort out which are the ones that require further investigation.
For each complaint, there is the option to run further investigations. In “organ-specific complaints” (i.e. those with symptoms that refer to a particular site or system), it is easier to decide what tests to do. For instance, coughing is usually associated with the respiratory system. By carrying out a chest X-ray, computed tomogram of the lungs and an examination by an ENT (ear, nose and throat) specialist, one can confidently exclude cancer as the cause of the cough.
However, when the symptoms are general ones like loss of weight, loss of appetite or tiredness, the possible causes are many – some related to cancers and others not.
Handling a patient with cancer phobia requires good clinical acumen as well as patience and compassion. It is easy to get exasperated. In my younger days, I considered them a waste of my time. I felt that I ought to be caring for those who have “real” disease and not imaginary ones.
Over the years, I have noticed more patients who have an excessive fear that they have cancer. This may be partly due to increasing awareness and exposure of the disease – through the media or from personal encounters with friends and relatives. I begin to realise that while they may not have cancer, they do have a real illness.
Being extra careful
In dealing with patients with cancer phobia, it is easy to dismiss them and blame it all on anxiety. But as an oncologist, the onus is on me to be extra careful to make sure that this is not one of those patients who actually have cancer.
Once the diagnosis of cancer has been excluded, I refer them to nurse counselors. The more serious cases get referred to psychiatrists for care.
As for the cancer-free housewife, she continues to see me ever so often. Even though I think I have managed to convince her that she does not have cancer, she insists on coming. When I asked her why, she says: “Safer, lah!” and smiles.
** This article first appeared in “Mind Your Body”, a Straits Times supplement. It has been reprinted with permission from Parkway Cancer Centre.
Dr Ang Peng Tiam, the medical director of Parkway Cancer Centre, has been treating cancer patients for nearly 20 years. He has also published a book on patient stories, “Doctor, I Have Cancer. Can You Help Me?”, which has been translated into nine other languages.
(* PHOTO CREDIT: medical doctor, Kurhan, stock.xchng)
Two years ago, my younger sister decided to have Endoscopy done with
the Colonscopy ordered to investigate bleeding in her stools. It turned
out that her colon was clear; but she was diagnosed with Cancer of the Stomach. On May 13, 2011, her entire stomach was removed. She’s alive and well today! There wasn’t any symptoms or discomfort to indicate
stomach cancer – in fact she was eating well and worried about weight gain,
before her Endoscopy.
Therefore, routine investigations do serve a purpose, cancer phobia notwithstanding.