Mental Wellbeing and Skin Cancer

A diagnosis of skin cancer brings up many emotions, including feelings of shock, surprise, fear, and worry. What happens after a skin cancer diagnosis Over 900 survey respondents to the recent Skin Cancer in America 2017 survey conducted by Health Union shared their experiences on the emotional journey from diagnosis through cancer treatment and living with the fear of recurrence. Many respondents expressed how their diagnosis of skin cancer changed their lives, starting with the emotional impact. People with skin cancer said they were scared for themselves, as well as breaking the news to beloved family members, and that the news of a skin cancer diagnosis made the future uncertain. Risks that led to skin cancer diagnosis The vast majority (98%) of people with skin cancer surveyed in the Skin Cancer in America 2017 survey identified skin cancer risk factors that applied to them, including: Not using sunscreen when in the sun (77%) Being fair skinned (72%) Having had blistering sunburns (69%) Having skin that easily burns (58%) Having a family history of skin cancer (38%) The importance of self-examination Regardless of what types of skin cancer people were diagnosed with, most people who receive a diagnosis of skin cancer first found it themselves. 39% had a reddish, raised patch of skin that may have been itchy or scaly, and 37% recognized a mole meeting any or all of the “ABCDE” characteristics (Asymmetry, Border, Color, Diameter, and Evolving).1 Others had an elevated growth on the skin (27%), a shiny red, pink, or translucent bump (27%), an open sore that bled or oozed (21%), or a wart-like growth (14%). The Skin Cancer in America 2017 survey found that: 57% were diagnosed with basal cell carcinoma 46% were diagnosed with melanoma 44% were diagnosed with squamous cell carcinoma In addition, 29% of respondents had 2 types of skin cancer, 12% had 3 types, and 1% had 4 or more types of skin cancer. Taking action after a skin cancer diagnosis After being diagnosed with skin cancer, most people take precautionary measures against its recurrence. People who were reluctant to use sunscreen when outdoors wear clothing that provides protection from the sun, or avoid sun exposure found that after diagnosis. Tanning bed usage among survey respondents also greatly dropped after a diagnosis of skin cancer. In addition to practicing healthy sun behaviors, more people were likely to perform regular skin checks on themselves and visit a doctor for skin checks. Doctors recommend self-examinations be conducted monthly, as skin cancers that are detected and removed early are more likely to be curable. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site"] We are officially almost through the summer and vacations of all shapes and sizes are in high gear. If you are a skin cancer survivor, you are inclined to look twice at vacation plans with friends and family. You are leery of trips that lead you to sunny destinations and boast of fun-filled, sun-soaked hours outdoors. Skin cancer will do that to a person. If you are like me, you have mixed feelings about planning trips-vacations are great, but being the Debbie Downer of the group is the pits. Your plans aren't always shady The desire to remain indoors or in shady spots doesn’t always mesh with the plans your children have at high noon on day one of your Florida vacation. It’s not uncommon to feel overwhelming panic at the thought of standing in line for a ride at an amusement park under the scorching sun as you pray your sunscreen holds out. Feeling the heat beating down on your shoulders and stinging your cheeks as you browse flea market booths, you realize you should have suggested a later time in the day for shopping outdoors. It’s hard being that person-the person who feels obligated to operate around the sun’s schedule. "I'm sorry. I can't go." Skin cancer or the threat of recurrence can wreak havoc-if you allow it-on outdoor plans during peak hours of sunlight. It’s not always easy to say, “Hold on, guys. I need to reapply my sunscreen.” It’s certainly not enjoyable to glance out the window at a bright blue sky while weakly raising a hand in quiet objection to a 1:00 pm beach excursion. You’d likely rather do anything than utter those dreaded words, “I’m sorry. I can’t go.” Tips for sun protection Raining on everyone else’s parade doesn’t have to be your summer go-to. In fact, there are a few things you can do to avoid dragging everyone else down as you fight tooth and nail to avoid overexposure to the sun’s UV rays. Make everyone else a part of the sunscreen routine. After all, you are an advocate now for safe sun habits, and you definitely want to be a good example. When it’s time for you to reapply, it’s time for them to do it as well. Invest in a couple pieces of UPF clothing. These items provide a layer of protection between you and those rays in the event you are outdoors during peak hours. Provide your own shade when possible. Grab an umbrella or rent one on the beach so you, too, can enjoy your group’s beach adventure. Arm yourself with a list of alternate activities. Be ready with several activities in the area that you and your crew can enjoy during the hottest and most severe hours of sunlight. Find some options indoors everyone can enjoy. After all, the heat isn’t a friend to anyone, and chances are high they will be grateful some cool inside activities. The most important thing to remember here is to tell them up front when you plan to do the things they want to do. Everyone in your party needs to feel valued. Don’t shut yourself out. This is probably the most important of all. That being said, I will repeat myself. Do not, under any circumstances, shut yourself out of the family’s plans. Go and have a blast There are plenty of ways for you to enjoy a vacation in a sunny locale-it just takes a little planning, some smooth-talking, and a lot of sun-smart tools. Debbie Downer does not have to be a part of your group’s plans and neither does skin cancer. You better believe your people want you around and want to see you enjoy yourself as much as you want to see them have a blast. Plan a little more, and live it up! [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:”] The National Cancer Institute (NCI) estimates that between a third and half of all cancer patients suffer from insomnia. Not only this, but when someone goes into cancer remission, their sleeplessness may still affect them. According to Dr. J. Kim Penberthy, Ph.D., a psychologist at UVA Cancer Center, “Symptoms of insomnia continue to be very high in patients two to five years after treatment for cancer.2" Insomnia in cancer patients can be traced to: The side effects of treatment (chemotherapy, radiation, prescription drugs, withdrawal following treatment) Poor sleep hygiene (poor sleeping environments, long daytime napping, inconsistent sleep-wake schedule, nighttime exposure to blue-spectrum light) However, an ever-present, anxiety is another chief reason why people with cancer struggle to get sleep. Skin cancer, in particular, can lead to anxiety-induced sleeplessness. Connecting the dots: anxiety, insomnia, and skin cancer Evidence gathered by the NCI1 suggests that insomnia is the most common sleep disturbance in those with cancer, frequently a bigger annoyance than the physical and/or emotional factors related to cancer and/or cancer treatment. It isn’t surprising that sleepless nights follow a new cancer diagnosis. Anxiety is considered a normal psychological response to a cancer diagnosis, its treatment, and the life-altering challenges that come with it.1 Still, it makes us vulnerable to worrying at night when there aren’t daytime distractions to prevent us from the racing thoughts that are sure to follow. Special concerns for those with skin cancer Non-melanoma skin cancer (NMSC) is the most common cancer worldwide. Some research shows that almost 1 in 5 NMSC patients have significant levels of emotional distress and may have trouble adjusting to the disease and its treatment.3 Scanxiety Even before the diagnosis, screening can bring lots of anxiety. In fact, there’s a term for it: scanxiety. Fear of the unknown (Will it be cancer? If it is cancer, is it a death sentence? (as well as fear of treatment (Will I have a big scar on my face? Will I survive chemo?) are two of many reasons why people don’t go in for scans. Circadian disruption The skin has its own circadian functions, which help us to know when it is and isn't time to sleep. Cancer (especially its inflammatory nature) can disrupt these functions. Throw in a bad case of insomnia, and you can further disturb the sleep-wake cycle through a series of changes in the inflammation of the body.4 Visibility By its very nature, skin cancer typically (though not always) occurs in areas where the skin is exposed. That makes it a visible reminder of its presence, either as an untreated lesion or one which has been treated and has left scarring. Visible tumors or scarring can negatively impact self-esteem, confidence in social situations, and workplace anxiety.4 Feeling “disfigured” by skin cancer, especially on the face, may also increase the risks for substance abuse, posttraumatic stress, and poorer quality of life.4 Uncertainty For some, living with visible evidence of skin cancer remission is a badge of honor. For others, it causes fear that it will return. It’s not an unfounded fear: a skin cancer diagnosis ups one’s risk for recurrences. Regular skin checks become a new, possibly disruptive, reality for those in remission. In Part 2 next week, I’ll review solutions for managing anxiety and insomnia for people with skin cancer. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:”] ,Remember when you were in school and had just taken a really hard test? And how anxious you were while waiting to find out how you did on it? And how relieved you were once you were finished with school, that the days of tests were over? Unfortunately, if you have skin cancer, your days of waiting for test results are not over, even if you’re an adult and have been out of school for many years. Even worse, these are tests you can’t study for. Let's learn about biopsy anxiety especially after skin cancer. A skin cancer biopsy with a side of anxiety Throughout my experience with basal cell and squamous cell carcinoma, each procedure brought on not only the anxiety of having the procedure, but also the anxiety of waiting for two test results – the initial pathology report after a biopsy to determine if an area is indeed skin cancer and needs removed, and once the removal has occurred, the results on if the excision was successful and the entire cancerous area removed. Wondering if skin cancer hurts I recently had a new area appear rather quickly. It looked like a hard red bump but soon thereafter formed a bit of crusting on top of it....and it hurt, which wasn’t normal for my cancerous areas. I did a quick internet search on if skin cancer hurts (even though I’ve had skin cancer for over 20 years, there’s still much for me to learn about it), and what I got were results all over the place. One site said that skin cancers typically don’t hurt until they’ve grown rather large. One site said that skin cancers typically don’t hurt at all. Another site said that skin cancers can itch or be painful. Yet another said that while skin cancer areas can be painful, they will more likely be itchy. Clear as mud, right? In denial about squamous cell carcinoma And so, I decided that this quick-growing bump was not skin cancer, even though my dermatologist told me it looked like squamous cell to her and that squamous cell areas were typically fast-growing and seem to appear out of nowhere. Of course, my thinking wasn’t logical, but that was what I wanted to believe – and because I really did not want to have a surgery so close to the holidays. Pathology report causing more anxiety The day my doctor did the biopsy, she asked if I wanted to go ahead and schedule the surgery for removal, and I told her that I’ll wait until the pathology report comes back (because it wasn’t going to be cancerous, right?) And when the pathology report came back the next day as squamous cell, my brief time of disillusionment was over and I scheduled the surgery. Test result number one was finished.....1 down, 1 to go. I had made it through the waiting for the first result without too much anxiety. But after finding out it was indeed skin cancer and I then had a 3-inch incision on my chest from the removal of the squamous cell, the anxiety of getting the next test result set in because I did not want to have to undergo another excision, which would be necessary if the entire cancerous area hadn’t been removed. Good news post surgery I was in a meeting at work when I noticed my phone was ringing.....there it was - the call from my doctor. My phone screen continued to flash “Dr. K”, but I wasn’t able to answer. I knew she was calling with the test results, which suddenly made me extremely anxious. What if the results came back that the entire area hadn’t been removed and I had to go back for more surgery? Won’t it really hurt to re-open an incision and cut out more? How much bigger would the new incision need to be? Yikes. I’d worked myself into a tizzy within a matter of minutes. As soon as the meeting was over, I hightailed it out of there so I could listen to the voicemail from my doctor. Thankfully it was good news, and she said she was calling to let me know that all the margins were clear and I didn’t have to come back in for additional surgery for this spot. And what a relief it was to hear that I had passed the test! [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site"] Being a cancer patient is difficult, and I would argue that being a young adult cancer patient is infinitely more difficult. I went from being a normal, totally healthy 29-year old to being diagnosed with metastatic melanoma in a matter of weeks. The scans that I joked about being a very expensive inconvenience soon told me the truth I was very unprepared to hear. My metastatic melanoma diagnosis Typically a cancer diagnosis comes with some sort of immediate treatment plan. For me, I had already scheduled the stereotactic radio-surgery procedure of my brain before I even had a tissue biopsy to verify metastatic melanoma. The PET scan that lit up in several places, a brain MRI with a solid mass, and a history of melanoma was enough to convince my medical team we were dealing with something very serious. My doctors and medical team spent a great deal of time explaining the potential side effects of my treatment. They tried so hard to prepare me for the storm I was being forcefully thrown into. While it was immensely helpful to know what to expect, we neglected to discuss the mental side effects of a late-stage cancer diagnosis. I think this is often (unfortunately) an afterthought when it comes to cancer treatment. It wasn’t until I was nearly a year into treatment when my mind sort of caught up with everything that was happening. The physical and emotion struggle Once a very passionate, energetic person, I now found myself searching for things to care about and fighting the urge to take a nap (always). Fatigue was a side effect of my treatment, but I’m fairly certain going through day-to-day like a zombie, was not. There was a solid 6 weeks or so where I felt like I could burst into tears at any given moment. Sort of like my emotional capacity was completely spent. I was physically exhausted, emotionally exhausted, and sick and tired of being tired! 8 ways to deal with a metastatic melanoma diagnosis Let me tell you, it’s been one heck of a process to figure out and work through the mental trauma of a late-stage melanoma diagnosis. I wanted to share some of the ways I’ve learned to process being a metastatic melanoma survivor. 1. Feel your emotions Some days you might be having a not-so-great day, and that's 100% OKAY! I’ve learned that suppressing my emotions only causes them to be 10 times worse when they finally surface. If you let yourself feel through your emotions, they tend to pass a little quicker. Don’t dwell by any means, but recognize how you’re feeling and why you’re feeling that way and let yourself move through those feelings. 2. Don’t be afraid to let your mind wander You’ll likely run into a “what if” type of thoughts. Let yourself travel down that thought path. Assess the threat, determine the likelihood of it actually happening, and let your mind develop a plan. Don’t spend unlimited time in “what if” world, but I’ve learned that it helps to eliminate the fear of the unknown if you make it known. 3. Find a support system You can’t do it alone, no matter how independent you think you are. I’ve always considered myself a very independent person and I hated relying on other people. I found myself physically and emotionally incapable of doing certain things while going through active treatment. Find yourself a support system and let them help you. 4. Develop a toolbox This was something that became very important to me. There isn’t one single thing to help you cope with a cancer diagnosis. For me, it was a combination of therapy, a low-dose antidepressant, an activity log, and journaling. I started three different types of gratitude journals before I found a method that worked for me. Each person’s tool kit is different, so find what works for you. 5. Have patience for yourself Physically and mentally, you’re going through a lot. Have some patience and compassion for yourself and recognize that. Give yourself some overdue credit for all the things you’re doing and going through. This continues to be the biggest obstacle for me. I have a very high standard for myself, and I’ve had to reset my expectations and improve my self-love. I started an activity log to document all the things I was doing and to help me visualize it. 6. Don’t compare yourself to other cancer patients Every. Single. Person. Is. Different. Every diagnosis is different and every response to treatment is different. Finding people going through similar things might help you not feel so alone, but don’t compare your diagnosis or prognosis. 7. Set your boundaries This is oh, so important. Your cancer story is as public or private as you want it to be. You get to determine what pieces of information you share and who you share it with. Be mindful that the more you put information out there, you’re giving others permission to probe you for progress updates. 8. Try new things to find gratitude It doesn’t really matter what it is, but trying new things allows you to be present in the moment. It forces you to be hyper-aware and appreciate the things around you. I found this technique especially helpful leading up to scan days. So, tell me! How have you learned to cope with a cancer diagnosis? What information do you wish your medical team would have shared with you during your diagnosis? How do you process and cope with all your emotions? [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site]

Mental Wellbeing and Skin Cancer

Shock After Diagnosis

Ditching Debbie Downer

Nighttime Worry, Insomnia, and Skin Cancer: Part 1

Test Result Anxiety - The Adult Version

Fear When Being Diagnosed with Cancer

8 Ways I've Learned to Cope with the Trauma of a Late-Stage Cancer Diagnosis

Community Poll

Coping with Reality: Dermatologist Visit Edition

Getting Through The Days Before My Full Body Skin Check

How To Be Kind To Yourself

Fear of Recurrence? Not Me. Well, Maybe Me

Melanoma and Mental Health