Dr James: Why ‘scanxiety' around cancer is common

Telegraph

20 hours ago

Cancer being a most serious business inevitably evokes alarm and despondency. This might be mitigated, at least in part, by awareness of its favourable prognosis, particularly for those where it is diagnosed early. The combination of surgery to remove the tumour plus appropriate 'adjuvant' therapy should hopefully result in a complete cure in excess of 90 per cent of those with, for example, the common cancers of the bowel, prostate and breast.
These excellent outcomes from 'treatment with curative intent' (as it is known) necessarily poses the question 'What next?'. Specifically, how frequently and thoroughly should doctors seek out with tests and scans the possibility it may have recurred in the small minority in whom it does?
Patients' attitudes to this continuing ' routine surveillance ' are mixed. They certainly welcome the reassurance from those follow-up appointments – initially every few months and then at yearly intervals – that all is well, and the opportunity to discuss any concerns they may have. That reassurance may, however, be offset by trepidation in the weeks leading up to the appointment and particularly 'scanxiety', the apprehension that the findings of those scans might be inauspicious. 'It is all quite nerve-racking', comments a participant in a study of the phenomenon. 'Even if you are feeling fine, the fear of what might be revealed is most distressing'.
While the rationale for 'routine surveillance' is entirely plausible – cancer recurrence detected before causing symptoms is likely to respond more readily to further treatment – the value of those repeat scans has recently been questioned. 'The empirical case is weak', notes Dr Gilbert Welch, commenting on the absence of the measurable benefit from the full canopy of investigations (ultrasound, bone scans, CT and MRI scans), which does not preclude the possibility they might be advantageous for some. The equivocal merits of such investigations is a common conundrum of modern medicine, but perhaps further encouragement to those 'treated with curative intent' to put their cancer diagnosis behind them and look optimistically towards the future.
Coffins that inspire
Many will have noted the diverting correspondence in this paper on embellishing funerals with idiosyncratic (and witty) allusions to the enthusiasms of the deceased. What more fitting tribute for a man who loved working his allotment than to bury him in his gardening clothes: or to place a jar of honey amongst the flowers on a beekeeper's coffin: or, for an adventurous climber, a compass 'to navigate his way to eternity'?
Those seeking further inspiration might consider visiting the British Museum's enthralling Living and Dying gallery. Perhaps the most striking of the many exhibits are replicas of the tall, thin, elaborately decorated upright coffins of the North Australian Aborigines. The bones of the deceased painted in red ochre are broken up and placed in a tree trunk – hollowed out by termites – in which the spirit will travel to the Land of the Dead. Carvings on the exterior illustrating local landmarks ensure it will not get lost on the way, while family and friends dance around acting out the hazards that might be encountered. Following the ceremony, the coffin is left standing upright to be gradually eroded away by the elements. It is difficult to imagine a more uplifting – or ecological – send-off.
A clever solution to athlete's foot
Finally, my thanks to a couple of readers for passing on their experience of simple remedies for the intense itchiness of athlete's foot, where the standard antifungal creams, as a university lecturer comments, 'never work for very long'. Following his customary evening bath, he now rubs a tuft of cotton wool soaked in surgical spirit under and between his toes that keeps the skin 'a lovely healthy pink colour'. The next is an exercise in lateral thinking, the principal being that both athlete's foot and dandruff are primarily caused by a fungal infection. 'After soaking my feet in anti-dandruff shampoo for a few minutes, massaging it between the toes, the macerated skin floats away and the itching resolves', writes a Bath reader. 'Occasional supplement applications keep it in check'.