Perfectionism May Drive Fear of Recurrence in Breast Cancer Survivors

A common pattern regarding fear of cancer recurrence was seen in patients with breast cancer who are driven by behavioral aspects of perfectionism, an expert told CURE®.

“For both perfectionists and those who have simply lost confidence in their own body knowledge, there is a need to develop a ‘new norm.’This is the subject of much patient dialogue as they approach the end of treatment and survivorship care. The terror of encountering one’s limitations and vulnerability that is the result of this experience certainly exacerbates the many unknowns of the breast cancer experience, said Lisa Donley-Lanyi, an oncology social worker in the Department of Supportive Care Medicine at City of Hope.

Donley-Lanyi discussed the importance of knowledge on perfectionism and fear of cancer recurrence correlation, alongside resources and solutions based for the patient population.

CURE®: Can you further explain perfectionism within patients, and how it affects their fear of cancer recurrence?

Donley-Lanyi: Perfectionism is a compensatory mechanism for fears of unwanted vulnerability. When perfectionism is an aspect of personality development, it results in a focus on maintaining perfect control of self and others as well as life circumstances. The diagnosis of cancer, in and of itself, is a serious challenge to any concept of control related to one’s health. If a patient’s health has been generally good and reliable, then the experience of the diagnosis of breast cancer presents a special challenge to any perception of physical invulnerability. Once it has occurred, there is no longer the same confidence in control that had previously characterized most intentional efforts on the part of the patient.

Are there any solutions for this?

There are undoubtedly different “solutions” or approaches to this process dependent upon each individual’s unique predispositions and competencies and past life experiences. For the perfectionist with the associated high degree of vigilance necessary to capture and control as much of life as possible, the encounter with cancer defeats their perfectionistic need to control what is clearly rarely an event that can be predicted and therefore controlled. Because perfectionism relies on extreme vigilance to achieve control, understanding how to self-soothe in circumstances of vulnerability can be a key starting place.

We encourage patients to develop a shared understanding with their medical team of the kinds of aches, pains or changes in their body which their oncologist would want to hear about as well as the team member who can be their contact to facilitate assessment and resolution of physical concerns.

What resources are available, or how can patients advocate for themselves?

Essential to the successful integration of new strategies is to first facilitate comprehensive assessment of the impact of cancer-related acquired hypervigilance on the patient’s general well-being. This may manifest as disturbances in sleep, appetite, stamina and diminished recovery. It may require specific psychopharmacologic intervention to appropriately position the patient to benefit from efforts at developing new skill sets.

In the Department of Supportive Care Medicine at City of Hope, we have a team of psychiatrists, psychologists, clinical social workers and pain management experts assessing and treating any emerging biochemical correlate of hypervigilance as an essential starting point.

Within this field, which advancements have been seen in 2023? Alongside this, what is the plan for 2024, what can we expect to see?

As 2023 ends and 2024 begins, we at City of Hope queried our own Matt Loscalzo, professor emeritus of the Department of Supportive Care Medicine and executive director of the transformation office at City of Hope, for his insights as to the achievements in the field of psychosocial oncology over the past year as well as the anticipated areas of focus in 2024.

Per Matt, “in recent years, cancer risks and treatments have become more aware and sensitive to the diversity of cancer patients as complex bio-psycho-social entities. This has driven research and clinical medicine to precision medicine that takes the totality of person and society into account. In the next year, the importance of social determinants of health* will only accelerate as approaches to cancer prevention and cancer become more precise and effective.”

This transcription has been edited for clarity and conciseness.

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