Phobias and cancer treatment: What to know

Cancer is incredibly stressful. Phobias, or intense fears, can add another layer of stress and anxiety to the process – especially when that phobia is related to cancer treatment.

As a psychiatrist, I help patients manage their fears and anxieties so they can receive the best treatment possible.

Ahead, I answer common questions about phobias, how they impact cancer treatment and how your care team can help you navigate them.

What is the difference between nerves and a phobia?

Psychiatrists diagnose phobias based on criteria from The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5.)

Here are two examples of the criteria we use to separate phobias from nerves or anxiety.

Distress level

A phobia creates fear or anxiety that causes a clinically significant level of distress or impairment.  

For cancer patients, a phobia may cause a reaction that impacts their ability to get treatment. For example, some patients have such a strong phobia of needles that they feel nauseous or even vomit before lab draws. Their phobia causes a physical reaction that impairs their ability to have their labs drawn.

Distress frequency

This refers to how often the object or situation causes distress. Is a phobia causing a high level of distress often or just occasionally? Phobias often cause repeated distress for patients.

Whether or not you're diagnosed with a phobia, we can still help reduce your treatment-related anxiety. You don't need to have a phobia-level fear for something to be treatable. Cancer is hard enough; we don’t want to add any more stress to it. We want to help you manage that anxiety. 

What are some common phobias people face during cancer treatment?

Two common phobias faced during cancer treatment include:

• Claustrophobia: fear of tight, enclosed spaces
• Trypanophobia: fear of needles 

These phobias can cause treatment delays or impact a patient’s ability to receive the recommended treatment option. 

For example, sometimes a doctor will request their patient get an MRI. However, if you’re so claustrophobic that you can’t undergo an MRI, you might get a quicker imaging procedure such as a CT or an X-ray instead. This is an instance where someone's claustrophobia is affecting their recommended treatment.  

What should patients do if they have a phobia?

It's important to know that these fears are very common, regardless of whether they reach the level of a phobia. These fears are often exacerbated by the stress of the cancer diagnosis. 

Be sure to tell your treatment provider about any phobias or fears you have so they can find a treatment option that works for you and your needs. Sometimes that looks like managing a fear directly and moving forward with your recommended care plans. Other times, it looks like finding an alternative care plan. If we need to change to an alternative option, your doctor will discuss each option and its risks and benefits with you.

How can psychiatrists help patients manage phobias? 

In Psychiatry, our goal is to help patients achieve their treatment goals by meeting them where they’re at. If you aren’t comfortable with a specific treatment, we're not going to push you. If you want to overcome your fear, we will explore options with you.

Some ways we can help you manage your phobias include: 

Medication

A psychiatrist can prescribe medications that you can take as needed before a situation that causes anxiety. This medication can help reduce the anxiety that accompanies procedures such as MRIs, needle sticks or infusions. Medication can help patients manage their anxiety without delaying treatment.

Exposure therapy

Exposure therapy and other guided techniques are long-term options that can help you overcome your fear or phobia. In exposure therapy, you take the object that is causing your anxiety and purposefully expose yourself to a mild version of that object in a safe, calm environment. 

What is your best advice for patients who get nervous during procedures?

First, normalize the feeling. There's nothing wrong with you for feeling this way.

Then, try to distract yourself from anxiety and fear. Distraction can take on many forms. It could include bringing a friend or family member with you, playing a game, watching a video or listening to music.

Often, there is music playing when patients get MRIs or radiation treatment. Lots of times, patients can request something specific be played. Its a good opportunity to listen to your favorite song on repeat. 

Request an appointment at MD Anderson online or call 1-877-632-6789.