Scanxiety (n) “scan zi et ee”: Anxiety and worry that accompanies the period of time before undergoing or receiving the results of a medical examination (such as MRI or CT scan). [Author's note: This word does not yet appear in any legitimate dictionaries, so I have jacked this definition from urbandictionary.com, where I normally go only to look up slanglish terms like waifu and weeaboo.]
Board Examination-Type Question:
Which of the following is true about scanxiety?
1. It is rational.
2. It is irrational
3. It is nearly universal among patients with cancer.
4. It attenuates over time
A. Choices 1, 2, and 3 are correct.
B. Choices 1 and 3 are correct.
C. Choices 2 and 4 are correct.
D. Only choice 4 is correct.
E. All choices are correct.
The correct answer is A.
Scanxiety is rational because the results of each scan can, literally, be a matter of life or death. It is irrational because patients feel it regardless of the actual probability of bad results. It really is nearly universal among patients with cancer who are getting scanned as part of their disease surveillance. It does not attenuate over time. (These answers are based on my personal experiences and on those experiences that lots of other cancer survivors have shared with me.)
Actual Blog Post:
My next scan (a MUGA scan to make sure that my trastuzumab is not damaging my heart) is next week, which, I suppose, is why I have chosen this topic for this month. I have had a lot of scans since my stage IV gastric cancer diagnosis 5 years ago. Initially I was getting scanned every 3 months, then every 6 months, and now just once a year. My last MUGA scan showed that my left ventricular ejection fraction (LVEF) was still normal limits, but had declined 10% since I had started trastuzumab infusions. If my LVEF has declined further, I will need to contemplate whether or not to stop trastuzumab, which, I am pretty sure, is what has been keeping me alive. I am very anxious. I am also feeling very tired and sort of syncopal, which I hope is all in my head.
Regardless of the results of my MUGA scan, I will be very anxious again in the fall when I have my next CT scan, although my post-surgery CTs have always shown no evidence of disease (NED, the three most wonderful letters in the English language) and I am not having any new symptoms.
Of course, sometime in the next couple months I will start getting new symptoms, particularly poorly defined abdominal pains. I will tell myself that those are all in my head too, but I will not really believe myself. That is to say that the frightened, irrational part of me is not really amenable to logic.
What has been most surprising to me is that my scanxiety has not attenuated over time. It seems that I should be exponentially less anxious each time, since the longer I go without a recurrence, the less likely I am to get a recurrence.
Which brings us to “Terror Management Theory” (TMT), which I know sounds like something I would make up, but you can look it up on Wikipedia. TMT has nothing to do with the TSA. It is a social psychology concept based on the fact that humans innately want to live, but know that sooner or later they are going to die. The attempt to resolve this opposition leads to terror, and that terror has a lot to do with the development of human culture. TMT uses culture to refer to the way that a specific group of people generally live their lives, including their behavior, their beliefs, their religions, and their attitudes. If you would like to move your level of understanding of TMT up from Wikipedia level, here is a link to the subject on Psychology Today.
The theory owes a lot to Ernest Becker’s Pulitzer Prize-winning book The Denial of Death, published in 1973, the year after his diagnosis of colon cancer and the year before his death from that disease. Becker argues that in order to escape the fear of death, each person constructs an “immortality project,” which allows the person to literally (as in religion) or symbolically (through influence on others or through membership in a larger group) continue to live after death.
My immortality project has included becoming spiritual for the first time in my life, joining the cancer survivor culture of “never give up” (although I am also a member of the hospice culture, which has a different message), spending as much time as possible with my granddaughter, teaching medical students, and writing papers and blog posts, which I hope will live forever through PubMed and the Wayback Machine.
I would have gotten the question "Are you going to die?" correct on a Board Examination. However, I spend most of my time between scans writing essay question answers that allow me to avoid the horrifying truth.
In the face of a new scan, though, my immortality project crumbles. All of the terror that I have been able to avoid suddenly comes back in full force.
So, what can you do to help your patients deal with scanxiety?
Well, you can get their scans scheduled as quickly as possible and get the results back to them as quickly as possible. Of course, this does not make a major difference in the course of their illness, but it does make a major difference in the course of their living. You can also bring up scanxiety with your patients when you order a scan and let patients know that it is normal and unavoidable. Perhaps most important, you can emphasize that you will be there to help them understand the results and the implications of the results and to help them make plans based on those results.
You can also join my efforts to have “scanxiety” included in the Oxford English Dictionary. When I entered the word in the OED website, here is what I got:
- No exact match found for “scanxiety” in US English
- Here are the nearest results from our other dictionaries:
- Garner's Dictionary of Legal Usage safety society variety
- Garner's Modern American Usage scansion scarify variety
- English-Spanish skankiest
- Italian-English sconquassiate
- English-Chinese skankiest
Come on, people, “scanxiety” deserves to be in the dictionary at least as much as “skankiest”!