MONITORS AND BLUNTERS

It’s normal to feel anxious after a cancer diagnosis. Denise Steuber, R.N., B.S.N., O.C.N., a nurse navigator with Mission Hospitals in Asheville, North Carolina, says cancer creates a different level of anxiety from other illnesses. “It’s not like having appendicitis,” she says. “You take out the appendix and that’s it. Women with breast cancer [have to be monitored by] their physicians for the rest of their lives. And they always worry: What if it comes back?”

The way a woman reacts to a breast cancer diagnosis has roots in her normal patterns of problem-solving and risk perception. Some women approach the diagnosis by learning as much as they can, searching the Internet, asking friends, poring over books and magazine articles, asking their doctors for more information, and seeking second opinions. Others need only the basic facts, preferring to go on with their lives rather than focusing on their illness. Psychologist Suzanne Miller, Ph.D., senior member and director of behavioral medicine at the Fox Chase Cancer Center in Philadelphia, calls these two types “monitors” and “blunters.”

Monitors are highly attuned to information, but they tend to dwell on the negative aspects of it, which makes them prone to anxiety. If a monitor’s Pap smear comes back abnormal, for instance, she might react by thinking: It’s cancer, and I’m in for months of painful treatment. “The more threatened monitors feel, the more anxious they get and the more they process the potentially negative, risky part of their diagnosis or treatment,” Miller says. “The more they do that, the more anxious they become, which in turn makes them focus more selectively on the risk component.”

Blunters are so named because, she says, “they psychologically blunt the impact of threatening information; they soften the edges around it. They’re not ignoring their health, but they tend to hear the more reassuring aspects of it. Information does not set off the same alarm bells it does for the monitors.” These types might react to that same abnormal Pap smear by thinking, I feel fine, so it’s probably nothing.

In between are women who are a mix of both styles. They accept the reality of their situation without taking a glass-half-empty attitude, and they actively look for information that will move them forward.

In a perfect world, every doctor would recognize a patient’s coping style and anxiety level and advise her accordingly. Realistically, however, it’s up to the individual to recognize what she needs from her health care team to make her less anxious. For doctors, Miller says, “DCIS is minimally threatening. But, psychologically, often the woman hears ‘breast cancer’ and she sees endless days and nights of suffering and endless complications. This psychological impact needs to be recognized and not trivialized.” So ask yourself which type you are. (Read more about these traits at the National Cancer Institute Web site.) If you are a monitor, you need information that provides reassurance—statistics, case studies and details that prove that cancer is not automatically a death sentence. If you’re a blunter, you need a more concrete, pragmatic approach: a schedule of what needs to be done and when. “And sometimes blunters need to be reminded to take the situation seriously and not avoid taking action because of their tendency to downplay things,” Miller says. For instance, a blunter with a diagnosis of DCIS needs to recognize that, as excellent as her prognosis is, she still requires follow-up mammograms and regular doctor visits.

Diane Glass’s anxiety instincts paid off. Glass, 60, of Carlisle, Iowa, sensed that something was wrong despite having a clean mammogram. A second mammogram and an ultrasound showed only a shift in calcification. One doctor suggested a biopsy, a choice with which Glass strongly agreed. It showed stage IIIA lobular carcinoma. Blending a monitor’s need to know with a blunter’s emphasis on the positive aspects, Glass learned all she could about her disease and attacked it with a mix of medicine both traditional—two separate mastectomies, chemotherapy, radiation and tamoxifen—and nontraditional: acupuncture, qi gong, and meditation. That was eight years ago. Today she is cancer-free.