Tackling the Fear of Cancer Recurrence: An Interview With Survivorship Researcher Dr. Christine Maheu

By Sangeetha Paramathas

How long have you been in the research field?

I started my PhD in 1998 and began conducting research in 1996 by being a research assistant at the master’s level.

What does your research focus on?

For my PhD at UBC, I interviewed 22 families who were testing inconclusive for the genes BRCA1 and BRCA2. They had a very strong family history of breast and ovarian cancer but they couldn’t find a mutation. I studied what the psychological impact is of knowing that you are at risk of developing cancer. For my post-doc at U of T, I developed an intervention to deal with the anxiety and the uncertainty that arises from living with an unknown inherited mutation for cancer. Afterwards, that study led me to the fear of cancer recurrence study for patients finishing cancer treatment. Fear of cancer recurrence is often the number one concern and is also often unscreened and untested. With a colleague from the University of Ottawa, Dr. Sophie Lebel, we put together an intervention – it is a 6-week therapy group, that was built from evidence and is theory based. It is a cognitive existential group therapy that is currently offered for breast and gynaecologic cancer survivors and is available in Montreal, Ottawa, and Toronto.

What is cognitive existential therapy?

It focuses on how to reframe your thoughts in such a way that the patients do not automatically feel that every pain, ache or bodily sensation is a sign of recurrence. We help them look at how to unfreeze themselves from their anxiety and what the impacts of living in constant worry are. We’re teaching them coping skills such as: reading, going out for a walk, doing relaxation exercises and calming self-talks. We teach them how to self assess so that they know when to use their coping skills and what method is more effective for them to lower their anxiety and fear of recurrence.

What does a typical workday, like today, look like for you?

I am involved in many studies. Right now, we are in the recruitment phase for three studies. I ensure that we have pamphlets and ads up for recruitment and I talk to physicians to see if they have patients to refer. I like to keep up-to-date on where we are with data collection and oversee data entry from questionnaires. I coordinate follow-ups with patients, prepare for presentations and talks and work on my own scientific papers. I also supervise graduate students!

What are the best and hardest parts of the therapeutic interventions that you run?

The last session of the 6-week intervention is what I look forward to the most. Realizing that we’ve made a difference in these women and that it has helped them. Rarely do I see that the work we do hasn’t made any change, and it is nice to see that.

The hardest part is helping patients go through difficult sessions (such as sessions 4 and 5) where they talk about their worst-case scenarios and having to discuss it. Often their fears are about “What happens if I pass away” and “What would happen to my family”.  These are difficult moments that we need to prepare for ourselves as group leaders to make sure that we are well grounded.

Why is survivorship research important?

All the late and long-term effects of cancer and its treatments are important. Often patients who have finished their treatment will tell you that they feel they are forgotten, that they still have questions, and wonder who will be following up with them. Cancer survivorship is a stage of the disease and cancer is a chronic illness that you have to live with; it’s not like catching a cold. We have to develop a program of care for these patients who will be feeling different (long-term) symptoms that require professional care.

Is integrating survivorship care into primary care important?

Once patients finish treatment, the transition to their primary care (family) physician is difficult; there is no streamlined approach. Some patients will get good follow-up care whereas others may not. Ideally, we would like for the family physicians to be involved with the patients cancer care from the start with the oncology team. Patients would gain from being informed early on of the possible late and long-term effects that may result from their cancer and cancer treatment, and these include the psychological impact. Survivorship care needs to be discussed at the start of treatment using a standardized approach, and perhaps one that is universal across all provinces. The issues with cancer and its treatment remains the same no matter what province you are from.

How has research in survivorship research changed since you started in research?

The psychological aspects of cancer care weren’t considered an issue 15-20 years ago. Now it is becoming more known and accepted that there is a psychological aspect to cancer care. Now, there are many organizations and conferences (such as the Canadian Association of Psychosocial Oncology (CAPO) for nurses, social workers, doctors, psychologists and psychiatrists to come together and discuss the psychosocial aspects of cancer. Distress and anxiety are becoming additional vital signs that are screened for as part of follow-up cancer care. Today, most provinces have in place a survivorship program or a wellness centre available to patients right from the beginning.

Thank you so much for your time Dr. Maheu. Your work sounds very important and it addresses key aspects of cancer care and illustrates cancer research in a new light. You are doing some amazing work, good luck!