What is reassurance seeking after cancer?
Reassurance seeking is anything done to get a quick answer to the question "is it back?". Some of it involves other people and some of it happens alone.
Asking a partner whether a lump looks the same as last week. Ringing the clinic about an ache. Asking the oncologist the same question at every appointment, worded slightly differently. Pressing on the same spot every morning. Reading forum threads about a symptom at eleven at night. Looking up what a word on a scan report means, and then what the words in that explanation mean.
None of these are strange things to do. After cancer the body has already been wrong once, in a way that mattered, so wanting to check it is a sensible response to a real threat. And during treatment, paying close attention to the body was exactly what everyone asked of you.
What changes is the job it is doing. At some point, often without anyone noticing, checking stops being about gathering information and starts being about getting the feeling back to a level that can be lived with.
Why does reassurance only work for a few days?
Because relief is short-lived by design, and every time it follows a check, it strengthens the link between the two.
Here is the mechanism, stated once.
Every check buys real relief. That relief teaches the brain that the check is what produced the safety. So the next time the worry turns up, the brain reaches for a check a little sooner, and settles for a little less. Over weeks and months the gap between checks narrows, the relief wears off faster, and the reassurance that used to last a fortnight now lasts an afternoon.
The loop is built out of something that works. That is exactly why it is so hard to see from the inside. If checking made you feel worse straight away, you would stop. It makes you feel better, so it is repeated, and the feeling better is what keeps the whole thing turning.
It helps to separate two things that look identical. One is the information: the scan was clear. The other is the feeling: I am calm now. The information does not expire. A clear scan from last Tuesday is still a clear scan. What expires is the feeling, and once the feeling is the thing being chased, no amount of information is ever quite enough.
Why do I keep checking when the results were fine?
Because the results answered the medical question, and the check is trying to answer a different one.
A scan can tell you what was visible on the day of the scan. It cannot tell you that the cancer will never come back, and that second question is the one the worry is really asking. So the relief from a good result is real, but it is relief about the day of the scan. Within a few days the question drifts forward again to tomorrow, next month, next year, and there is no test for those.
This is also why a good result can sometimes be followed by a strange flatness, or even a spike of worry, rather than lasting calm. The result did its job. It just was not built to do the job the worry has handed it.
If you notice yourself asking the same question in a slightly different way, or needing to hear it from one more person, that is usually the sign. The information has not changed. The feeling has worn off.
Does googling symptoms make anxiety worse?
It often does, although it rarely feels that way in the moment.
Searching a symptom is a form of reassurance seeking that is available at any hour and never runs out. The first search usually brings a flicker of relief, because something ordinary comes up. But search results also contain the frightening explanation, somewhere, and a worried brain is very good at finding it. So the search that was meant to settle the worry often ends with a new thing to check, and another search.
A large review of the research found a strong link between this kind of repeated, distressing symptom searching and health anxiety, alongside a harder time tolerating not knowing (Schenkel et al., 2021).
There is nothing wrong with looking something up. The useful question is what happened afterwards. If you closed the laptop and got on with the evening, that search did its job. If it led to another search, and then another, and then a sleepless hour, the searching has become part of the loop rather than a way out of it.
Is it bad to ask for reassurance?
No. Asking for reassurance is a normal human thing to do, and a lot of it is sensible and necessary.
The distinction worth making is between checking that brings new information and checking that is repeating an answer you already have. Ringing about a new symptom brings new information. Asking your partner for the fourth time today whether the spot looks the same usually does not.
Nobody needs to feel embarrassed about which side they have been on. The loop is a description of learning, and people learn it because it worked. It says nothing about someone's character or strength, or how well they are coping.
It is also worth saying that the people around you get caught in it too. Partners and family often become the most reliable source of reassurance, and they give it because they love you. That can quietly become part of the loop for both of you, and it is one of the reasons it helps to understand the mechanism together.
When should I get help with reassurance seeking or fear of recurrence?
Keep two things separate here, because they need different responses.
A new or persistent physical symptom is always a question for your GP or treating team. Understanding the reassurance loop never means a symptom is only anxiety, and nobody should talk themselves out of getting something checked.
The worry itself is worth raising with a professional if it has been there most of the day, on most days, for two weeks or more; if the checking, searching or asking is taking up a lot of your time; or if it is getting in the way of sleep, work, relationships or making plans. Start with your GP or your treating team and say plainly that worry about the cancer coming back is taking up a big part of your day. Booking that appointment does not commit you to anything. It gets a proper look at what is going on.
If the fear is taking up a lot of room but you are not in crisis, there is also help built specifically for it. Calm After Cancer is my eight-week program for fear of cancer recurrence: the checking, the scan anxiety, the reassurance that never quite holds. It teaches the skills used in research-tested treatments for this fear, one week at a time, with a members' group where you can ask me questions as they come up. It is education rather than therapy, and it works alongside your GP and treating team rather than replacing them. Take a look at Calm After Cancer.
If you are having thoughts of harming yourself, contact Lifeline on 13 11 14, or call 000 in an emergency.
If you are not sure how much room the fear is taking up for you, how to tell whether your fear of cancer coming back is normal walks through the different levels and what each one tends to look like.
Where does this understanding come from?
The idea that reassurance seeking keeps health worry going, rather than resolving it, comes from cognitive behavioural models of health anxiety. The international consensus on fear of cancer recurrence lists coping strategies that maintain the problem among the features that distinguish a clinical level of fear from a normal response (Lebel et al., 2016). The approach here also draws on metacognitive and acceptance-based approaches, which look at what a person does in response to worry rather than arguing with the content of the worry.
This article is education. It is not therapy, it does not replace an individual assessment, and it makes no promise that the worry will go away.
Where can I go from here?
If this sounded familiar, The Cancer Rollercoaster community is free to join. You can read and listen at your own pace, nobody has to post anything, and reading along for months without saying a word is completely normal there.
On Tuesday 13 October at 1:30pm (Sydney time) there is a free live session on fear of cancer coming back: why the reassurance never quite sticks, what keeps the loop going, and what you can do when the worry is asking for the next check. It runs inside the community and it is recorded, so you can come live or watch it afterwards.
New to the community? Join here first, then save your spot.
Already a member? Save your spot for 13 October
References
Lebel S, Ozakinci G, Humphris G, et al. From normal response to clinical problem: definition and clinical features of fear of cancer recurrence. Supportive Care in Cancer. 2016;24(8):3265-3268. doi:10.1007/s00520-016-3272-5
Schenkel SK, Jungmann SM, Gropalis M, Witthöft M. Conceptualizations of cyberchondria and relations to the anxiety spectrum: systematic review and meta-analysis. Journal of Medical Internet Research. 2021;23(11):e27835. doi:10.2196/27835