People diagnosed with cancer and under treatment suffer severe stressors that can be overwhelming and debilitating. Cancer patients face physical challenges including side effects from disease and treatment, loss of bodily functions and independence, and body image concerns. They also experience social and emotional changes including socio-economic stress, anxiety, fear, grief, lack of social support and family-related distress.
Oncology social worker, Rebecca Cammy, says the top contributors to stress as a cancer patient can be:
- anxiety and fear of recurrence
- long-term physical changes and treatment side effects
- financial burdens from loss of income and medical bills
One study found that 1 in 3 people with cancer are diagnosed with a mental illness. A recent study presented at the AACR annual meeting found that women with ovarian cancer were three times more likely to be diagnosed with a mental illness than the general public. Additionally, colorectal cancer survivors are at increased risk for mental health concerns, including depression, during and after cancer treatment. In this study, mental health disorders were associated with decreased survival.
How to Manage and Reduce Stress
One of the best things to do is seek support–don’t go through the journey alone. Gregory D. Garber, an oncology social worker at Sidney Kimmel Cancer Center, suggests seeking support from others in similar situations. “Make sure to have your medical questions answered in terms of what to expect, what to report to the medical team and your follow-up needs. Get back to previously enjoyable activities, seeing friends and family, resuming work, regular meal and bedtimes as soon as you’re able to.”
Lisa Capparella, who is also an oncology social worker at Sidney Kimmel Cancer Center, suggests asking about support groups or peer-to-peer support. Lisa is actively involved in the Buddy Peer to Peer program at her local cancer center. “At SKCC, we have a Buddy Peer to Peer support program where patients who are a year or more out of active treatment can be linked to newly diagnosed patients to help normalize a lot of feelings and emotions. There are also many national agencies that have peer to peer support.”
Participate in Stress-Relieving Techniques
Capparella notes, “Each person is unique in what will help them cope with the stress. Some people seek educational programs, while others seek integrative techniques such as yoga, movement and mindfulness programs. It’s very important for patients and families to try a variety of programs to find what works best for them and provides them with comfort. For some, they enjoy programs that have very little to do with actual cancer and more to connect with others who are similar to them in diagnosis.”
Ask your providers about programs that are available to you or search for free programs such as:
- disease-specific symposia
- mindfulness-based practices
- monthly nutrition series
- art or music-based programs
- support groups
- massage and reiki
- survivorship series focusing on managing any side effects of cancer
- dance, movement or yoga classes
- healing through humor programs
Engage in Healthy Behaviors
Engage in Physical Activity
Most patients are encouraged to engage in physical activity, but each patient should talk with their physician about limitations on movement and creating a plan that fits the patient’s individual needs. “A recent expert panel convened by the American College of Sports Medicine reviewed the scientific literature and concluded that aerobic exercise 3 times weekly for 30 minutes was effective for addressing anxiety among people living with and beyond cancer,” says Dr. Kathryn Schmitz, leading exercise oncology researcher at The Pennsylvania State University. “This is notable, given that 45% of patients report elevated anxiety during cancer treatment.”
While stress and anxiety are separate emotional responses, they can go hand in hand. The American Psychological Association (APA) notes that anxiety “is defined by persistent, excessive worries that don’t go away even in the absence of a stressor. Anxiety leads to a nearly identical set of symptoms as stress: insomnia, difficulty concentrating, fatigue, muscle tension, and irritability.”
Focus on Healthy Eating
Nutrition is important while undergoing cancer treatment. As a specialist in oncology nutrition myself, I have counseled many people with cancer who have chosen to focus what they can control (foods that they eat) instead of what they cannot (cancer progression).
The American Institute for Cancer Research’s New American Plate model is an easy guide to help build meals that are centered on plant-based, whole foods. AICR also has a library of healthy recipes specially crafted for those undergoing cancer treatment.
Managing Emotions Through Mindfulness-Based Stress Reduction
Dr. Claire Conley, a psychologist and assistant professor of oncology at Georgetown University, encourages the practice of mindfulness. “Mindfulness helps you to stay focused on the present moment, instead of ruminating about the past or worrying about the future. There’s a lot of uncertainty when it comes to cancer treatment, and there’s a lot that you can’t control. Mindfulness can help you stay focused on the things that you can control, like going to your appointments, taking your medications, and engaging in healthy behaviors like physical activity and eating a balanced diet. By focusing on the things that you can control and letting go of the things that you can’t control, you can feel less overwhelmed and reduce your overall stress level.”
Improve Quality of Sleep
Sleep quality is often a problem for people receiving cancer treatment because of cancer medications, erratic schedules and the mental burden. Dr. Conley doesn’t typically recommend prescription and over-the-counter medications to treat sleep problems, but instead encourages cognitive behavioral therapy (CBT) for insomnia. “Many sleep medications have significant side effects and could potentially interact with cancer treatments. I recommend CBT for insomnia. CBT is a type of psychotherapy that focuses on recognizing and changing unhelpful thoughts and behaviors. One version of CBT specifically focuses on changing thoughts and behaviors about insomnia. CBT for insomnia has been shown to improve sleep quality in the general population, and there is growing evidence that CBT for insomnia is effective for cancer patients as well.” You can find a CBT Therapist here.
Improve Quality of Life
Cancer can have a significant impact on a person’s physical and mental health, ability to complete daily tasks, overall sense of wellbeing and may progress regardless of treatment. Palliative care teams focus on improving quality of life by bringing relief of physical and emotional symptoms caused by cancer. Sarah Hines, a psychotherapist in palliative care, encourages people to seek help for improving their quality of life. “It is a sign of strength to recognize the need for support,” she says. “In addition to oncologist and palliative care specialists, patients can benefit from establishing a relationship with a counselor, seeking spiritual/pastoral care, consulting with a dietitian, training with physical or occupational therapists and exploring integrative medical options. Cancer will do everything possible to take over, but balance is essential to quality of life.”
Avoid Using Unhealthy Habits to Manage Stress
“When life feels stressful, it is normal to turn to unhealthy strategies of coping, such as drug or alcohol consumption or other unhealthy behaviors like disordered eating,” says Capparella. “Generally, once patients or their families feel connected to resources and feel comfortable talking to a social worker, their healthcare team or other support systems and are making informed treatment decisions, the need for unhealthy behaviors seems to decrease. Helping patients and families find support that offers relief from distress is vital to helping patients feel a sense of control.”
Dr. Conley reminds us that many of those unhealthy habits are actually linked to cancer. “For example, not only does smoking cigarettes and alcohol abuse increase the risk for developing cancer, but these habits can also make cancer treatments less effective. While there are no guarantees, changing your unhealthy habits can give you the best chance for your cancer treatments to work. That’s a really big motivation for many people!”
AICR offers several free programs for cancer survivors including the Healthy10 Challenge and access to the iThrive program. The Healthy10 Challenge is a free, online program where participants are encouraged to live healthier by making improvements to their diet, nutrition and physical activity over the course of 10 weeks. Each weekly challenge focuses on either nutrition and diet or physical activity and movement.
iThrive is an educational tool for people with cancer that offers an integrative approach to health through personalized wellness plans. If you are dealing with an overwhelming amount of stress from your cancer journey, begin with the iThrive rejuvenation pillar.
Managing cancer-related stress is imperative during your cancer journey and it’s important to remember that you are not alone. There are support systems and resources to help you navigate the stressors that come with a cancer diagnosis. Talk to your healthcare provider to find the right resources for you.
- Mitchell AJ, Chan M, Bhatti H, et al. Prevelance of depression, anxiety, and adjustement disorder in oncological, haematological, and palliative-care settings: a meta-analysis. The Lancet Oncology. 2011;12:160-174.
- Ovarian Cancer Patients Face Increased Risk of Mental Illness. American Association Cancer Research website. Updated April 10, 2021. Accessed May 13, 2021. https://www.aacr.org/about-the-aacr/newsroom/news-releases/ovarian-cancer-patients-face-increased-risk-of-mental-illness/
- Shane L, Baraghoshi D, Tao, R, et al. Mental Health Disorders are More Common in Colorectal Cancer Survivors and Associated with Decreased Overall Survival. Am J Clin Oncol. 2019;42(4):355-362.