Stress: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources.

You may feel overwhelmed by the changes cancer brings to your life. Many survivors feel this way. These changes often lead to stress. Stress is the physical and emotional response to the pressures of life. Stress comes from events and situations that happen to you-such as having cancer- as well as from thoughts or feelings that you have- such as worries or fears that are a part of the cancer experience.

Stress is a normal part of everyone's life. Everyone feels "stressed out" - worried or tense- at some point in their lives. But long periods of persistent, unrelenting  stress can cause problems. Experiencing stress will not bring your cancer back, but it can affect how well you feel. Feeling overwhelmed by stress can reduce the overall quality for your life and lead to other physical and emotional problems.

If constant worry or tension makes it hard to live day to day, there are many things you can do to reduce you stress. Learning how to manage stress won't eliminate stress from you life, but it can improve how you feel during stressful times.

Is stress something that affects all survivors?

Stress affects many cancer survivors at one time or another during their survivorship.

Many cancer survivors remember feeling a lot of stress during their diagnosis and treatment. But most people don't realize that being a post-treatment cancer survivor may also cause stress. When cancer treatment ends, some survivors worry becuase they are suddenly left without hte constantattention and medical care they received from their health care team. Stress may also come from worrying that the cancer will come back, trying to pay off medical bills and adjusting to life after cancer.

Each survivor, however, responds to stress in his or her own way. You may feel that cancer didn't bring any added stress to your life. If it did add stress, you may be able to handle the stress without much effort. Or you might have a hard time expressing how much stress you feel because you think that once your treatment ends, cancer shouldn't affect you anymore. That is not true. It's important to realize that stresscan be a very natural response for survivors ho are trying to cope with life after cancer.

Cancer can be scary. Before your diagnosis, you may have not known much about cancer or known how much it would change your life. There is a lot to learn and this can seem very overwhelming at times.

You might benefit from learning how to manage stress if:

• You think about your cancer first thing every morning and last thing every night
• You are frightened or upset by minor aches and pains
• You think that cancer has changed your life too much and you can't figure out how to manage your life now
• You think that your family and friends do not understand you

What are some signs that stress may be affecting a survivor?

If you are experiencing a lot of stress in your life, you may notice physical side effects or changes in your behavior.

Some physical signs of stress are:

• Headaches
• Loss of appetite or eating too much
• Body aches and pains
• Pounding heart
• Grinding teeth
• Stomach/bowel problems
• Tense muscles
• Fatigue

Some ways that stress might affect your behavior:

• Misuse of alcohol or drugs
• Mood swings
• Difficulty concentrating or making decisions
• Nightmares
• Worrying
• Becoming forgetful
• Difficulty sleeping
• Sexual problems

Because some of the physical symptoms may feel like signs of a recurrence of cancer, experiencing them can add even more stress to your life because you may worry that the cancer has come back. Discussing your symptoms with a member of your health care team can help determine whether or not they are stress related.

When might survivors notice more stress in their lives?

Many cancer survivors describe the time immediatly after treatment ends as one of the most stressful times in their cancer experience. Finishing treatment and seeing your health care team less frequently can be scary. Worries about your health staatus can be extremely stressful during this time. Concerns about changes in important areas of your life, such as realtionships, finances, or work, can also add stress.

You may notice added stress in your life anytime you experience a significant change.Examples of changes that might cause survivors stress:

• When you change jobs and change insurance plans
• When you move to a new city and need to find a new health care team
• If you or someone close to you has a new health problem

Adjusting to change is not always easy. Being aware of events and situations that are likely to cause you stress can help. You think ahead of time about ways you can best manage expected stress and take steps to handle it before it becomes overwhelming.

You may not be able to predict when the stressful times will come or how much impact they will have on your life. If unpredictable events and situations cause you to feel overwhelmed or helpless, you can learn and practice some simple skills that can help you handle symptoms of stress as you experience them.

Will survivors always feel stress?

For most people, there are some areas of daily life that cannot be changed. However, it's sometimes possible to find less stressful ways to fulfill your daily responsibilities. It's not always easy, but you might want to consider asking others for help. You might want to spend some time thinking about areas of your life that you can change to reduce your stress level. Changing small parts of your day may make a big difference in the amount of stress you experience.

It is almost impossible to completely eliminate stress from your life. There are stressful events in normal, everyday life. When you are concerned about your health, stress can increase. However, with practice and support, many survivors can and do learn skills that help them achieve peace and relaxation in spite of stressful circumstance. Not all stressful situations can be managed in the same way, but you may feel more confident knowing you have a place to start.

This document was produced in collaboration with:
Hester Hill Schnipper, LICSW
Chief, Oncology Social Work
Beth Israel Deaconess Medical Center, Boston

Stress: Suggestions

Do activities that help you relax:

• Walk around your neighborhood or a park
• Get a massage
• Practice breathing and relaxation techniques
• Practice yoga
• Talk to friends and family
• Talk with a professional therapist
• Attend a support group
• Make time for hobbies and things you enjoy
• Ask for help with daily activities such as housework, errands and cooking
• Pray or meditate
• Write in a journal
• Listen to music
• Read
• Watch your favorite TV show or movie

Find ways to sleep better when you are feeling stressed:

• Try to do something quiet and relaxing for the last hour before you go to sleep.
  • Read a good book
  • Watch a television program you enjoy
  • Listen to soothing music
  • Practice yoga
  • Meditate
• Take a warm bath
• Try a white noise machine to block out street noise and provide soothing background sounds.
• Learn a few simple relaxation exercises that you can do in bed. Breathing exercises are a good thing to try in bed if you are having trouble sleeping. Breathe deeply and concentrate on your breath as you tighten and then relax your muscles.
• If you find that you are tossing and turning, it may help to get out of bed and go to another room in your house. One option is to have a cup of herbal tea or get comfortable on the couch and read for fifteen minutes. Then try going back to bed.

Learn and practice relaxation techniques such as guided imagery, progressive muscle relaxation, or meditation:

Training your body and mind to relax takes practice. But one you do it, you will be able to create the same realxed state whenever and wherever you want. There are many ways to meditate, but they all are intended to help you relax and feel more centered in the moment in you body. One of the easiest methods is called the Relaxation Response. To try it you should sit comfortably, close your eyes, and repeat a single word of phrase over and over in your head or aloud. As other thoughts intrude, just tell yourself that you will think about them later. Some people meditate by concentrating on a peaceful image. Think of a place you love and try to transport yourself there in your mind. Prayer is a common form of meditation. For some people, it is the best way to clear your mind and feel soothed.

Although most people meditate while sitting or lying still, some people find it easier to combine meditation with movement: walking, knitting, even doing dishes. The idea is to try to focus on the moment, on a single phrase or image. You shouldn't get upset if you find yourself thinking about other things while you are trying to meditate. It may take practice to relax and calm your mind.

Learn to say "no" to things you don't have to do:

It can feel rude or ungrateful to say "no," but it might help if you think of and practice ways to say no before people ask you to do things that you can't or don't want to do.

• I wish I could, but I just don't have the energy right now.
• Thanks for thinking of me, but I just can't do it.
• Not this time, but thank you for asking.
• My doctor has told me that I have to do less. So, I'm sorry but I can't.

Try to have a few quiet and calming moments in every day possible:

Wake up a few minutes earlier in the morning. Take a walk or just sit with your cup of coffee or tea and look at the new day outside your window.

Consider planting a small garden or bringing home a few flowering indoor plants. Check them every day to watch their growth.

Above all, remember to sometimes put yourself and your own needs first. You deserve the time you need to take the very best care of yourself that you can.

Look at how you handled stress in your life before cancer:

Ask yourself these questions about how you have handled stress in the past:

• Do you feel better trying to maintain your usual life routines?
• Do you feel better taking a break as you handle stress?
• Does it help to talk with your family and friends?
• Does it help to speak with a therapist?

This may help you as you learn how to manage stress that is related to your cancer experience. However, you might need to learn new ways to handle this type of stress. You can use these strategies as a place to start for managing your cancer-related stresses. A stress management training program - either through self-study or ith the guidance of a health care professional - may also help you cope more effectively with life after cancer.

Include healthy behaviors in your daily life:

Sometimes, eating healthy foods and including an exercise plan that fits your recovery needs into your life may help you manage stress. Any changes in your diet or exercise plan should first be discussed with a member of your health care team.

Some healthy behaviors that may help you manage stress:

• Eat a well-balanced, healthy diet including 5-7 fruits and vegetables a day
• Do not overeat.
• Exercise in ways that are healthy for you – talk to your health care team about what exercises are right for your recovery needs.
• Limit caffeine and alcohol 
• Do not use nicotine or recreational drugs.

Hester Hill Schnipper, LICSW
Chief, Oncology Social Work
Beth Israel Deaconess Medical Center, Boston