Stress

Stress is a feeling of constant worry or tension. Stress affects many survivors at one time or another during survivorship, and each survivor will respond to stress in his or her own way. There are things that you can do to reduce stress and improve your quality of life.

Detailed Information

Suggestions

Additional Resources

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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 sections for questions to ask and for more resources.

Many survivors feel that the changes that cancer can bring are sometimes overwhelming and can lead to stress. This is the physical and emotional response to the pressures of life that come from events and situations that happen to you, such as having cancer. Stress may also come from thoughts or feelings that you have including the worries or fears that are a part of the cancer experience.

Everyone feels stressed, worried or tense at some point in their lives—it is a normal part of life for most. However, long periods of persistent, unrelenting stress can cause problems. Although stress will not bring your cancer back, it can affect how well you feel. Feeling overwhelmed can reduce the overall quality of life and lead to other physical and emotional concerns.

Some signs that learning ways to better manage stress include:

• Cancer is the first thing that is thought about every morning and last thing every night
• Minor aches and pains become frightening and upsetting You think that cancer has changed your life too much and you can't figure out how to manage your life now
• It feels like no one understands—not even loved ones and friends

When might survivors notice more stress in their lives?

Some survivors may not feel a great deal of stress during their experience with cancer. However, many describe the times when they are newly diagnosed, going through treatment, and immediately after treatment ends as some of the most stressful times.

Finishing treatment and seeing the health care team less frequently can add to worries about health. You may notice added stress in your life anytime you experience a significant change such as a change in jobs and insurance plans. Concerns about changes in important areas of your life, such as relationships, finances, or work, can also add stress. A move to a new city and need to find a new health care team may also add stress.

Adjusting to change is not always easy. Being aware in advance of events and situations that might cause stress can help. You may not be able to predict when these events 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.

What are some good ways to manage stress?

There are many things you can do to reduce stress levels if constant worry or tension begin to make it hard to live from day to day. Learning how to manage stress will not eliminate stress from your life, but it can improve how you feel during stressful times.

Do activities that help you to relax and de-stress.

• Walk around your neighborhood or a park
• Get a massage
• Practice breathing and relaxation techniques
• Practice yoga or tai chi
• 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 such as:
  • 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, and meditation.

Training your body and mind to relax takes practice. But once you do it, you will be able to create the same relaxed 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 your 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 or sound. 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 such as walking, fishing or knitting.
• The idea of meditation is to try to focus in the moment, on a single phrase or image. This may take some practice. At first, you will most likely 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 that you do not want to do or have to do.

Many survivors find that they develop new priorities after a cancer diagnosis. You may find that you no longer want to spend time doing certain things. If you have not been one to say no in the past, it may be helpful to think about and practice ways that will not be hurtful to others. For example, you may want to say something like:

• I wish I could, but I just do not have the energy right now.
• Thanks for thinking of me, but I just cannot do it.
• Not this time, but thank you for asking.
• I am sorry, but my doctor has told me that I have to do less right now.

Try to take time for a few quiet and calming moments in every day.

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 and 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

Is stress something that affects all survivors?

Stress affects most cancer survivors at one time or another during their cancer journey. Many experience a great deal during the diagnosis and treatment phases. However, some are surprised to find that completing treatment may also bring some stress. When treatment ends, survivors may worry because they are now without the constant attention and medical care that they received from their health care team.

Worrying that cancer could come back is a frequent concern of survivors. In addition, many are working to pay off medical bills and adjusting to life after cancer. Each survivor responds to stress in his or her own way.

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. Because some 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.

• Some physical signs of stress are:
  • Headaches
  • Loss of appetite or eating too much
  • Body aches and pains
  • Pounding heart
  • Grinding teeth
  • Stomach or bowel problems
  • Tense muscles
  • Fatigue
    
• Some ways that stress can affect behavior:
  • Misuse of alcohol or drugs
  • Mood swings
  • Difficulty concentrating or making decisions
  • Nightmares
  • Worrying
  • Becoming forgetful
  • Difficulty sleeping
  • Sexual problems

Will survivors always feel stress?

It is almost impossible to completely eliminate stress from your life. There are stressful events in normal, everyday life for everyone. 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 circumstances. Not all situations can be managed in the same way, but you may feel more confident knowing that you can take steps to eliminate many stressors.

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. For most people, it is possible to find less stressful ways to fulfill daily responsibilities. It may not be easy, but you might want to consider asking others for help. You may be surprised by how willing they are to help you get through this challenging time.

This document was produced in collaboration with:

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

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Stress: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. 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 Additional Resources section for links to more resources.

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 with the guidance of a health care professional –may also help you cope more effectively with life after cancer.

Make healthy behaviors a part of 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.

The following are some healthy behaviors that may help you manage stress:

• Eat a well-balanced, healthy diet including 5 – 7 servings of fruits and vegetables a day.
• Do not overeat.
• Talk with your health care team about good ways to exercise for your recovery needs.
• Limit caffeine and alcohol.
• Avoid the use of nicotine or recreational drugs. 

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Stress: Additional Resources

The previous sections of this document provide detailed information, suggestions, and questions to ask related to this topic. This section offers a listing of additional resources that are known to provide support and quality services that may be helpful to survivors during the cancer journey.

LIVESTRONG SurvivorCare Program
www.livestrong.org/survivorcare

LIVESTRONG SurvivorCare offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about treatment options and matching to clinical trials or treatments in development. Counseling services and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations including CancerCare, Patient Advocate Foundation and EmergingMed.

Cancer and Careers.org
www.cancerandcareers.org

This website provides information and tips for women who are balancing work with cancer treatment. Although targeted to women, much of the information is helpful to men as well including ideas for managing stress and talking to coworkers and others about being a survivor. Information includes making treatment decisions, organizing your health care information, managing health insurance, and maintaining your appearance and physical comfort during treatment.

Other sections of the website are directed to employers, co-workers, caregivers and the community. Specific guidelines are provided on how to support and help survivors in the workplace. The site includes charts, checklists, and questions to ask your health care team. They also offer an online career resource center with free career coaching services.

U.S. Institutes of Health - National Cancer Institute (NCI)
www.cancer.gov

The National Cancer Institute’s website provides accurate information about the challenges cancer can bring. You can search for information by cancer type or topic. You can find information about treatment, financial and insurance matters. You can also learn how treatments in development work and search for a clinical trial in your area. This site also has a good dictionary of cancer terms, drug information and other publications. Cancer information specialists can answer your questions about cancer and help you with quitting smoking. They can also help you with using this Web site and can tell you about NCI's printed and electronic materials. The knowledgeable and caring specialists have access to comprehensive, accurate information on a range of cancer topics, including the most recent advances in cancer treatment. The service is confidential, and information specialists spend as much time as needed for thorough and personalized responses.

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Stress: Additional Resources

The resources listed below provide more detailed information and support services to help you manage stress.  Please read the Detailed Information and Suggestions document for more information and questions to ask.

Click a resource for more information:

• LIVESTRONG SurvivorCare Program
• National Cancer Institute (NCI)
• AMC Cancer Information and Counseling Line
  

LIVESTRONG SurvivorCare Program
www.livestrong.org/survivorcare

LIVESTRONG SurvivorCare offers assistance to all cancer survivors, including the person diagnosed, caregivers, family and friends. The program provides education, information about treatment options and new treatments in development, counseling services and assistance with financial, employment or insurance issues. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations, including CancerCare, Patient Advocate Foundation and EmergingMed.

The LIVESTRONG Survivorship Notebook is a tool that can help you organize and guide your cancer experience. The portable, three-ring binder contains a variety of information covering a full range of physical, emotional and practical survivorship topics. You may order a free LIVESTRONG Survivorship Notebook at www.livestrong.org/notebook. Shipping and handling charges will apply.

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National Cancer Institute (NCI)
www.cancer.gov

Cancer.gov, the National Cancer Institute Web site, provides accurate, up-to-date information on many types of cancer and the challenges cancer can bring. You can also use the site to search for information by cancer type or topic, and you can access information about treatment-related issues. Information about financial and insurance matters is also included. You can learn how clinical trials work and search for a clinical trial in your area. This site has a detailed dictionary of cancer terms. Web site information and publications are available in Spanish.

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AMC Cancer Information and Counseling Line
www.uccc.info

This counseling line is staffed by trained professional counselors who can talk to you about your concerns. In addition, they provide medical information, resource referrals and emotional support through short-term counseling at no charge. Services are available to survivors, caregivers, family members, or anyone with questions about cancer.  This service is operated by the AMC Cancer Research Center, affiliated with the University of Colorado Cancer Center. The Web site has additional information about a variety of cancer topics, as well as links to other cancer sites.

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