by Dr. Bonnie McGregor, clinical psychologist and behavioral medicine researcher, Fred Hutchinson Cancer Research Center
Recovering from cancer treatment isn't just about your body—it’s also about healing your mind. As a cancer survivor, you know that the stresses in your life didn’t end just because you got cancer, nor did moving beyond cancer eliminate all of your worries.
Stress—the physical, mental or emotional tension experienced in reaction to an event—occurs when we perceive demands exceeding our resources. When you had cancer, probably most of your time and energy was focused on your treatment and getting healthy. As life returns to normal (or a “new” normal), projects and to-do’s that were rightly ignored can make you feel overwhelmed. Many survivors report common stressors like:
While some may underplay the role of stress (“It’s just part of life”), there’s strong evidence that we should take it seriously. In recent years, research has been able to definitively show how chronic stress can negatively affect health. Researchers have proven that long periods of high stress increase our vulnerability to colds, slows wound healing, decreases overall immune function, and raises blood pressure and cholesterol levels. It also increases heart disease, leads to poor control of blood sugar in diabetics, and raises the likelihood of poor health behaviors (unhealthy diet, smoking, no exercise). We’ve also learned that stress shortens telomeres—stretches of DNA at the end of chromosomes that protect the DNA from destruction, damages DNA and impacts its ability to repair, and increases the growth of blood vessels in tumor cells, which can fuel cancer.
When I counsel patients or teach stress-management classes, I urge people to increase their awareness of their stress levels by paying attention to their symptoms of stress. These signs range from headaches, sleeping difficulties and anger to chronic diarrhea, poor concentration and depression.
We can learn to manage stress by decreasing perceived demands and increasing perceived resources. Our thoughts affect our feelings, and stressful situations tend to prompt unhelpful automatic thoughts. For example, a lot of survivors understandably fear cancer recurrence and for many, every ache and pain triggers an automatic thought: maybe the cancer’s returned. It helps to challenge those thoughts by reminding yourself that you have gotten regular screening, you’ve been taking good care of your body, and that the odds are, it is just a sore muscle. At the same time, if the pain persists, it is important to contact your doctor. It can also help considerably to talk to close friends and family in your support system about your concerns. Other coping strategies include exercise, managing anger, and taking time for regular meditation or other relaxation practices.
Your health can be improved by reducing stress. A psychologist colleague, Dr. Samantha Artherholt, and I have recently begun offering SMART (stress management and relaxation training) classes at SCCA for cancer survivors, using scientifically proven techniques to reduce stress. Being a survivor can create added stress in your life. Many survivors find that it is helpful to talk with others about concerns, get emotional support from those who understand, and learn new ways of coping with life’s stressors.
Q: Does stress cause cancer?
No, scientific evidence does not point to stress directly causing cancer. There are many factors that contribute to whether or not we develop cancer. Cancer cells are always arising in our bodies and we have natural processes in place to stop this unchecked growth. But stress can make one more vulnerable to illnesses, including the common cold, cardiovascular disease and cancer. Stress can influence the course of cancer, whether through poor health behaviors like unhealthy eating or smoking, increases in DNA damage and poor DNA repair, decreased immune function or social isolation.
Q: How can I stop stressing so much about my cancer returning?
The thought of cancer recurring is very common in survivors; it’s stressful because it feels completely out of our control. But all situations have controllable and uncontrollable aspects. It’s true that to some extent, you have no control over whether or not your cancer recurs. But you can assert some control over the situation by getting regular follow-up screenings, exercising, avoiding tobacco, eating a healthy diet, having a good network of friends and family, and managing your stressors (including talking to other cancer survivors about your shared fears).
With practice, you can also become aware of your stressful thoughts (“This new pain in my back must be cancer.”) and change your thinking by challenging those notions with facts (“I’ve had all of my check-ups and everything looked fine. If my back’s still painful in two weeks, I’ll see my doctor. It’s unlikely that my cancer has come back.”). Gradually, this effort will help lower your stress levels. Most cancer survivors also report that the fear of recurrence fades with time.