Stress and cancer

 

Introduction

What is stress?

Stress is the body's reaction to any change that requires an adjustment or response. The body reacts to these changes with physical, mental, and emotional responses. Stress is a normal part of life. You can experience stress from your environment, your body, and your thoughts.

 

Here we will discuss on stress in relation to cancer. Stress happens at various times during the cancer trajectory. It could be at the time of symptoms, then at the time of biopsy, waiting for results before start of treatment, during every follow up visit, during a relapse and often during the end of life phase. Here not only is the person with cancer but also the family and loved ones are suffering from stress.

 

The impact of stress on life can be harmful or maybe not depends on how stress is handled. Sometimes one is unable to recognise the symptoms and it gets worse.

 

We describe below a story of one particular case. When we first visited the couple, both appeared cheerful. The wife had advanced stage cancer and chemotherapy and other specific treatments had failed. However, she appeared to be relatively comfortable. Her husband on the other hand appeared anxious but would often play it down. We visited her on many occasions as with time, her symptoms got worse. With medications her pain was controlled. On one occasion we had to visit her urgently. During that visit we found out that her pain was pretty bad and she had not been taking her pain medications. They were told not to take the pain medications as it would make her an addict. We answered all their questions and explained about side effects especially about addiction. They were highly anxious and stressed by her pain.

 

In this scenario which is very common in cancer patients who are reluctant to take pain medication due to fear of addiction. Sometimes their fear is reinforced by medical professionals too. Times like this they get confusing messages. That adds onto their stress.

 

The carer becomes even more stressed as he is not sure if he will be blamed if he continues to give his wife the pain medications.

 

When one is stressed pain gets heightened. It is crucial to advise both regarding managing pain as well as managing their associated stress. Many of the symptoms that were described to us were linked to stress rather than pain.

 

Listed below are the most common symptoms of stress.

 

1. Emotional symptoms of stress include:

• Becoming easily agitated, frustrated, and moody
• Feeling overwhelmed, like you are losing control or need to take control
• Having difficulty relaxing and quieting your mind
• Feeling bad about yourself (low self-esteem), lonely, worthless, and depressed
• Avoiding others

 

2. Physical symptoms of stress include:

• Low energy
• Headaches
• Upset stomach, including diarrhea, constipation, and nausea
• Aches, pains, and tense muscles
• Chest pain and rapid heartbeat
• Insomnia
• Frequent colds and infections
• Loss of sexual desire and/or ability
• Nervousness and shaking, ringing in the ear, cold or sweaty hands and feet
• Dry mouth and difficulty swallowing
• Clenched jaw and grinding teeth

 

3. Cognitive symptoms of stress include:

• Constant worrying
• Racing thoughts
• Forgetfulness and disorganization
• Inability to focus
• Poor judgment
• Being pessimistic or seeing only the negative side

 

4. Behavioural symptoms of stress include:

• Changes in appetite -- either not eating or eating too much
• Procrastinating and avoiding responsibilities
• Increased use of alcohol, drugs, or cigarettes
• Exhibiting more nervous behaviors, such as nail biting, fidgeting, and pacing

 

When we have stress, our body reacts with neurological and endocrine changes. For a temporary stress like having to do public speaking, this is healthy. However, when this stress becomes chronic, it impacts our immune system and healing process. Hence it would be advisable to learn how to react to stress and return to a calm state of mind.

 

By adopting psychological and medical interventions, stress can be reduced. Most of the physical symptoms stated above can be reduced. We have stated some tips below on managing stress.

 

Tips for reducing stress

 

Stressors are sources of stress. Some stressors are predictable and, therefore, sometimes avoidable. You can often lower the amount of stress in your life by making small changes. Consider the following tips for reducing stress:

 

1. Avoid scheduling conflicts.

Use a day planner, your phone, or an online calendar to keep track of appointments and activities. When you schedule activities, allow plenty of time to finish 1 activity before starting the next. Do not schedule too many activities for the same day or week, especially activities you need to prepare for. If managing your schedule is exhausting, ask someone you trust to help review your appointments.

 

2. Be aware of your limits.

If you do not have the time, energy, or interest, it is okay to politely decline when people ask you to take on tasks. Do not feel guilty over saying no. A cancer diagnosis is life-changing, and focusing on the things that matter most makes good sense. At work, do not volunteer for projects that would make your workload unmanageable. If saying “no” feels difficult, tell the person asking what you can do instead. This could be doing a smaller part of the task or having more time to complete the task.

 

3. Ask for help.

It is also good sense to ask family, friends, and coworkers for help. People are likely to offer their support, so think about particular tasks you need help with beforehand. People appreciate being able to help in specific ways. For example, family or friends may be able to help with shopping, meal preparations, pet-sitting, or picking up a child from school.

 

4. Prioritize your tasks.

Make a list of the things you routinely do, such as work and household chores. Rank these things by importance, considering the things you must do and the things that are most important to you. If you do not have time to do everything, focus on the tasks and activities at the top of your list.

 

5. Break down tasks into smaller steps.

Sometimes large tasks can be done in smaller steps. This process can make seemingly overwhelming problems easier to handle. For example, instead of spending an afternoon cleaning your entire house, tackle 1 or 2 rooms each day.

 

6. Concentrate your efforts on things you can control.

A stressor may be something you cannot change or control, even with the best planning. Traffic is one example. People who can remain flexible keep their stress low. Sometimes the only aspect of a problem you can control is how you react to it. If it helps, think of it as saving your energy to spend on things more important to you.

 

7. Get help with financial problems.

Talk with an oncology social worker or a financial advisor who knows about cancer-related insurance and financial matters. Do not wait to find financial help. Late bills and debt can quickly become overwhelming.

 

Stress management strategies

 

Although you can try to reduce the number of stressors in your life, you cannot completely avoid stress. However, stress management strategies can help you feel more relaxed and less anxious. The following are tips to help reduce stress:

 

1. Exercise regularly.

Moderate exercise such as a 30-minute walk several times a week can help lower stress. Talk with your doctor before starting an exercise schedule.

 

2. Spend time outside.

If possible, take a walk outside in a park or other natural setting. Sunlight, fresh air, and the sounds of nature can help brighten a person’s day.

 

3. Schedule social activities.

Make time to socialize with family or friends, as it is a good way to lower stress.

 

4. Eat well.

Maintaining a healthy diet and getting enough rest will give you more energy to deal with daily stressors.

 

5. Get plenty of sleep.

Life is busy and some people may think that sleep is indulgent. But sleep is essential to help the body stay healthy and heal. Try to get 7 or more hours of sleep each night. Naps during the day can also help. If you are having difficulty sleeping, talk with your health care team about ways to manage sleeping problems.

 

6. Join a support group.

Support groups offer you the chance to talk about your feelings and fears with others who share and understand your experiences. You can also talk with a trusted friend, a counselor, or a social worker.

 

7. Schedule daily relaxing time.

Spend time doing an activity you find relaxing, such as reading a book, gardening, or listening to music.

 

8. Do things you enjoy.

Eat at your favourite restaurant or watch your favourite television show. Laughter reduces stress, so consider seeing a funny movie or reading a humorous book to help cope with stress.

 

9. Write in a journal. Writing about the stresses and events in your life provides a private way to express your feelings.

 

10. Learn a new hobby.

Engaging in a new and challenging activity gives you a sense of accomplishment and provides a distraction from daily worries. Examples include taking an art class or playing a musical instrument.

 

Relaxation techniques

Many people learn and practice relaxation techniques to lower stress. You can learn most of them in a few sessions with a counsellor. Many hospitals and cancer centres also have classes to teach patients relaxation techniques. Consider doing the following techniques daily or at specific stressful times, such as during a medical procedure:

 

1. Relaxed or deep breathing.

This involves deep, slow breathing while concentrating on filling the lungs and relaxing muscles.

 

2. Mental imagery or visualization. This helps you create peaceful and relaxing images in your mind.

 

3. Progressive muscle relaxation.

This technique involves tightening and then relaxing muscles. Most people start at either the toes or the head and progressively relax all the muscles across the body.

 

4. Meditation.

With this technique, you can learn to relax your mind and concentrate on an inner sense of calm.

 

5. Biofeedback.

This technique can teach you to relax and control your body's response to stress by paying attention to signals from the body.

 

6. Yoga.

Yoga focuses the mind on breathing and posture to promote relaxation and reduce fatigue.

 

Tips for Home case

In the home environment when one is physically unable to carry out many of the exercises, simple passive exercises like stretching can be done by oneself or with the help of others. Meditation can be done by listening to music or gazing at a plant or garden or even a fish in a simple aquarium. The aim is calm the mind.

 

One can address issues that needs closure if that would help ease one’s state of mind.

 

Create a home environment that can bring some calmness. Either the bed can be facing a window with natural light coming in. Or if that is difficult, one can have a bottle with a plant or a potted plant to gaze. Try not to have harsh light directly above the ill person as the glare can be stressful. Preferably a small table lamp would be adequate.

 

The bed linen need to be clean with adequate cushions or towels to support the knees and elbows to provide comfort.

 

Ensure there are no unpleasant smell and try to reduce it as much as possible. Baking soda is a good deodorant that be used to dust as powder over the ill person. It can also be used as dry shampoo for the hair if hair washing is not possible.

 

Remarks

We hope the tips provided here will be useful for home care. Identifying causes of stress is the first towards providing a peaceful environment for the ill or dying person.

 

References:

1.How can We Improve Stress Levels in Cancer Patients. www.cancernetwork.com

2. https://my.clevelandclinic.org/health/articles/11874-stress