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Stress and anxiety

Dr. Christine Maheu, RN, PhD

Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.

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Ms. Rosemary Cashman

Ms. Rosemary Cashman is a nurse practitioner at the BC Cancer Agency and an Adjunct Professor in the Faculty of Nursing at the University of British Columbia. Her professional experience includes the care of lymphoma, lung cancer and brain cancer patients. She co-chairs the Patient and Family Advisory Council, which guides the brain tumour care program at the BC Cancer Agency. She has authored book chapters and articles related to the care of brain tumour patients and their families. Ms. Cashman was involved in developing and implementing a rapid-access radiotherapy clinic for the palliative treatment of lung cancer and she continues to work in this clinic.

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Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C, BC Cancer

Ms. Maureen Parkinson is the province-wide vocational rehabilitation counsellor at the BC Cancer Agency. She has also been vocational rehabilitation counsellor at a public rehabilitation hospital and vocational rehabilitation consultant to insurance companies and the court system. She has instructed and facilitated Service-Canada-funded programs on job searching and career exploration. Ms. Parkinson has a Masters in Counselling Psychology, is a Canadian Certified Rehabilitation Counsellor, and completed the Certified Return to Work Coordinator Program through the National Institute for Disability Management and Research. She has developed return-to-work and job-search seminars for cancer patients and created the guidebook “Cancer and Returning to Work: A Practical Guide for Cancer Patients” as well as on-line articles about returning to work and school. She also co-authored a paper commissioned by the Canadian Association of Psychosocial Oncology, “Cancer and Work: A Canadian Perspective”.

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Cancer is a challenging life stressor. Over time, the strain of coping with the diagnosis and treatment may be compounded by other life stressors, such as problems at work and with family and friends. It is important for patients to take some time to reflect on the psychological impact their cancer has had on them, any apprehensions they may have about returning to or staying at work, and any on-going concerns they may have about their cancer.

High stress will lead to increased blood pressure, a more rapid heart rate, decreased digestion, increased muscle tension and higher levels of stress hormones like adrenaline which can lead to impaired immune function. As best as possible, patients should engage in some form of stress reduction so that they can stop the body’s “stress response” before it gets out of hand.


Everyone has times of feeling anxious, and there are good reasons for that! Anxiety can play an important role in motivation or even survival in particular situations. For example, it can be good to feel a little worried or anxious about an upcoming job interview because it might prompt one to prepare more.

Unfortunately, for many people, anxiety can also come at unhelpful times. If thinking about having dinner with family is like thinking about that looming job interview, that is not helpful anxiety. Excessive anxiety can prevent us from doing things we want or need to do such as spending time with other people or moving forward with a return to work plan. Fortunately, anxiety is one of the most successfully treated psychological symptoms and there are lots of treatment options. Psychotherapy (talk therapy), medication, exercise, meditation, workbooks, and other strategies are all likely to have a positive impact on excessive anxiety. Because there are several different kinds of anxiety (constant worrying, panic attacks, obsessive thinking, flashbacks to past events, etc.), it’s a good idea to ask your patients if they need to speak with their family doctor, a psychologist, and/or a psychiatrist about their anxiety to get an expert opinion on what resources or treatments might work best for them.

Vocational implications

Stress and anxiety may negatively affect concentration or memory at work. They may also cause a patient to avoid anxiety-provoking situations such as returning to work. Stress can be tiring and thus cause more fatigue.

For cancer survivors, returning to work can produce mixed emotions – relief that life is back to normal,” fear and anxiety about how colleagues will view them, hope that work will be as the same as it was before they left or perhaps discomfort and concern that they will be the “person with cancer.” Even if the patient is sure they are ready to return to work, they may worry – Will I experience skepticism or support from others?
If patients are outgoing, talkative and share information easily, then it will be a matter of updating co-workers and the supervisor on their recovery. On the other hand, if they are private or quiet, it may be better to just tell everyone they are doing fine and let it go at that. Of course, how much patients divulge depends on the work environment and whether other employees have taken time off for cancer treatment and returned to work successfully. For other things to consider in deciding whether and what to divulge at work, read the article from our section for survivors, who gets to know: how to exercise your power of “disclosure.”

What patients can do

When people are under stress, they tend to take short, shallow breaths that do not bring much oxygen to the heart, lungs and brain and increase tension in the chest and shoulders. Advise your patient, when they feel panicky or tense, to take a few moments to breathe slowly and deeply. Getting more oxygen into the system will slow the heart rate, decrease the blood pressure, relieve the sense of panic and enable clearer thinking.

Encourage patients to tell their healthcare team if they notice signs of depression and/or anxiety. Consider referring the patient for cognitive behavioural therapy (CBT). To find emotional support, they can call an information specialist at the Canadian Cancer Society toll-free at 1-888-939-3333 (TTY 1-886-786-3934).

Strategies for reducing stress:

  • Practice stress management techniques.
  • Learn to say no.
  • Delegate tasks.
  • Use progressive relaxation exercises.
  • Use creative visualizations and guided imagery techniques.
  • Exercise.
  • Loosen up with laughter and humour.
  • Go for a walk in nature.
  • Practice deep breathing exercises for 3 minutes every hour while working.

Other resources: