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.
Anxiety
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:
- Moodgym
- The Feel Good Handbook: Using the New Mood Therapy Everyday (1989) by David Burns, published by William Morrow
- Screening Self-Tests – HeretoHelp
- Could it be Depression?
- If the patient is afraid that their cancer will return after treatment, refer them to this 30-minute talk on fear of recurrence by Dr. Christine Maheu
