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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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It is important to take some time to reflect on the psychological impact that your cancer has had on you, any apprehensions you may have about returning to work and staying at the workplace, and any on-going concerns you may have about your cancer.


Cancer is a challenging life stressor. Over time, the strain of coping with the diagnosis and treatment will be compounded by other life stressors, such as work, family and friends. 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, you should engage in some form of stress reduction so that you can stop your body’s stress response before it gets out of hand.
When we are under stress, we tend to breathe in short, shallow breaths that do not bring much oxygen to our heart, lungs and brain causing increased tension in the chest and shoulders. Next time you feel panicky or tense, take a few moments to breathe slowly and deeply. Getting more oxygen into your system will slow your heart rate, decrease your blood pressure, relieve that sense of panic and help you to think more clearly.


Everyone feels anxious sometimes, and with good reason! Anxiety can play an important role in motivation or even survival some situations. For example, it can be good to feel a little worried or anxious about an upcoming job interview because it might prompt you to prepare more. Or if you’re walking through a forest and you see a grizzly bear up ahead on the trail, it’s best that you not fearlessly stride up to it to give it a pat.

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 or if thinking about driving around the block feels like thinking about shaking hands with a grizzly, that’s 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. As there are several different kinds of anxiety (constant worrying, panic attacks, obsessive thinking, flashbacks to past events, etc.), it’s a good idea to speak with your family doctor, psychologist, and/or psychiatrist about your anxiety to get an expert opinion on what resources or treatments might work best for you.

Vocational implications

Anxiety about returning to work after illness is common. For cancer survivors, returning to work can give you mixed emotions – relief that life is back to “normal,” fear and anxiety about how your colleagues will view you, hope that it will be as it was before you left, or perhaps discomfort and concern that you will be the “person with cancer.” In some cases, fear about return to work might result in delaying a return to work date beyond recouping from physical effects.  Such avoidance without addressing the concern can make it harder to return to work over time.

Even if you are sure you’re ready to return, you may worry about whether you will experience skepticism or support from others? If you’re outgoing, talkative and share information easily, then it will be a matter of updating your co-workers and boss on your recovery. On the other hand, if you are private or quiet, just tell everyone you are doing fine and let it go at that. Of course, how much you divulge depends on the work environment and whether other employees have taken time off for cancer treatment and returned to work successfully.

What you can do

If anxiety does not improve over time or is so severe that it’s preventing return to work, ask to see someone who can help such as a psychiatrist or psychologist. In general, mental health professionals are very successful in effectively treating anxiety with psychotherapy/talk therapy, medication, or a combination of the two. A vocational counselor may also be able to suggest specific strategies for your work or work environment.

Self-management strategies:

  • Please see your doctor if you are noticing signs of anxiety.
  • Learn stress management strategies.
  • Learn to say no.
  • Delegate.
  • Use breathing and relaxation techniques.
  • Do progressive relaxation exercises.
  • Creative visualizations and guided imagery.
  • Exercise.
  • Laugh and enjoy humour.
  • Go for a walk in nature.
  • Practice deep breathing exercises for 3 minutes every hour while working.
  • Apply cognitive behavioural therapy (CBT) approaches.

If you are coping with depression or anxiety, there are various online resources that can be useful, such as the Antidepressant Skills at Work: Dealing with Mood Problems in the Workplace. This can be downloaded through BC Mental Health & Substance Abuse Services or Centre for Applied Research in Mental Health & Addiction.

Other helpful resources include:

Fear of recurrence

Fear of cancer recurrence is a common occurrence following the diagnosis of cancer and may continue long after cancer treatments have ended. It is the fear, worry or concern about cancer returning or progressing.1 Fear of cancer recurrence has been associated with anxiety and depression, and when present after the end of treatment, tends to stay present until addressed professionally. Experiencing some level of fear of cancer recurrence is normal considering the life-threatening nature of cancer. However, what is not normal is experiencing high levels of fear of cancer recurrence that can interfere with your everyday life activities. When you start feeling that it invades your thoughts on a daily basis, it may be time to consider professional support. To learn more on how to manage fear of cancer recurrence, see the following resources and video.

Modify your work environment:

  • Identify a ‘calm’ place in your work environment (private bathroom, car, stairwell) where you can go when feeling overwhelmed to practice deep breathing exercises.
  • Schedule “mini-breaks” throughout your day- use this time to step away from your workspace, perform a few simple stretches and take a deep breath.

To learn more about emotions and cancer, see the Canadian Cancer Society website. For further emotional support, you can talk to an information specialist from the Canadian Cancer Society, a national, toll-free service available to cancer patients, caregivers, families and friends, the general public and healthcare professionals. Call toll-free at 1-888-939-3333 (TTY 1-886-786-3934).

Job accommodations

Modify your work tasks and how you work:

  • Develop or enhance your time management and organizing skills – make a routine of planning your day each morning.
  • Reduce multi-tasking. Focus on one task at a time making sure to complete the first task before moving to the next one.
  • Make to-do lists and prioritize items; Check the list throughout the day.
  • Reduce distractions, such as notifications, phone calls, noise and clutter in your workspace.

Practice energy conservation:

  • Prioritizing:
    • Which duties are essential for your job to be done? Which could be delegated to someone else? Use your energy to accomplish the most important duties and help reduce stress by sharing tasks.
  • Planning:
    • Track your energy levels to recognize patterns of high and low energy points. Schedule more demanding tasks or those of higher priority during times of high energy.
    • Plan your day so that fatiguing tasks are spread out. Balance high and low energy tasks.
    • If possible, spread high energy tasks over several days in your work week.
    • Allow time to rest between tasks.
    • Do one thing at a time—ensure that you finish every task prior to starting a new one. Things will be accomplished quicker and with less mistakes which reduces your stress!
    • Gather all necessary materials for a task prior to beginning it.
  • Pacing:
    • Anticipate that things may take longer; make sure that you take this into account when scheduling your day. Do not expect to be working at the same speed as you were before. Be sure to communicate with your manager and team members the need for more time and less pressure to complete tasks.
    • Implement regular rest breaks. Schedule these rest periods and stick to your schedule. Taking the time to recharge is fundamental.
    • Change tasks before you become fatigued.
    • Take two minutes every hour to stretch

Modify your work environment:

  • Identify a ‘calm’ place in your work environment (private bathroom, car, stairwell) where you can go when feeling overwhelmed to practice deep breathing exercises.
  • Schedule “mini-breaks” throughout your day- use this time to step away from your workspace, perform a few simple stretches and take a deep breath.



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