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The Stress of Cancer: Seeking Support
Learning that you have a diagnosis of cancer is usually a traumatic experience. And following the shock of diagnosis, people have to face treatment decisions and side effects, changing personal relationships and uncertainty about their future.
"Stress can appear at every stage of the disease, at diagnosis, during treatment and after treatment," says Josée Savard, PhD, a professor of psychiatry at Université Laval in Quebec, Canada. While some stress is expected to accompany a diagnosis of cancer, Dr. Savard and other experts say that people with cancer should monitor their stress levels to make sure they are not crossing the line into depression and anxiety, which are conditions that can interfere with someone's quality of life and even their health status.
Stress vs. Anxiety and Depression
Most of the research on the psychological impact of cancer has been conducted in women with breast cancer. It's estimated that between 22 and 50 percent of women with breast cancer are depressed, while 33 percent have acute stress disorder and 3 to 19 percent have post-traumatic stress disorder (PTSD), a condition seen in people who have experienced traumatic events such as natural disasters or military combat.
A Canadian study published June 14th in the British Journal of Cancer found that almost 38 percent of its 3,095 participants—who included people with breast, prostate, colorectal and lung cancer—met the criteria for distress levels that should be treated. But almost half of these patients had not sought psychosocial support, primarily because they weren't aware of support services or because they didn't think they needed them.
According to study author Linda Carlson, PhD, a clinical psychiatrist with the University of Calgary/Tom Baker Cancer Centre in Alberta, Canada, not getting help can have major repercussions. "If people don't feel like they can talk to anyone, their distress just snowballs over time," she says, adding that people with untreated depression and anxiety often end up visiting doctors more often.
That snowball effect may be one of several reasons patients find the post-treatment period stressful. "Some patients find it most difficult when treatments end because they feel they're not fighting anymore and they don't have the support of their medical team," Dr. Savard says.
Sometimes people with cancer find that the friends and family they thought they could rely on aren't offering them the support they need. In fact, cancer can sometimes expose existing cracks in relationships, particularly in couples. "For couples who were functioning well before cancer, the cancer will usually have a minimal impact on their relationship, or even improve it. In couples who had difficulties before cancer, it will generally create more problems," Dr. Savard explains.
Other times, Dr. Carlson says, people don't want to overburden their friends and family with their worries and may feel pressure to stay upbeat. And those friends and family members don't always know what to say or how to be helpful, especially if they haven't faced a life-threatening illness themselves.
Many people with cancer find the support they need in psychotherapy. Depending upon someone's personality and preferences, they may choose one-on-one psychotherapy or a support group of their peers that is led by a mental health professional, such as an oncology social worker. A study published in May 2001 in The Archives of General Psychiatry found that support groups helped reduce distress in people with metastatic cancer, primarily by helping them face their advanced disease on an emotional level. (Because the concerns of people with early stage and advanced cancer are so different, separate support groups are often found to be helpful for participants.)
"Supportive treatment, whether it's individual or group therapy, allows people to express their concerns and fears," Dr. Carlson says. "There's this myth that you have to be positive all the time when what's really important is that people are able to express their feelings, whatever they are."
Support groups and psychotherapy are also available to the family and friends of people with cancer. People with cancer and their families can find psychosocial support though their hospital or cancer center, or though support and advocacy organizations such as the American Cancer Society and The Wellness Community and CancerCare, which offer online support groups led by health professionals.
Other options available to people with cancer include hypnosis and guided imagery, where you relax by focusing on a positive mental image. Biofeedback, a technique that helps people learn how to relax, works with bodily functions such as breathing and muscle tension. If it's feasible, mild aerobic exercise can also provide energy and a mood lift. Some people, especially those who have had anxiety disorder or depression in the past, may need antidepressants or anti-anxiety medications to help them cope.
Cancer is an isolating experience, Dr. Carlson says, but reaching out for support can help people living with the discomfort and uncertainties of cancer gain reassurance and a better quality of life.
National Cancer Institute's Symptoms of Depression Having a depressed mood for most of the day and on most days:
Loss of pleasure and interest in most activities
Changes in eating and sleeping habits
Nervousness or sluggishness
Feeling of worthlessness or inappropriate guilt
Thoughts of death or suicide