Author: Nancy Christie
Thirty-seven-year-old Michelle Hastings, like others with cancer, is dealing with the one-two punch that the disease delivers. The self-described “wife, mother, daughter, sister, friend and cancer warrior” is currently undergoing treatment for stage IV colon cancer at Cancer Treatment Centers of America® (CTCA) in Goodyear, Arizona, where she is coping with both the physical impact of the disease and its treatment as well as the emotional and psychological stress it brings.
In a recent post on her blog, “Mission: Remission” (michellewillwin.blogspot.com), Michelle described the intensity of managing the combined physical and emotional burden she faced during a tough stretch of treatment: “My physical state was precarious. My mental state was just awful. It’s really hard to try to keep a smile on your face when you feel like death warmed over…Cancer, as I’ve said before, has a way of amplifying all emotions.”
Many cancer patients experience a similar perfect storm of physical and emotional stress during treatment. This anxiety and worry can cause cracks in patients’ psychological and emotional foundation, leaving them even more vulnerable. Niki Barr, PhD, psychotherapist and author of Emotional Wellness: The Other Half of Treating Cancer (Orion Wellspring, 2013; $14.95), says that the stress patients experience can be “exhausting and debilitating over the long run and greatly negatively affect their ability to handle the challenges of treatments.”
The good news is that while it may be impossible to eliminate all of the causes of stress during the cancer journey, there are tools and techniques that patients can use to deal with it more effectively. According to the National Cancer Institute, people who use coping strategies, such as relaxation and stress management techniques, “have been shown to have lower levels of depression, anxiety and symptoms related to the cancer and its treatment.”1
Stress and the cancer patient
Stressors that can affect cancer patients range from worries about finances, body image, intimacy, sexual functioning and quality of life to concerns about the diagnosis, available treatment options and, especially, prognosis, says Corliss Ivy, LPC, Mind-Body Therapist at CTCA in Zion, Illinois. “Most adults with cancer experience significant stress,” Ivy says.
In Maureen Ragan’s case, it wasn’t so much the initial diagnosis of colon cancer in 2005 that worried her as it was the recurrence of the disease several years later, after she had been cancer-free. “The return of cancer to my stomach, liver and lymph nodes gave me great concerns, as I lost my mother and brother to stomach cancer,” Maureen says. “I knew the severity of the diagnosis.”
Ivy says that coping with fear and loss in the wake of a cancer diagnosis as Maureen describes “often produces feelings of helplessness, anger, fear, confusion or even hopelessness.” At the same time, “patients and their caregivers also balance care for other family members, bills and other health conditions” because the reality is that life—and its attendant obligations— doesn’t stop when a person has cancer. Instead patients and their families must manage their day-to-day obligations with the new reality of the disease, its treatment and the accompanying financial stressors.
The burden on patients during this time can be pressing, as can their worry over the increased stress on their loved ones. Ivy says that patients often express guilt over the stress that they and their family experience: “As therapists we often hear comments such as, ‘This isn’t fair to my family,’ ‘I’m used to being the one taking care of others’ and ‘Why can’t I just be positive?’”
As a result of this sense of guilt, some patients may feel that they owe it to their friends and family to “put on a happy face” so as not to add to their worries. Patient Michelle Hastings says, “We don’t want those who love us to worry, so we may not be completely honest with them about our treatments or the side effects. We may put on a smile, suffer through social events and pretend to be happy about what we are dealing with.” Michelle encourages patients to recognize that it is okay to let down the façade and be honest. “I want other survivors to know that it’s perfectly normal to not be upbeat, optimistic, happy and funny all the time. It’s normal to have down days.”
As a therapist, Ivy says that she strives to recognize when a patient’s stress level transitions from causing the occasional down day to something more debilitating. “I listen for changes in daily functioning, when patients might notice changes or disruptions in their sleep, appetite or energy level. Key indicators may also include strained relationship dynamics with loved ones or in the workplace. It is not uncommon to support patients around feelings of irritability, confusion or mood disturbances.”
Thankfully, Ivy says, there are effective coping strategies that patients can employ when they reach a point where stress levels are too high, providing them with the ability to have a “more positive outlook on their health and wellness, function better and report greater overall quality of life.”
Patients who are experiencing stress can benefit from a variety of tools and strategies. Ivy says that counseling can be very helpful, and that mind-body therapists at CTCA work with patients, individually or together with family members, to help them work through difficult decisions, discover and use their inner strengths and resources and explore ways to still enjoy life despite their diagnosis. “We work with patients to fully explore and process their feelings and continually remind them that these feelings are normal. We use our time together to actively grieve losses, and we support patients in seeing and experiencing themselves with kindness and compassion, even in the midst of what could be one of the most frightening experience of their lives,” Ivy says.
In addition to counseling, Ivy says that CTCA provides a wide selection of additional integrative therapies that can help patients and their caregivers manage stress. Massage therapy, chiropractic treatments and acupuncture can all provide welcome relief. The Mind-Body Medicine Department offers qigong classes to teach patients how to use gentle physical movement, breathing and focused attention to boost their immune system and enhance the natural flow of energy in their body; reiki sessions with a trained practitioner can help balance energy, reduce stress and physical discomfort and increase feelings of well-being; and meditation, relaxation techniques and guided imagery focus on quieting the mind and using positive mental images to increase comfort and healing. Group classes at CTCA, including movement and music groups and Laughter Club, can also provide benefit, Ivy says, as can animal-assisted therapy sessions.
Making use of any tools available is key, as is seeking support from friends and family. “Many people who have a loved one with cancer are eager to get involved,” Ivy says, and she urges patients to reach out. “Utilize the help that others offer in whatever way you need. This could include taking people up on offers to make meals, arrange transportation or provide family respite care so that you as a patient—or your caregiver— can observe quiet time.”
Ivy also recommends that patients consider reaching beyond their immediate circle of friends and family to seek support from their wider community, including their faith community, local social service providers and cancer support groups. Connecting with these resources can not only help patients feel less isolated but also provide them with useful information and advice on how to handle everything from spiritual questions to the side effects of treatment and the overall “life upheaval” the disease can cause.
Michelle says that it was hard for her initially to accept the help people offered, but ultimately those helping hands have been invaluable. “Cancer has a way of humbling you,” she says. “It took me a while to figure out that asking for help isn’t a sign of weakness. People want to help, and there is no shame in asking for it.”
Maureen Ragan agrees, but adds that sometimes friends and family may need to wait to provide support until the patient makes it clear that he or she is comfortable accepting those offers. “The patient must want help before others can be of assistance,” she says. “However, once the patient wants help, family members and friends can be supportive by being there, sending cards of encouragement and offering prayers.”
Ivy encourages caregivers and friends who want to offer support to allow the patient to express all of their emotions and to avoid offering platitudes like “Don’t worry” and “You’ll be okay.” “Simply put,” Ivy says, “this is a promise they do not have control over—we cannot promise or predict medical outcomes.” And pressure to be upbeat, positive and brave can actually backfire and make it harder for patients to be open and honest about how they are feeling. The best approach, she says, is to offer “caring from a space of compassion, which gives patients permission to feel and express any and all of the emotions that they may experience.”
Also helpful for patients seeking to alleviate stress, Ivy says, is to “intentionally engage in activities that they’ve experienced as life-giving. This could include spending time with the people you love, treating yourself to a spa service, listening to music, playing with a beloved pet and finding time to journal.”
A sense of empowerment
Perhaps one of the greatest benefits of using these coping tools is the sense of empowerment they provide to patients. By learning strategies to alleviate stress, patients gain some control over the mental and emotional side effects that the diagnosis brings, providing them with the strength they need as they continue their cancer journey.
No case is typical. You should not expect to experience these results.