Reducing Stress as a Treatment Strategy

A study presented at a recent National Institutes of Health conference on genetic testing has demonstrated that women who undergo testing for the BRCA1 breast cancer gene experience symptoms of severe stress that can last for as long as two years-and possibly longer.

Led by Dr. Ken Smith, a team of University of Utah researchers reported that they were not surprised that stress levels spiked once it was determined that a woman carried the so-called "breast cancer gene," which indicates a significantly increased risk for the disease.

Rather, they were taken aback by how long such high stress levels were maintained-up to two years for women with the BRCA1 genetic marker.

Stress and the Immune System

Can stress hurt the immune system? Can it therefore affect a person's ability to fight diseases, including cancer?

A study published in the Journal of the National Cancer Institute concluded that the stress of being diagnosed with breast cancer may indeed adversely impact a woman's immune system and possibly her ability to recover from the disease.

Barbara Andersen, Ph.D., a professor of psychology at Ohio State University in Columbus, studied 116 newly-diagnosed women with breast cancer. She found that those with the greatest stress levels had reductions in three important measures of immune-cell activity, compared with women who reported lower stress levels.

Researchers believe stress may cause the immune system to release hormones that alter the function of disease-fighting immune cells. Stress may also increase a person's smoking or drinking habits, or cause a loss of sleep, all of which may impair immune function.

Addressing Emotional Needs

Yet, given the understandable impact that stress can have on a cancer patient's immune system, why aren't their emotional needs given more priority?

Dr. Maria Hewitt of the National Academy of Sciences and colleagues from the National Cancer Institute recently surveyed more than 24,000 cancer survivors to look beyond their physical treatment needs in order to gauge the emotional and quality of life issues which they are facing.

Among the many findings of their study, reported in the Journal of the National Cancer Institute, they found that less than 15 percent of cancer survivors received psychological support.

Dr. David Spiegel and colleagues of the Stanford University School of Medicine in Palo Alto, California reached a similar conclusion. In a presentation to the American Society for Therapeutic Radiology and Oncology, they recommended that psychotherapy become an important component of overall cancer care. They found that breast cancer patients who underwent group therapy reported lower levels of pain and other treatment side effects than women who did not undergo such emotional support.

Their therapy focused on helping patients express emotions, improve communication with doctors and family members, minimize pain through meditation and self-hypnosis, and build bonds with other cancer patients. They found that patients who tend to suppress their emotions are significantly more likely to suffer from depression and to report a greater degree of mood disturbance.

A study published in the journal Oncology Issues reported that fully one-third of patients diagnosed with cancer will eventually develop significant problems coping with their diagnosis and treatment. Susan Davis-Ali, Ph.D., a medical consultant, noted that numerous studies have demonstrated that unmet psychosocial needs of cancer patients result in lower levels of compliance with treatment regiments, poorer treatment outcomes, and greater demands on the time of medical staff.

Davis-Ali said each newly diagnosed cancer patient should be seen by a social worker or a psychologist to discuss issues related to their psychosocial adjustment to the illness. However, she also realized that this is probably not feasible in many hospitals and clinics because of increasing workloads and time constraints on the medical staff. At a minimum, therefore, those patients who are clearly experiencing distress need to be "red-flagged" for treatment beyond simply their medical needs, she said.

Self-Help with Stress

The National Cancer Institute and the American Cancer Society offer the following tips for coping with cancer survivor stress:

• Be kind to yourself. Instead of telling yourself you can't do something, focus on what you can do and what you want to do.
• Help others. Reaching out to someone else can reduce the stress caused by brooding. Don't be afraid to say no. Polite but firm refusals help you stay in control of your life.
• Talk about your concerns. It's the best way to release them.
• Learn to pace yourself. Stop before you get tired.
• Give in sometimes. Not every argument is worth winning.
• Get enough exercise. It's a great way to get rid of tension and aggression in a positive way.
• Take time for activities you enjoy.
• Take one thing at a time. If you're feeling overwhelmed, divide your list into manageable parts.
• Set priorities. Don't try to be Superman or Superwoman.
• Solve problems like an expert. First, identify the problem and write it down. Second list your options with each one's pros and cons. Third, choose a plan. Fourth, list the steps to accomplish it, and then give yourself a deadline and act. Sometimes just having a plan can reduce the stress of the problem.
• Eat properly.
• Get enough sleep.
• Laugh at least once a day.

SOURCES:
National Institutes of Health Conference, "The Ethics of Genetic Testing," January 17, 2001, Bethesda, Maryland
Health Psychology, January 2001
Journal of the National Cancer Institute, 1999; 91:1480-1486
Oncology Issues, 1997; 12(6): 12-17
National Cancer Institute, (http://rex.nci.nih.gov)
The American Cancer Society (http://www.cancer.org)

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