Counseling Care Center

Symptoms of Anxiety• Restlessnessorfeelingonedge

• Difficultyconcentrating

• Feelingsofintensefear

• Irritability

• Muscletension

• Difficultysleeping

• Physicalsymptoms:clammyhands,trembling,twitching,feel-ingshaky,sweating,chestpain,heartpalpitations

Anxiety and distress can affect the quality of life of patients with cancer and their families.Patients living with cancer feel many different emotions, including anxiety and distress.

• Anxietyisfear,dread,anduneasinesscausedbystress.

• Distress isemotional,mental, social,or spiritual suffering.Patientswhoaredistressedmayhavearangeoffeelingsfromvulnerabilityandsadnesstode-pression,anxiety,panic,andisolation.

Patientsmayhavefeelingsofanxietyanddistresswhilebeingscreenedforacan-cer,waitingfortheresultsoftests,receivingacancerdiagnosis,beingtreatedforcancer,orworryingthatcancerwillrecur(comeback).

Anxietyanddistressmayaffectapatient’sabilitytocopewithacancerdiagnosisortreatment.Itmaycausepatientstomisscheck-upsordelaytreatment.Anxi-etymay increasepain,affect sleep,andcausenauseaandvomiting.Evenmild

anxiety can affect the quality of life forcancerpatientsandtheirfami-lies andmay need to be treated.

Patients living with cancer can feel differ-ent levels of distress.Somepatients livingwithcancerhave a low level of distress and others have higher levels of dis-tress. The level of distress ranges frombeingabletoadjusttolivingwith cancer to having a serious mental health problem, such asmajor depression. However, mostpatientswithcancerdonothavesignsor symptomsofany specific

directly affects cancer outcomes, some data do sug-gestthatpatientscandevelopasenseofhelplessnessorhopelessnesswhen stress becomesoverwhelming.Thisresponseisassociatedwithhigherratesofdeath,although the mechanism for this outcome is unclear. Itmay be that peoplewho feel helpless or hopelessdonotseektreatmentwhentheybecomeill,giveupprematurelyonorfailtoadheretopotentiallyhelpfultherapy,engageinriskybehaviorssuchasdruguse,ordonotmaintainahealthylifestyle,resultinginpre-mature death.

How can people who have cancer learn to cope with psychological stress?Emotionalandsocialsupportcanhelppatientslearnto copewithpsychological stress.Such support canreducelevelsofdepression,anxiety,anddisease-andtreatment-related symptoms among patients. Ap-proachescanincludethefollowing:

• Traininginrelaxation,meditation,orstressman-agement

• Counselingortalktherapy

• Cancereducationsessions

• Socialsupportinagroupsetting

• Medicationsfordepressionoranxiety

• Exercise

More information about how cancer patients cancopewithstresscanbefoundinthePDQ®summa-ries listed in the Related Resources section at the end of this fact sheet.

Someexpertorganizationsrecommendthatallcan-cerpatientsbescreenedfordistressearlyinthecourseoftreatment.Anumberalsorecommendre-screeningatcriticalpointsalongthecourseofcare.Healthcareproviders can use a variety of screening tools, suchas a distress scale or questionnaire, to gauge whether cancer patients need help managing their emotions or with other practical concerns. Patients who show mod-erate to severe distress are typically referred to appro-priate resources, such as a clinical health psychologist, social worker, chaplain, or psychiatrist.

Selected References1.ArtherholtSB,FannJR.Psychosocialcareincan-cer.CurrentPsychiatryReports2012;14(1):23-29.[PubMedAbstract]

2. Fashoyin-Aje LA, Martinez KA, Dy SM. Newpatient-centered care standards from the Com-missiononCancer:opportunitiesandchallenges.JournalofSupportiveOncology2012;e-pubaheadofprintMarch20,2012.[PubMedAbstract]

3. Lutgendorf SK, DeGeest K, Dahmoush L, et al.Social isolation is associated with elevated tumor norepinephrine in ovarian carcinoma patients.Brain, Behavior, and Immunity 2011;25(2):250-255.[PubMedAbstract]

4.LutgendorfSK,SoodAK,AndersonB,etal.Socialsupport,psychologicaldistress,andnaturalkillercellactivityinovariancancer.JournalofClinicalOncology 2005;23(28):7105-7113. [PubMed Ab-stract]

5.LutgendorfSK,SoodAK,AntoniMH.Host fac-torsandcancerprogression:biobehavioralsignal-ingpathwaysandinterventions.JournalofClini-cal Oncology 2010;28(26):4094-4099. [PubMedAbstract]

6. McDonald PG, Antoni MH, Lutgendorf SK, etal.Abiobehavioralperspectiveoftumorbiology.DiscoveryMedicine2005;5(30):520-526.[PubMedAbstract]

7.Melhem-BertrandtA,Chavez-MacgregorM,LeiX,etal.Beta-blockeruseisassociatedwithimprovedrelapse-freesurvival inpatientswithtriple-nega-tivebreastcancer. JournalofClinicalOncology2011;29(19):2645-2652.[PubMedAbstract]

8.Moreno-SmithM,LutgendorfSK,SoodAK.Im-pactofstressoncancermetastasis.FutureOncol-ogy2010;6(12):1863-1881.[PubMedAbstract]

9. Segerstrom SC, Miller GE. Psychological stressandthehumanimmunesystem:ameta-analyticstudyof30yearsofinquiry.PsychologicalBulletin2004;130(4):601-630.[PubMedAbstract]

10.SloanEK,PricemanSJ,CoxBF,etal.Thesym-pathetic nervous system induces a metastaticswitchinprimarybreastcancer.CancerResearch2010;70(18):7042-7052.[PubMedAbstract]

All material in this brochure was reproduced by per-mission from the National Cancer Institute of Mental Health.

Sally Greer,MS,NCC,LPC,IL,CADC

SallyGreerhasaMasterofScienceinHumanServicesCounselingfromNationalLouisUniversityinChicago,Illinois.SheisanIllinoiscertifiedad-dictionscounselorandhasover40yearsexperiencevolunteer-ing,workingandsupervisinginthefieldofsocialservicesandmentalhealth.Shehasextensiveexperienceworkinginthefieldofalcoholanddrugaddictions,domesticviolenceandindividualtrauma.Shealsoworkswithindividualswhohavebeendiagnosedwithalifethreateningillnessandwithfamilymembers.Herclinicalin-terestsincludewomen’sissues,depression,anxiety,traumaandrelationshipconcernswithindi-viduals,couplesandfamilies.

Counseling Care Center Hours:

Mon., Wed., Fri.: 9 am–5 pmTues.: 11 am–7 pmThurs.: 9 am–5 pm as needed.

The Counseling Care Center is located on the second floor of Beloit Hos-pital, 1969 W. Hart Rd., Beloit, WI 53511

Anxiety DisorDers

CAnCer&

mentalhealthproblem.Thissummarydescribestheless severe levels of distress in patients living withcancer,including:

• Normaladjustment—Aconditioninwhichaper-sonmakeschangesinhisorherlifetomanageastressful event such as a cancer diagnosis. In nor-maladjustment,apersonlearnstocopewellwithemotional distress and solve problems related tocancer.

• Psychologicalandsocialdistress—Aconditioninwhichapersonhassometroublemakingchangesin their life to manage a stressful event such as a cancerdiagnosis.Helpfromaprofessionaltolearnnewcopingskillsmaybeneeded.

• Adjustment disorder—A condition in which apersonhasalotoftroublemakingchangesinhisor her life to manage a stressful event such as a cancer diagnosis. Symptoms such as depression,anxiety,orotheremotional,social,orbehavioralproblems occur and worsen the person’s qualityof life.Medicineandhelp fromaprofessional tomakethesechangesmaybeneeded.

• Anxietydisorder—Aconditioninwhichapersonhasextremeanxiety.Itmaybebecauseofastress-fuleventlikeacancerdiagnosisorfornoknownreason.Symptomsofanxietydisorderincludewor-ry,fear,anddread.Whenthesymptomsaresevere,it affects a person’s ability to lead a normal life.Therearemanytypesofanxietydisorders:

• Generalizedanxietydisorder.

• Panic disorder (a condition that causes suddenfeelingsofpanic).

• Agoraphobia(fearofopenplacesor situations inwhichitmightbehardtogethelpifneeded).

• Socialanxietydisorder(fearofsocialsituations).

• Specificphobia (fearof a specificobjector situa-tion).

• Obsessive-compulsivedisorder.

• Post-traumaticstressdisorder.

There are certain risk factors for seri-ous distress in people with cancer.Nearlyhalfofcancerpatientsreporthavingalotofdistress. Patients with lung, pancreatic, and braincancersmaybemorelikelytoreportdistress,butingeneral, the type of cancer does notmake a differ-ence. Factors that increase the risk of anxiety anddistress are not always related to the cancer. The fol-lowingmayberiskfactorsforhighlevelsofdistressinpatientswithcancer:

• Troubledoingtheusualactivitiesofdailyliving.

• Physicalsymptomsandsideeffects(suchasfatigue,nausea,orpain).

• Problemsathome.

• Depressionorothermentaloremotionalproblems.

• Beingyounger,nonwhite,orfemale.

• Havingalowerlevelofeducation.

Psychological Stress and CancerKey Points

• Psychological stress alonehasnotbeen found tocausecancer,butpsychologicalstressthat lastsalongtimemayaffectaperson’soverallhealthandabilitytocopewithcancer.

• Peoplewhoarebetterabletocopewithstresshaveabetterqualityoflifewhiletheyarebeingtreatedforcancer,buttheydonotnecessarilylivelonger.

What is psychological stress?Psychologicalstressdescribeswhatpeople feelwhentheyareundermental,physical,oremotionalpressure.Althoughitisnormaltoexperiencesomepsychologi-cal stress fromtimetotime,peoplewhoexperiencehighlevelsofpsychologicalstressorwhoexperienceitrepeatedlyoveralongperiodoftimemaydevelophealthproblems(mentaland/orphysical).

Stress can be caused both by daily responsibilitiesandroutineevents,aswellasbymoreunusualevents,such as a trauma or illness in oneself or a close family member.When people feel that they are unable to

manageorcontrolchangescausedbycancerornormallifeactivities,theyareindistress.Distresshasbecomeincreasinglyrecognizedasafactorthatcanreducethequalityof lifeofcancerpatients.There isevensomeevidencethatextremedistressisassociatedwithpoorerclinicaloutcomes.Clinicalguidelinesareavailabletohelpdoctorsandnursesassesslevelsofdistressandhelppatientsmanageit.

Thisfactsheetprovidesageneralintroductiontothestress that peoplemay experience as they copewithcancer.Moredetailed informationaboutspecificpsy-chologicalconditionsrelatedtostresscanbefoundinthe Related Resources and Selected References at the end of this fact sheet.

How does the body respond during stress?Thebody responds tophysical,mental,oremotionalpressurebyreleasingstresshormones(suchasepineph-rineandnorepinephrine)thatincreasebloodpressure,speed heart rate, and raise blood sugar levels.Thesechanges help a person actwith greater strength andspeedtoescapeaperceivedthreat.

Researchhas shown that peoplewho experience in-tenseandlong-term(i.e.,chronic)stresscanhavedi-gestiveproblems,fertilityproblems,urinaryproblems,andaweakened immune system.Peoplewhoexperi-ence chronic stress are also more prone to viral in-fections such as the flu or common cold and to have headaches, sleep trouble, depression, and anxiety.

Can psychological stress cause cancer?

Althoughstresscancauseanumberofphysicalhealthproblems, the evidence that it can cause cancer isweak. Some studies have indicated a link betweenvariouspsychological factorsandanincreasedriskofdevelopingcancer,butothershavenot.

Apparentlinksbetweenpsychologicalstressandcan-cer could arise in several ways. For example, peopleunder stress may develop certain behaviors, such assmoking, overeating, or drinking alcohol, which in-crease a person’s risk for cancer. Or someone whohasarelativewithcancermayhaveahigherriskfor

cancerbecauseofasharedinheritedriskfactor,notbecauseofthestressinducedbythefamilymember’sdiagnosis.

How does psychological stress affect people who have cancer?

Peoplewhohavecancermayfindthephysical,emo-tional,andsocialeffectsofthediseasetobestressful.Thosewhoattempttomanagetheirstresswithriskybehaviors such as smoking or drinking alcohol orwhobecomemoresedentarymayhaveapoorerqual-ityoflifeaftercancertreatment.Incontrast,peoplewhoareabletouseeffectivecopingstrategiestodealwith stress, such as relaxation and stress management techniques,havebeenshowntohavelowerlevelsofdepression,anxiety,andsymptomsrelatedtothecan-ceranditstreatment.However,thereisnoevidencethat successful management of psychological stressimprovescancersurvival.

Evidence from experimental studies does suggest that psychological stress can affect a tumor’s ability to grow and spread. For example, some studies have shown that when mice bearing human tumors were kept confined or isolated from other mice—condi-tions that increase stress—their tumors were more likely to grow and spread (metastasize). In one set of experiments, tumors transplanted into the mammary fat pads of mice had much higher rates of spread to the lungs and lymph nodes if the mice were chroni-cally stressed than if the mice were not stressed. Stud-ies in mice and in human cancer cells grown in the laboratory have found that the stress hormone nor-epinephrine, part of the body’s fight-or-flight response system, may promote angiogenesis and metastasis.

In another stuhdy, women with triple-negative breast cancer who had been treated with neoadjuvant che-motherapy were asked about their use of beta block-ers, which are medications that interfere with certain stress hormones, before and during chemotherapy. Women who reported using beta blockers had a better chance of surviving their cancer treatment without a relapse than women who did not report beta blocker use. There was no difference between the groups, how-ever, in terms of overall survival.

Althoughthereisstillnostrongevidencethatstress