Tips for Managing Stress During Cancer Treatments

Let yourself grieve the diagnosis. Crying is normal. When sadness settles in and does not lift, that is something different, and the signs to watch for are under when to get help now.

The despair, and the feeling of not being in control of your body, can be intense and can last a long time. Working through those feelings is usually better than having them spill over onto the people around you when you least expect it. Journaling can be a helpful way to work through stress and anxiety during treatment. If you notice the same low mood showing up on the page day after day, mention it to your care team. They can help with that too.

Why did this happen to me, and not to a friend or someone in my family? It is one of the most human questions a diagnosis brings up, and it often arrives with a wave of guilt, as if wishing it away from yourself meant wishing it on the people you love.

The question usually comes from somewhere deeper. You may wonder whether you are being punished for something you did. You may feel that life has always been unfair to you. Or you may be afraid of facing something this frightening alone.

None of that makes you a bad or selfish person. Wishing the illness had passed you by says how scared you are. It says nothing about how much you love the people around you. It can help to say it out loud to someone you trust or to a counselor.

People mean well when they tell you to stay positive. It can still land as one more job, and one more thing to feel guilty about on the days you cannot manage it.

The research takes that weight off you. There is no convincing evidence that your attitude affects whether you survive cancer or whether it comes back.^{1, 2} Feeling sad, angry or scared some days, and hopeful on others, is a normal part of having cancer.¹

Trying to be upbeat all the time is tiring.² You can be honest with the people close to you about a hard day. If someone keeps telling you to look on the bright side, it is fine to say, "Today I just need you to listen."

The same goes for advice you did not ask for. When someone sends you a cure they read about online, you can say, "Thank you. I'm leaving my treatment decisions to my care team," and leave it there.

Some days the best you can do is go on autopilot: stop thinking about the big picture and just get to the next appointment. That is a way of coping, and it is enough.

And if your cancer was caught early, or your treatment is shorter than someone else's, your fear is still real. Nobody has to earn the right to ask for help.

Many patients say the stretch between hearing the word cancer and having a treatment plan is the hardest part of all. Not knowing leaves your mind free to imagine the worst, and it is common to stop eating well or sleeping well while you wait.

Waiting for scan results, biopsy results or the next appointment can be just as hard. Patients even have a name for it: scanxiety. It does not always fade with time, and the weeks before a follow-up scan can bring the old fear back years later. If scan week is always hard for you, that is normal. Let your family know you may be on edge, and let yourself be scared; accepting the fear is often easier than forcing yourself to be calm. A few things make the waiting easier to carry.

• Ask how and when you will hear. Before the scan, ask when results should be ready, who will call you, and whether they might show up in your patient portal before anyone calls. You can also turn off portal notifications and ask your doctor to go over results with you, so you are not reading a report full of medical terms alone at night.
• Plan the waiting days. Fill them with something that holds your attention: lunch with a friend, a comfort show you have seen before, or something that keeps your hands busy, like baking, painting or a puzzle.
• Bring someone with you. For the scan and for the results appointment, a second person can hold your hand, listen, and take notes while you take it in.
• Use your breath. The slow belly breathing under learn a way to relax works in a waiting room too.

Telling people is its own kind of work, and repeating the news over and over is exhausting. You get to decide who hears it, how much they hear, and when.

One friend or family member can be your point person, passing along updates, answering questions and organizing offers of help. A group text, an email list or a free site like CaringBridge lets you write an update once and share it with everyone, and ending it with "no need to reply" saves you from answering dozens of messages.

For neighbors, coworkers or anyone you would rather not say more to, keep a short answer ready: "I'm in treatment, and I'm taking it one day at a time. Thank you for thinking of me."

talking with children

Your children will be upset when they learn about your cancer, and the National Cancer Institute still advises against pretending everything is okay.³ Tell them as much as they want to know, and make sure they hear that nothing they did, said or thought caused your cancer.³

With young children, keep it simple and start with the facts: that you have cancer, where it is in your body, and how treatment will change their days.⁴ Encourage teenagers to talk about their fears with people they trust, not only with you, and include adult children when you talk about your treatment, even if the news upsets them.³

You may feel alone and find it hard to talk with the people in your life right now. Don't be afraid to reach out for emotional support. A local cancer support group can be very helpful if you are comfortable sharing your feelings in a group.

A group is not for everyone, and that is a fine answer. Look Good Feel Better is a gentler door: free workshops for women in treatment on skin care, makeup and eyebrows, with other women going through the same thing and nobody asking you to share.

You may also find it very stressful to juggle everything in your life right now. Don't be afraid to ask friends and family for help with housework, cooking, shopping, and rides to your doctors' appointments.

If you do not have someone you can depend on, tell your care team. Ask whether an oncology social worker can help you find practical and emotional support; CancerCare's oncology social workers offer that help too, free, at 800-813-4673.^{5, 6}

Hair loss is one of the losses treatment can bring, and grieving it is not vanity. Your hair is how you have recognized yourself in the mirror your whole life.

In our experience fitting women since 1995, a hat or wig can help, even when the sadness of losing your hair is still there. You can like what you are wearing and still miss your own hair. You do not have to feel ready before you ask us for help. When you want the practical side, our chemo and hair loss guide takes it one step at a time, and should I shave my head before chemo? helps with one of the first decisions. When you start looking at headwear, our guide to choosing a cancer hat walks you through it.

Hair is only one of the changes, for women and for men. Weight that shifts, skin that changes, scars, and losing one or both breasts each carry their own grief, and it is fine to mourn them too. Our chemo makeup guide covers skin and brows, how to get dressed after mastectomy helps with clothes that fit your body now, and our mastectomy collection has bras and breast forms.

Relaxation techniques are simple skills for calming your body and quieting your mind when worry takes over. You can practice most of them anywhere: in bed, in the waiting room, or in the chair during treatment.

An instructor or a class can help you get started, and you can practice at your own pace. Techniques that can ease stress include relaxed or deep breathing, imagery or visualization, progressive muscle relaxation, meditation, and biofeedback.

• Deep breathing. Breathe in slowly through your nose and let your belly rise, then breathe out slowly through your mouth. A few minutes of slow breaths can settle you before an appointment or a scan.
• Imagery or visualization. Close your eyes and picture a place where you feel calm and safe. Fill in as much detail as you can: what you see, what you hear, how the air feels.
• Progressive muscle relaxation. Tighten one group of muscles for a few seconds, then let it go. Work your way up from your feet to your face, and notice how each part feels as it relaxes.
• Meditation. Sit quietly and rest your attention on your breath, a word, or a sound. When your mind wanders, and it will, bring it back gently. A few minutes is a fine place to start.
• Biofeedback. A trained therapist uses sensors to show you signals from your body, such as your heart rate or muscle tension, so you can learn to calm them yourself.

Ask your cancer center whether it offers classes.

Gentle exercise during treatment, like walking, swimming, or yoga, can ease the stress of cancer and some of the mental and physical effects of chemotherapy. The exercise guidelines for people with cancer point to aerobic exercise, such as walking, for easing anxiety and depressive symptoms; about 30 minutes, three times a week, is the amount studied, and any amount you can manage is a start.⁷

Check with your care team before you start, and go by how you feel on the day. On the days treatment knocks you flat, rest is the right call. If swimming is your exercise, read swimming during chemo before your first time back in the pool. On very hot or rainy days, some people walk laps inside a large store, pushing a cart for support. If your blood counts are low, ask your care team about crowds first.

A combination of therapies can help you and the people caring for you manage stress, including massage, art therapy, music therapy, and acupuncture. Tell your care team before you start any of these during treatment, acupuncture and massage especially.

A counselor or mind-body therapist can see you on your own or with your family. Counseling can help you talk through your fears, cope with changes in your relationships, and find ways to enjoy life despite a cancer diagnosis. It can be a good fit if you are more private and would not feel comfortable sharing your thoughts with strangers in a support group.

Talk therapy helps some people with cancer-related depression, in one-on-one sessions or in small groups.¹¹ To find someone, ask your cancer center whether it has an oncology social worker or a counselor who works with cancer patients. If it does not, ask your doctor for a referral. Ask early, because counselors who specialize in cancer can have long waits, and an oncology social worker at your cancer center may be able to see you sooner.

Cancer treatment and follow-up care can put a real strain on your finances and your family's, even with health insurance. If you are uninsured or out of work, paying for treatment can add to your stress.

Many hospitals and treatment centers have financial counselors and patient navigators. They can help you with the insurance paperwork and give you an estimate of what your treatment will cost.¹² Most NCI-designated cancer centers offer financial navigation, and about half of community cancer centers in one national program had a financial navigator on staff.^{13, 14}

There are also national organizations that help pay for cancer medications and care, and local groups that help with practical things like transportation, food, and childcare. Ask your doctor or hospital for a list.

Good places to start: call the American Cancer Society at 1-800-227-2345 to ask about free rides to treatment in your area and free lodging if you are treated far from home.¹⁵ You can also search CancerCare's Helping Hand database by your diagnosis, ZIP code and the kind of help you need, to find groups that may help with costs such as copays, and even wigs.^{6, 5} Your hospital's financial counselor can tell you whether the company that makes your medicine has a patient assistance program. Help depends on your diagnosis and where you live, and funds can run out, so ask more than once.

Ask early, and ask even if it feels awkward. More than half of the cancer centers in a national survey said their patients were reluctant to ask for financial help when they needed it.¹³

Many people expect to feel only relief when treatment ends, and some feel a little lost instead. Visits to your care team become less frequent, the support changes, and you are left to work out what comes next.¹⁶

Even after treatment ends, many survivors are afraid their cancer will come back, and that fear brings its own stress. In a large research review, about six in ten cancer patients and survivors reported at least a moderate fear of it coming back.¹⁷

This is normal, and it takes time. Getting used to life after treatment, sometimes called a new normal, does not happen in a week.¹⁶ Keep using what helped you during treatment: the people you lean on, the counselor, the walks. If a low mood settles in and stays, the signs under when to get help now apply after treatment too.

The feelings you held off during treatment can also catch up with you weeks or months later, sometimes while everyone around you is celebrating. People may expect you to be back to normal when you feel changed, and wondering who you are now is part of it. Be patient with yourself, and tell the people close to you that you still need them.

Sadness, worry and tears are part of a cancer diagnosis for most people. Depression is a medical condition of its own. It is treatable, and about 2 in 10 people diagnosed with cancer develop it.¹¹

Caregivers are at risk too. If you are the one doing the driving, the cooking and the worrying, watch for the same signs in yourself and talk with your own doctor.¹¹