Managing Mental Health Consequences

The stress that comes with your cancer diagnosis can be overwhelming, and managing the psychological effects can be key to ensuring longer survivorship. This section will help you understand the ways in which you can help mitigate stress and improve your mindset and quality of life.

There can be significant psychosocial effects of a cancer diagnosis, especially amongst patients with a pre-existing mental health condition. According to The National Cancer Institute:

  • One in three people with cancer experience mental or emotional distress. It is most common in breast cancer (42%) and head and neck cancer (41%) patients.
  • Up to 25% of cancer survivors experience symptoms of depression and up to 45% experience anxiety.
  • Many cancer survivors also experience symptoms meeting the criteria for Post-Traumatic Stress Disorder (PTSD).
  • Cancer survivors are twice as likely to die by suicide than the general population.

Studies have shown a decrease in symptoms of depression was associated with psychologist-led small group sessions that offered strategies for reducing stress, improving mood, changing health-related behaviors and adhering to treatment and care.

Mental health professionals are an integral part of the care team for their patients managing a cancer diagnosis. They are able to work with their patients to identify positive coping mechanisms to manage stress, mitigate risky behaviors around smoking or other substance use, and encourage an active lifestyle which ultimately can lead to a better quality of life and survivorship post-cancer treatment. Mental health professionals can also encourage patients to manage their stress with effective coping strategies that have been proven to lead to lower levels of depression, anxiety, and symptoms related to cancer and treatment, including:

  • Mindfulness
  • Relaxation Techniques
  • Cognitive Behavioural Therapy
  • Meditation

Mindfulness

Mindfulness allows us to step outside of our own minds and observe how we think about things. Over time, you will learn to become less attached to your own thoughts, perceptions and beliefs. People begin to take actions based on the true nature of people and events, rather than how they wish or hope them to be. Mindfulness is the practice of focusing on your thoughts, emotions and feelings in the present moment with acceptance and without judgment.

By focusing on the details of our experiences, we are better able to understand what is happening in each moment. This new understanding will allow you to spot and avoid negative reactions. Mindfulness also better enables us to see the many ways we can positively respond to our situations. This helps us achieve inner peace and balance. It is one simple coping technique that's been found to reduce stress, boost energy and improve well-being.

While it may sound complicated, mindfulness practices are simple. One easy way to stay mindful is to focus on your breath and on the activity at hand.

Next time you're sitting in a waiting room, focus on your stomach. Your eyes can be closed or open. Now, follow your breath as you breathe in and out. Become aware of how many times you are breathing in and out, how your stomach moves, how your lungs feel, how each breath feels different, etc. If your mind wanders, gently bring your attention back to your breath.

Relaxation Techniques

Stress has not been shown to cause cancer, but chronic stress may weaken the immune system, causing other health problems and decreasing feelings of well-being. Some stressors are predictable and, therefore, sometimes avoidable. You can often lower the amount of stress in your life by making small changes. Consider the following tips for reducing stress:

  • Avoid Scheduling Conflicts

Use a day planner, your phone, or an online calendar to keep track of appointments and activities. When you schedule activities, allow plenty of time to finish 1 activity before starting the next. Do not schedule too many activities for the same day or week, especially activities you need to prepare for. If managing your schedule is exhausting, ask someone you trust to help review your appointments.

  • Be Aware of Your Limits

If you do not have the time, energy, or interest, it is okay to politely decline when people ask you to take on tasks. Do not feel guilty over saying no. A cancer diagnosis is life-changing, and focusing on the things that matter most makes good sense. At work, do not volunteer for projects that would make your workload unmanageable. If saying “no” feels difficult, tell the person asking what you can do instead. This could be doing a smaller part of the task or having more time to complete the task.

  • Ask for Help

It is also good sense to ask family, friends, and coworkers for help. People are likely to offer their support, so think about particular tasks you need help with beforehand. People appreciate being able to help in specific ways. For example, family or friends may be able to help with shopping, meal preparations, pet-sitting, or picking up a child from school.

  • Prioritize Your Tasks

Make a list of the things you routinely do, such as work and household chores. Rank these things by importance, considering the things you must do and the things that are most important to you. If you do not have time to do everything, focus on the tasks and activities at the top of your list.

Break down tasks into smaller steps. This process can make seemingly overwhelming problems easier to handle. For example, instead of spending an afternoon cleaning your entire house, tackle 1 or 2 rooms each day.

  • Concentrate Your Efforts on Things You Can Control

A stressor may be something you cannot change or control, even with the best planning. Traffic is one example. People who can remain flexible keep their stress low. Sometimes the only aspect of a problem you can control is how you react to it. If it helps, think of it as saving your energy to spend on things more important to you.

  • Get Help With Financial Problems

Talk with an oncology social worker or a financial advisor who knows about cancer-related insurance and financial matters. Do not wait to find financial help. Late bills and debt can quickly become overwhelming. Learn more about managing the cost of cancer care.

Many people learn and practice relaxation techniques to lower stress. You can learn most of them in a few sessions with a counselor. Many hospitals and cancer centers also have classes to teach patients relaxation techniques. Consider doing the following techniques daily or at specific stressful times, such as during a medical procedure:

- Relaxed or deep breathing. This involves deep, slow breathing while concentrating on filling the lungs and relaxing muscles.

- Mental imagery or visualization. This helps you create peaceful and relaxing images in your mind.

- Progressive muscle relaxation. This technique involves tightening and then relaxing muscles. Most people start at either the toes or the head and progressively relax all the muscles across the body.

- Meditation. With this technique, you can learn to relax your mind and concentrate on an inner sense of calm.

- Biofeedback. This technique can teach you to relax and control your body's response to stress by paying attention to signals from the body.

 

Cognitive Behavioral Therapy

Behavior Therapy and Cognitive Behavior Therapy are types of treatment that are based firmly on research findings. These approaches aid people in achieving specific changes or goals. 

Changes or goals might involve: 

A way of acting: like smoking less or being more outgoing; 

A way of feeling: like helping a person to be less scared, less depressed, or less anxious; 

A way of thinking: like learning to problem-solve or get rid of self-defeating thoughts; 

A way of dealing with physical or medical problems: like lessening back pain or helping a person stick to a doctor’s suggestions. 

Behavior Therapists and Cognitive Behavior Therapists usually focus more on the current situation and its solution, rather than the past. They concentrate on your views and beliefs about your life, not on personality traits. Behavior Therapists and Cognitive Behavior Therapists treat individuals, parents, children, couples, and families. Replacing ways of living that do not work well with ways of living that work, and giving people more control over their lives, are common goals of behavior and cognitive behavior therapy. 

If you are looking for help, either for yourself or someone else, you may be tempted to call someone who advertises in a local publication or who comes up from a search of the Internet. You may, or may not, find a competent therapist in this manner. It is wise to check on the credentials of a psychotherapist. It is expected that competent therapists hold advanced academic degrees. They should be listed as members of professional organizations. You can find competent specialists who are affiliated with local universities or mental health facilities or who are listed on the websites of professional organizations. 

There has been a lot of research on how cancer affects us. For some cancer patients, the level of disruption and emotional distress is quite high; for others, the adjustment is less difficult. The patient’s quality of life and age, the level of psychological adjustment before the cancer was diagnosed, the social support available, how advanced the cancer is, the time since diagnosis, and type of treatment received all affect the patient’s response. There is evidence that the majority of individuals with cancer adjust successfully over time.

 

Meditation

More than 3,000 scientific studies have been conducted on the benefits of meditation, and include positive outcomes for the treatment of depression, anxiety, lack of concentration, high blood pressure, inflammatory disorders, asthma, PMS, Arthritis, Fibromyalgia and more.

Having seen the results, many doctors are also encouraging patients to incorporate this ancient practice into their lives to promote well-being, positive outlooks and even faster recoveries. Research has shown that eight weeks of mindfulness meditation may elevate your serum serotonin levels – a compound in the brain that can affect mood and social behavior, appetite and digestion, sleep, memory and sexual desire and function – resulting in a significant decrease in depression, anxiety and stress as well as decreased acute or chronic pain.

In 2014, a breakthrough Canadian study conducted by researchers at the University of Calgary, (Alberta) and Alberta Health services concluded that meditation may be a powerful complement to treatment plans aimed at altering the cellular activity of cancer survivors.

Meditation is easy, convenient, inexpensive, safe and can be done in a variety of ways, based on individual preferences and has the added benefit of being risk free. Cancer patients have reported benefits including greater tolerance of side effects from chemo or radiation therapy during their meditative practices as well as reports that patients feel like their treatments worked better when they were meditating.

If you’re just starting out, keep in mind that there’s more than one way to meditate. The key to success is finding, through practice, what works best for you. You may want to begin by seeking out a group class, or using a guided meditation of which there are unlimited options on the Internet, most of which are free of charge.

You can start to meditate for as little as two minutes and gradually increase your time as you gain experience. To get you started, here are some basics:

Sit Tall

The most common position for meditation is sitting on the floor, in a chair or on a stool, but comfort is key, so find a position that works for you and focus on keeping your back straight. Imagine a thread extending from the top of your head that holds your torso and head erect in a straight line. Roll back your shoulders if that helps you to maintain a straight position.

Note: If sitting is uncomfortable, you can lie down in a straight position on your back. Support your back by putting a folded blanket or small pillow under your calves if necessary.

Relax

Close your eyes and focus on relaxing every part of your body, beginning with your toes and feet, and working your way all the way up to your neck, jaw, face, eyes, and forehead.

Be Still

This is often the difficult step, because most of us aren’t used to it. Just sit quietly. Be in the moment, aware of your surroundings and your place in it. If you are distracted by thoughts, allow them to enter and then release them. (You can always reclaim them later!)

Breathe

Breathe quietly, deeply, steadily. Ideally, breathe in and out through your nose, but if this is difficult, do what feels comfortable for you. Take your time and take notice of how your breath feels in your nose, throat, chest and belly, and then all the way down to your toes and back up again.

Repeat a Mantra

This is a personal preference. For some people, having a word or phrase in their mind helps to remove distractions. For others, just noticing their breath will suffice.

 Don’t Worry About Doing it “Right”

Just do it right for you. Meditation is not a test. Your mind may wander, but simply notice, pause and return to your gentle breath.

Other support services shown to improve mental health outcomes include:

Counseling and engaging patients in problem-solving strategies in a supportive environment can help patient work through their grief, fear and other emotions.

Leading and/or referring patients to support groups provides patients a chance to give and receive emotional support and learn from the experiences of others.

Collaborating with the oncology care team to help patients communicate more effectively and ensure care coordination with all health care providers.

Providing and explaining more information about the diagnosis to help patients make informed choices about treatment, enhance their understanding of the disease and treatment options and encourage adherence to treatment and follow up. 

Sources:

https://www.roswellpark.org/cancertalk/201702/meditation-cancer-patients

https://www.mdanderson.org/publications/cancerwise/how-mindfulness-can-help-cancer-patients-find-happiness.h00-158985867.html

http://www.abct.org/Information/?m=mInformation&fa=fs_COPING_CANCER

https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/emotional-mood-changes.html

https://www.bhthechange.org/resources/mental-health-impacts-of-a-cancer-diagnosis/

 


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acfonline@albertacancer.ca
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