How to Cope - Survivor How to Cope with the Stress of Cancer

woman thinkingLiving with cancer and its treatment can introduce new stressors into your life. Along your cancer journey, you may experience stress from adjusting to illness, making treatment decisions, coping with symptoms and side effects, managing your lifestyle, or navigating changes to your relationships. 

Acute stress is brief and can even be beneficial by enhancing performance or enabling to you react in ways that help you avoid danger. In brief intervals, acute stress (also known as the fight-or-flight response) is our physiological response to danger, maximizing our chance of survival. However, in response to a repeated stressor, we may live in a constant state of fight-or-flight, called chronic stress, which can be taxing on our health. However, even in chronically stressful situations (such as cancer), we can teach our bodies to dial down the fight-or-flight response by enhancing how we cope with stress. 

There are two main types of effective coping strategies: problem-focused and emotion-focused. Problem-focused coping involves using practical and action-oriented methods to reduce stress by resolving a situation. Typically, you use problem-focused strategies when a stressor is in your control. Alternatively, emotion-focused coping strategies focus on reducing the negative emotional response to a stressor. These are useful for stressors that are not in your control. 
However, even in chronically stressful situations (such as cancer), we can teach our bodies to dial down the fight-or-flight response by enhancing how we cope with stress.Problem-Focused Coping Strategies 
Here are some problem-focused coping strategies you can use to take action against cancer-related stressors. 
1. Gather information. Ask your medical team for information about your disease, risks and benefits of each treatment option, and potential clinical trials. Seek second and third opinions, if needed. Try to avoid searching for information online; there is plenty of incorrect information online, and the internet does not know your unique medical history. Make a pros-and-cons list of for each treatment to help you decide the right option for you. 
2. Take control by engaging in healthy behaviors. 
• Stop smoking. Quitting smoking, even after cancer treatment begins, promotes better outcomes compared to continuing to smoke throughout treatment. Ask your medical team for resources to help you quit. Programs that combine evidence-based therapy with nicotine replacement are most effective.
• Minimize alcohol consumption. Speak with your medical team about whether and how much you can drink during treatment. Some cancers and treatment may be more susceptible to negative effects of alcohol. In general, the American Cancer Society recommends limiting alcohol to one serving a day for women and two servings a day for men.
• Eat well. Increase your intake of vegetables and fruit to the recommended 2 ½ cups per day. Planning, preparing, and freezing meals ahead of time ensures nutritious eating even on a busy day. 
While you can’t change the fact that you are living with cancer, you can control how you react and respond to uncertainty and worry.3. Plan activities and pace yourself according to your energy levels. Cancer symptoms and side effects may interfere with daily activities. Try to maintain regular activities to buffer the effects of stress on your mood. Learn how to work with your symptoms and side effects. Make a list of daily, monthly, or weekly activities that you want or need to complete. Categorize each activity as a high- or low-symptom activity. For example, on a day of high fatigue after chemotherapy you may want to call a friend, and on a low-fatigue day you might go for a walk. Monitor your symptoms by taking note of the days and times you tend to feel more fatigue, worse mood, nausea, or other side effects. Schedule your activities based on trends you have observed, and readjust your schedule as things change.
4. Set goals. Keep up with personal goals by making a list of short-term and long-term goals. Break the goals 4 up into smaller steps or manageable tasks, and set a plan for accomplishing them. 

Emotion-Focused Coping Strategies
Remember, the problem-focused coping skills outlined above are best applied to a stressor that is in your control. When no other action can be taken to reduce the stressor, use emotion-focused strategies to change how you react to the stressor. Here are some examples of emotion-focused coping strategies.
1. Use expressive therapies. Expressive writing can be helpful for managing stress during cancer. Simply set a timer and journal for 15 minutes. Allow yourself to express your thoughts freely, without judgment. If you notice a lot of depressive, anxious, or suicidal thoughts, talk to your medical team. You can also try art, music, or dance, as these are all forms of expressive therapy. 
2. Get support. Notice the type of support you need (for example, emotional comfort vs. practical help), and make a list of people who can best provide that type of support. The quality of support is more important than the quantity. Find a support group, consult with a therapist, or speak with a friend or relative. 
3. Strengthen your relationship with your partner. Think of intimacy as a fluid concept that can change over time, but that does not go away with cancer. If you are physically unable to be sexually intimate, try being intimate in other ways, such as holding hands, hugging, or giving and receiving massages. To help maintain camaraderie with your partner, make sure you take time to create positive experiences. 
4. Process difficult emotions. While you can’t change the fact that you are living with cancer, you can control how you react and respond to uncertainty and worry.
• Schedule worry time. Think of negative emotions as a covered pot of water on a stove. If the lid is on too tightly, suppressing negative emotions, pressure will build and the negative emotions will come out in explosive ways. If the lid is on too loosely, negative emotions constantly overflow and interfere with life. To find balance, pick a 30-minute window each day (but not right before bedtime) that you can set aside to process negative emotions. If a worry comes up at another time, remind yourself that it is not worry time, and you will allow yourself to worry about it later. 
• Schedule difficult conversations. When conflict arises, schedule a time when you and the other person can discuss the conflict. Either resolve it or agree to disagree during that time, and then move on. 
5. Get plenty of physical activity. Physical activity is nature’s antidepressant. Try to incorporate physical activity into your daily routine. Take a walk outside, go dancing, take a bike ride, practice yoga, or just do any type of movement. Exercise for as much as you can tolerate; listen to your body. You can also look for a cancer survivor exercise program in your community or work with a personal trainer who specializes in medical conditions. 
6. Practice relaxation and restoration exercises. Between waiting for scan and bloodwork results, managing symptoms and side effects, and enduring treatments, life can feel pretty unsettling and uncertain. Practicing relaxation and distraction exercises can help keep you from going down the rabbit hole of thinking about “what-if” scenarios. Try these exercises the next time you notice yourself worrying: 
• Diaphragmatic (belly) breathing – Sit up straight with your feet flat on the floor. Place one hand on your stomach and one hand on your chest. Imagine filling up a balloon in your stomach with air as you breathe in, and allow the balloon to deflate as you breathe out. Breathe in for five seconds; breathe out for three seconds. Repeat. 
• Mindfulness – Pay attention to your five senses when you are doing any activity (for example, washing dishes or folding laundry). What do you hear, smell, feel, taste, and see? 
• Distraction – Take a page out of the newspaper or a magazine. Circle every other ‘a’ on the page. Go line by line. It is difficult to worry and circle every other ‘a’ at the same time. 
• Healing visualization – Try visualizing your cancer treatment as healing. You may visualize a Pac-Man eating the cancer cells, or a puppy licking cancer cells away. 

Putting It All Together 
Sometimes, we must rely on problem-focused strategies first to problem-solve a controllable situation, and then turn to emotion-focused strategies to find calmness as we accept what we cannot control. Other times, we may need space from a stressor before tackling it. By using an emotion-focused strategy to self-soothe and reduce negative emotions, we may then be able to more clearly resolve a situation with problem-focused strategies. 

Always remember that what matters most is not the actual stressor, but how we respond to the stressor through effective coping strategies. When we cope effectively, we can take control of stress so that it does not interfere with the life we want to lead. 


Dr. Nicole PensakDr. Nicole Pensak (left) is director of Psycho-Oncology at Jersey Shore University Medical Center, The Hope Tower, in Neptune, NJ. She is a licensed clinical psychologist and owner of Atlantic Coast Mind & Body, a private practice located in Red Bank, NJ. You can learn more about Dr. Pensak at RedBankAnxietyTherapy.com.

Dr. Jamie JacobsDr. Jamie Jacobs (right) is a clinical psychologist at the Massachusetts General Hospital Cancer Center in Boston, MA, where she is the director of Cancer Caregiving Research in the Cancer Outcomes Research Program. She is also an assistant professor at Harvard Medical School in Boston, MA and co-teaches the course, “Fighting Cancer with the Mind” at Harvard University. You can learn more about Dr. Jacobs at
massgeneral.org/cancer/outcomes-research.

This article was published in Coping® with Cancer magazine, July/August 2019.