Monday 17 October 2011

Dealing With Stress

Coping with cancer is obviously stressful. Not just for the patient, but for friends and family too. And it’s not just during treatment, the stress can be there even after a patient is declared to be in remission. A new paper, from Duke University Medical Center in the US, reports that post-traumatic stress is prevalent in cancer patients even in long-term remission.

An added factor in this stress is the well known fact that it can have negative effects on the immune system, cause depression and generally make things worse. There is also the worry that stress can make the disease worse, or can make it recur in patients in remission.

So, for all of these very obvious reasons, it’s important to look at what can be done to tackle this issue that can severely impact the quality of life for all of us. The good news is that there are some active steps that can be taken and which don’t involve taking more drugs.

Diet is one factor that may play a part in the ability to handle stress and deal with depression. There is plenty of evidence to show that diets having higher levels of omega 3 fatty acids helps the body deal with stress – it has been shown to reduce the levels of stress hormones and can improve mood and the ability to cope. In fact higher levels of omega 3 – obtained from supplements rather than diet – have also been used to treat depression. And, as a bonus, higher omega 3 than omega 6, helps reduce the inflammatory factors that are shown to be associated with cancer. As a bonus there is emerging evidence that omega 3s are helpful in coping with cancer treatments, and are being investigated for use against cancer cachexia in advanced disease.

In addition to diet, exercise is also emerging as an important method for improving mood, coping with stress and, just as importantly, coping with cancer treatments. Now for many patients coping with treatment, fatigue is a fact of life. It’s hard to deal with, it’s not just feeling a bit tired, it’s a whole different level. So telling them that they have to exercise might seem a bit cruel. But the evidence is very strong that doing exercise, even gentle exercise, helps fight that fatigue, improves mood and lowers the stress markers in the blood. Better yet, if the exercise is done in a group or with a couple of friends then it fulfils an important social function as well as having positive physical effects.

The final intervention to look at it is meditation. This might sound strange, but again there is strong evidence that it can make a difference. In my own case I can confirm that I have found this to be extremely helpful in coping with the loss of my son, George. I’m not one for religion or new age spirituality, but despite my scepticism I have found it works. And it’s not just my own experience, there are an increasing number of studies that show that mindfulness-based stress reduction programs have a positive effect on physical markers (such as stress hormone levels in the blood), and on mood. For example here  and here, The conclusion of one trial reported that:

Most participants expressed a number of perceived positive effects of participating in the mindfulness program including increased calm, enhanced sleep quality, more energy, less physical pain, and increased well-being. However, a few participants experienced no effect.
For those looking for a gentle and practical introduction to mindfulness meditation, I can recommend Mindfulness: A Practical Guide to Finding Peace in a Frantic World by Mark Williams and Danny Penman, which comes with a CD of exercises to help. It’s a completely practical introduction, with none of the mumbo jumbo that you’ll find in some books on the subject.

In all, it’s worth doing something concrete to tackle stress. Not just because stress is bad in itself, but also because it’s important to take back some control. For much of the time cancer sufferers are just patients – they are medical cases being treated. The sense of powerlessness and the lack of control are themselves stressful and depressing – doing something to change things is an important step to counter than powerlessness.

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