We began the chat by asking What is stress?
“stress is a physical, mental, or
emotional factor that causes bodily or mental tension. Stresses can be
external (from the environment, psychological, or social situations) or
internal (illness, or from a medical procedure).”
“Stress is the body's reaction to
any change that requires an adjustment or response. The body reacts to these
changes with physical, mental, and emotional responses.”
T1: What are some of the internal and external factors which can lead to stress/tension when dealing with a cancer-related diagnosis? How can stress differ at diagnosis, during treatment, and following initial treatment?
- T1: Stress morphs throughout the cancer continuum. The stress of "not-knowing" at the beginning, the stress of the schedule and treatment during therapy, the stress about potential recurrence after the completion of therapy #gyncsm
- T1 being newly dx'd can itself be stressful internally. letting stress continue has been known to increase cancer-related mortality https://medicalxpress.com/news/2019-08-stress-cervical-cancer-patients-higher.html
- T1 External stress can be visits from family or holiday prep
- Internal things include our thoughts and emotions we are experiencing and how these influence our behaviors and coping. (T1) #gyncsm
- T1 This is an area where #SDOH comes into play. The stresses associated with social determinants of health can contribute to mortality rates for minorities dx'd w/ gynCA #gyncsm
- T1:Financial concerns were an enormous stressor for me. What if I couldn’t work? How would I support myself. #gyncsm
T2: What are some changes doctors and other healthcare providers could make to reduce stress along various points in the patient experience?
- T2 Social workers or navigators trained to help with practical things helps.
- T2 Physicians and other clinicians can take care of themselves so their stresses aren't projected onto patients. #gyncsm
- T2: Establish with the patient ahead of time whether they prefer to receive a cancer diagnosis in person. #gyncsm
- A2: Social workers trained for specific cancers. I met an #AYACancer social worker at @MDAndersonNews at the AYA clinic and it was life changing! She really understood my issues and had solutions. #GYNCSM
- T2 try & keep to the schedule & not have patients waiting endlessly in waiting room to be seen #gyncsm
T3: What steps can patients take to reduce stress and to address the physical, mental and emotional responses to stress? What do you find to be helpful?
- T3 I exercise - blow off steam #gyncsm
- A3: Be honest! With everyone! Care team, family, friends, coworkers, spiritual advisors, neighbors, it doesn’t matter. Share what you need and don’t feel bad about it!! Need space? Cool. Need food and Netflix? Invite me! #GYNCSM
- Early access to #PalliativeCare can improve symptom control and cancer-related outcomes. Our group helps deal with stress and anxiety as well! #gyncsm
- T3 therapy. Ask for help finding a therapist who is skilled at working with folks with a life-altering illness and uncertainty. #gyncsm
- No one likes this answer - but EXERCISE Improved quality of life during treatment and in survivorship. 30 minutes, 5 days a week @AmericanCancer #gyncsm
- T3 seek out support from others LIKE THIS GROUP. There is strength and growth in connection. #gyncsm
- T3 Patients should work with their doctor and/or therapist to develop coping mechanisms. Yoga could be a possibility or simple #mindfulness exercises or recreation #gyncsm
- I also tell patients to decide on a goal - have something to look forward to. A trip, a birthday, an anniversary... #gyncsm.
- T3: Address #stress in a whole-person approach: adequate nutrition, rest, daily movement, emotional support. One of the things I found most helpful was a good therapist & support group. That, and giving myself permission to not be okay. #gyncsm
T4: Some studies show use of a stress-lowering heart drug (beta-blocker) by women w/ #ovariancancer is associated w/ a longer OS (overall survival). https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.29392
(2015) Is this drug and/or other stress reduction protocols now included in treatment plans?
- This study #gyncsm is fascinating. But whether an improvement in outcomes from a beta-blocker is generalizable for all patients with ovarian cancer is yet unknown.
- T4 I just quicking review NCCN guidelines for Ovarian CA and survivorship and at this point beta blockers are not included in recs. #gyncsm
- .@DrRamondetta went on to combine this with chemotherapy in a #clinicaltrial - it was feasible! The study was too small to determine if the combination impacted survival outcomes #gyncsm
T5: What are some signs that stress is becoming "distress" and/or impactful enough on daily activities that additional help is needed? What is known about PTSD in patients?
- T5 There is a lot of research now in cancer diagnosis and treatment as trauma. So makes sense that cancer survivors experience PTSD. #gyncsm
- T5 Sustained elevated BP can be a sign that stress has become distress. Anxiety and manic moods could also be a sign that stress has increased. #gyncsm
- When stress is getting in the way of functioning it is escalating to distress and beyond. Its time to ask for help. #gyncsm
- PTSD/PTSD-like symptoms can happen during cancer diagnosis, treatment, and survivorship. I found the NCIs site for more info/resources: https://www.cancer.gov/about-cancer/coping/survivorship/new-normal/ptsd-pdq #gyncsm
- T5 Sometimes you can keep stress from becoming distress by logging off, shutting the electronic down and taking some me-time. Grab a little #netflixandchill #gyncsm
- T5 lets not forget the healing power of laughter---even laughing at ourselves. Humor can be a powerful tool. #gyncsm
- PTSD linked to increased risk of ovarian cancer - Reuters https://www.reuters.com/article/us-health-ovarian-cancer-ptsd/ptsd-linked-to-increased-risk-of-ovarian-cancer-idUSKCN1VY2BB #gy…
T6: A recent study showed stress is associated w/ #ovariancancer risk
https://cancerres.aacrjournals.org/content/79/19/5113.short What is the difference between associations, correlations and causes of cancer?
https://cancerres.aacrjournals.org/content/79/19/5113.short What is the difference between associations, correlations and causes of cancer?
- T6: I'm guessing studies in this area - stress and cancer risk - are just coming out and there are many questions to answer. Here's some basics on "Correlation, Causation, and Association: What Does It All Mean?" https://www.psychologytoday.com/us/blog/all-about-addiction/201003/correlation-causation-and-association-what-does-it-all-mean #gyncsm
T7: Overall, what does research show about the relationship between the nervous system and the spread of cancer?
- There is this recent article on nerves and the spread of cancer https://t.co/9cX9FT5wfV #gyncsm An interesting article.
- T7 I think the research is fairly basic in this space. There needs to be more robust study of cancer survivors. #clinicaltrials #gyncsm
- T7 part 2 study of survivors in terms of risk for recurrence, coping, anxiety, depression, other stress sources, supports etc. #gyncsm
- Measuring stress is tricky. What's stressful for one person may not be so bad for another. Definitely we need more tools and research #gyncsm.
- T7 Central Nervous System Metastases in Patients With Cervical Carcinoma. - PubMed - NCBI https://www.ncbi.nlm.nih.gov/pubmed/27654265 #gyncsm
You may find resources mentioned during the chat at the end of this page.
Please join us for our Open Mic and Discussion of #gyncsm Survey Results chat on Wednesday December 11, 2019 at 9pmET.
Wishing our community members in the US a very Happy Thanksgiving!
See you in December!
Dee
#gyncsm Co-founder
RESOURCES
Stress in Cervical Cancer Patients Associated with a Higher Risk of Cancer-specific Mortality
PTSD Linked to increased risk of ovarian cancer
Cancer related PTSD
Correlation, Causation and Association What Does It All Mean
Central Nervous System Metastasis in Patients with Cervical Cancer Carcinoma
