Wednesday, November 13, 2019

November 13, 2019 Stress and Cancer Chat

The #gyncsm Community chat topic on November 13, 2019 was Stress and Cancer. We were pleased to see many familiar faces and to welcome some newcomers to our community. We had 26 participants with 1.8 million impressions. For complete analytics see this Symplur page and for the transcript please visit this page.

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.”

Below are a few topic question responses. Please refer to the transcript for all the 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?
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?
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

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