Stress can continue long after treatment has ended and possibly impact recovery. Doctors recommend cancer survivors use intervention techniques to combat stress during remission. 

When Tracy Maxwell finished treatment for stage 2C ovarian cancer, she thought her stress level had subsided. Then, she had two auto accidents in a month. Tracy, like many survivors, anticipated her cancer-related stress would simply disappear when treatment ended. “Everybody thinks your life is going to get back to normal after treatment ends, and it doesn’t,” she says.

Dealing with post-treatment stress means recognizing the relationship between physical and psychological stress and understanding how it can affect your immune system. 

Stress and Your Immune System

According to the National Cancer Institute, psychological stress combines an individual’s emotional and physiological reactions when confronting a situation where the demands may exceed the person’s ability to cope. While small amounts of stress are seen as beneficial, numerous studies indicate chronic stress could be harmful and increase the risk of obesity, heart disease and other illnesses.

The body responds to stress by releasing hormones, such as epinephrine (adrenaline) and cortisol (hydrocortisone), to help the body react to the stressful situation with speed and strength. At the same time, these hormones increase blood pressure, heart rate and blood sugar levels.

Michael Burke, MD, Clinical Director of Psychiatric Oncology at the Emory Winship Cancer Institute in Atlanta, explains how stress builds in phases:

• Alarm phase. Stress begins with the initial alarm stage, in which the body responds with stress hormones for a fight-or-flight response.

• Resistance phase. The alarm phase is followed by the resistance phase, when the body attempts to cope with the demands of an ongoing stressor.

• Exhaustion phase. Finally, there is an exhaustion phase, when the body has been unable to adapt to the stressor. 

Dr. Burke explains it’s during the exhaustion phase that negative biological and psychological effects occur. These negative effects can include the ­inability to get along with family and friends or feelings of depression. Stress beyond an individual’s ability to cope may also lead to unhealthy coping behaviors, some of which may affect cancer risk. 

Stress can also impact the immune system. Immunologist Ronald Glaser and psychologist Janice Kiecolt-Glaser examined how stress affected the immune system of medical students during a three-day exam period. After 10 years of gathering data, they concluded that during these periods of stress, students had:

• A lowered level of natural killer cells that fight tumors and viral infections

• A weakened response in their infection-fighting T-cell

• Virtually no production of immunity-boosting gamma interferon 

The immune system is fairly flexible, which gives it the ability to adapt and regulate the physical changes of short-term stress. However, a 2004 meta-analytic study found age and disease makes people’s immune system more susceptible to the affects of stress. 

The Connection Between Stress and Cancer

According to the National Cancer Institute, studies that examine the relationship between psychological factors, including stress, and the risk of developing cancer, have produced conflicting results. Newer studies indicate stress creates a cascade effect that promotes an inflammatory response in the body, which leads to a friendly environment for cancer. However, no direct cause-and-effect relationship has been proven.

Still, some studies have indicated there’s an indirect relationship between stress and certain types of virus-related tumors. Evidence from both animal and human studies suggests when chronic stress weakens a person’s immune system, it may affect the incidence of virus-associated cancers, such as Kaposi sarcoma and some lymphomas.

Researchers, in the field of psychoneuroimmunology, study the interaction between psychological processes and the nervous and/or immune systems of the human body. One area of research explores whether cancer and stress are connected in disease progression.

Michael Irwin, MD, Director of The Cousins Center for Psychoneuroimmunology at UCLA, says—while data connecting stress to relapse in human cancer are weak, there are a number of animal studies linking stress to the growth of specific tumors.

In one study, reported in Nature Medicine in 2006, mice injected with human ovarian cancer cells showed disease progression when exposed to stress. The study found behavioral stress led to the production of a biological mechanism that can promote malignant cell growth. This suggests blocking the mechanism could have therapeutic implications for managing ovarian cancer.

In addition, studies conducted through the Stress and Immunity Breast Cancer Project at Ohio State University suggest stress can affect survival. Study results published in the journal Cancer indicate the use of stress-reducing psychological interventions improved survival for the participating breast cancer patients.

OSU researcher Barbara L. Andersen, PhD, reported the results of the long-term trial, which included 227 breast cancer patients. A portion of the participants were randomly selected to participate in psychological interventions to manage stress after breast cancer treatment. The women were followed for seven to 13 years, and the analysis confirmed patients who practiced psychological intervention had:

• Reduced risk of breast cancer recurrent

• Lower risk of death from breast cancer

• Lower risk of death from all causes  

Dr. Andersen explained the study revealed, “By reducing stress and depressive symptoms, it yields better immune function and a better psychological profile.” 

Taking Control of Stressed-Induced Inflammation

While the exact biological cause and effect remains unclear, Dr. Andersen notes stress can trigger important effects involving the autonomic, endocrine and immune systems. One potential result is the release of pro-inflammatory cytokines, which are linked to a suppressed immune system. 

This is a concern for cancer patients, because inflammatory processes appear to promote tumor growth in both clinical studies and mouse models. Dr. Andersen hypothesizes psychological interventions that reduce stress could interrupt the inflammatory process, and thereby, reduce recurrence.

Stress-Reducing Intervention Techniques

Dr. Burke links learning to deal with post-cancer stress to how an oak weathers a storm versus a palm tree. In a hurricane, the rigid oak may snap, but the palm bends with the wind. Learning to adapt to changing conditions through psychological intervention can help you continuously manage stress. Dr. Burke recommends cancer survivors try:

• Reintroducing daily routines

• Making time for fun activities

• Taking a vacation

• Being productive at work

• Volunteering 

Intervention strategies, found to be effective during the OSU Stress and Immunity Breast Cancer Project, included: 

• Progressive muscle relaxation (a series of exercises in which participants tense and release specific muscle groups for stress reduction).

• Problem-solving for common difficulties, such as fatigue.

• Identifying supportive family members or friends, who were capable of providing assistance. 

• Using assertive communication to get their psychological and medical needs met.

• Increasing daily activity such as walking.

• Improving dietary habits.

• Finding ways to cope with treatment side effects.

• Maintaining adherence to medical treatment and follow-up. 

Dr. Irwin adds mind-body interventions that help patients sleep and relax are also very effective psychologically and physiologically. These include:

• Yoga. If you're new to the practice, start with simple stretches and poses.

• Tai Chi. A form of martial arts that uses slow, flowing movements to alleviate stress.

• Mindful Meditation. The conscious act of calming the mind and relaxing the body. This can also include the practice of praying, which is considered a form of mindful meditation.

• Social Interaction. “Socially isolated people do worse, and their mortality rates are significantly higher,” explains Dr. Irwin. That’s why he always emphasizes the importance of maintaining positive social contact with friends and family.

Some survivors, like Marcia Donziger, find helping other cancer patients and caregivers is an effective intervention strategy. Ten years after diagnosis, she launched MyLifeline.org, a nonprofit providing a free online communication tool for cancer patients and their families. “I thought I could do something to make big differences in the lives of cancer patients,” she says. Now Marcia receives thank you e-mails on how she has relieved the stress of other cancer survivors. 

Looking back at her cancer experience, Marcia says counseling helped her get through tough times. She also discovered yoga, good nutrition, exercising and adequate sleep helped her manage stress levels.  

If you're experiencing stress, whether short-term or long-term, discuss these intervention techniques with your doctor. Together, you can decide which options are best for your needs.