Category: Stress and Anxiety

As a mom to two boys and a second-grade teacher, Kris Johnson, was accustomed to asking her kids to recall what they had learned. But when undergoing chemo treatment to treat breast cancer at age 42, Kris noticed that she herself was having difficulty recalling information. “It was like my head was truly in the clouds…I was more than a little forgetful, I had trouble concentrating, I couldn’t remember how to do routine tasks, and sometimes I couldn’t find the right words.” If you or a family member are plagued by similar scenarios, then you may be experiencing what is known as chemo brain. 

What is Chemo Brain?

Chemo brain is also called cancer-related cognitive impairment — or brain fog — and affects around 70% of chemotherapy patients. Though chemo brain is a common phenomenon, it is difficult to pinpoint an answer to the question “why does chemo brain happen?”  

Some studies have suggested that chemo slows the growth of brain cells that handle learning and memory. Researchers are working to further understand the cognitive related changes experienced with chemo brain and have identified the following potential contributors:

• Inflammatory response in the brain attributed to chemo
• Drugs given for surgery or to manage side effects of radiation
• General fatigue and poor sleep quality
• Inadequate nutrition
• Depression, anxiety, worry, stress
• Damage to brain caused by type/location of tumor

What are the Symptoms of Chemo Brain?

Patients who’ve experienced cancer-related cognitive impairment generalize that it feels like a decrease in mental “sharpness”. Commonly reported symptoms include:

• Forgetting names, dates, common words
• Difficulties with multitasking 
• Taking longer to finish routine tasks
• Reduced attention span 
• Lack of focus/concentration
• Inability to learn new skills
• Misplacing objects/disorganization
• Short-term memory lapses

Often patients refrain from reporting problems until it affects their everyday life, so it is important to let your cancer care team and your family know if any of the above symptoms occur. For most patients, chemo brain symptoms resolve within 6-12 months after chemotherapy treatment.

How is Chemo Brain Treated?

There is no evidence-based, standard treatment for brain fog after chemo. Thomas Sult, MD, functional medicine practitioner, educator, founder, and author of Just Be Well explains, “There are many aspects of chemo brain. First is just the fatigue of the diagnosis and the treatment. Next is the effect the chemo has on your brain. Much of that effect is toxins from cancer cells die off, and the effect of the chemo on your mitochondria. A basic detox program and mitochondrial support can help with cognitive impairment after chemo.”

Chemo brain treatment options

Because of variability in and severity of symptoms, treatments are individualized and may combine behavioral, pharmacologic, and rehabilitative approaches. These are some of the more common options: 

• Physical Exercise: As hard as it may be during treatments, keep moving. Do what your body is capable of, perhaps walking, gardening, or biking may help. 
• Tracking: Notice which days of the week or times of day you have better cognitive function and schedule activities accordingly. 
• Cognitive Rehab: Activities that improve brain function like taking notes to stay on track, or learning how to commit details to memory and retrieve them later, are often part of cognitive rehab therapy.
• Relaxation Techniques: Meditation can help increase focus and awareness. Stress-relief techniques such as mindfulness practice and progressive muscle relaxation may also help chemo brain dissipate. Some find that engaging in spiritual practices can have a positive relaxing effect.

Other factors

Of course, other lifestyle interventions such as getting sufficient sleep and good nutrition are also a critical part of any cognitive treatment plan. Fueling your brain with a diet full of berries, seeds and greens can help minimize damage to brain cells, while restorative sleep improves cognitive function and reduces daytime fatigue. 

“Chemo brain feels like your brain doesn’t compute. I would often stare at a page only to wonder why I was staring at a page. For me, the only thing that really helped is if I stuck to my nutrition regimen of berries, beans, and greens,” explains Mend Together Founder and 2x cancer “edure-er” Lisa Lefebvre.

Questions to ask your doctor

Dr. Sult has treated a wide variety of individuals experiencing chemo fogginess, he advises to:

“Make it clear you are experiencing symptoms. Many factors can be at play such as depression, anxiety, anemia, sleep, and early menopausal symptom contributors. These can be addressed with reasonable medical treatments. Be open with family, friends, and your care team about chemo brain and ask for help, now is the time to build your tribe.” 

These are some questions to ask:

• What is likely causing my symptoms? And how long do they typically last?
• What is the best treatment for my chemo brain symptoms?
• Are there things I can do on my own to manage my chemo brain and improve my memory problems?
• Are there printed materials or websites that you can recommend? 
• Should I see a specialist? 

It can be difficult to remember all the information provided during an appointment, so take a friend or family member with you to take notes. You could also record the conversation with your doctor so you can listen to it later.

Seeking Additional Support

For more ways to support yourself, a friend, or family member with cancer who might be experiencing chemo brain, consider creating a Gift & Donation Registry.  Patients can register for over 300 items recommended by doctors, dietitians, and cancer survivors that offer symptom relief. Friends and family can send a gift, offer financial assistance, or send encouraging messages. 

---

Marci Clow is a Registered Dietitian Nutritionist (RDN) and writer of evidence-based food and nutrition communications.

Information provided here is not a substitute for medical advice. Please consult your healthcare team for advice tailored to your personal diagnosis and treatment.

You feel stressed and anxious. That’s normal, especially with cancer. We’ll help you understand why you feel this way—and help you manage cancer stress and anxiety better.

What is cancer stress?

Stress is a reaction to demanding circumstances, known as stressors. Some stress encourages growth, but other stress can take a toll on our health. For example, exercise is considered a stressor due to the temporary effects it has on the body. However, no one would argue that exercise does more harm than good.

Our bodies don’t distinguish between stressors that are physical and psychological stress. The role of stress in our lives plays an important evolutionary role, dating back to our early ancestors. You’ve likely heard about your fight-or-flight response. This survival mechanism kicks in to help us survive in cases of acute stress or danger.

While we’ve evolved from living in caves and discovering fires, our core systems have not. Our stress response systems, like the fight-or-flight response, activate no matter what triggers them, whether we’re running away from a lion, struggling to meet a work deadline, or getting news of a cancer diagnosis.

When we come face to face with something stressful, our stress hormones trigger a release of energy. Our heart rate and breathing speed up, our muscles tense up and we may start sweating. Our blood pressure rises and our inflammatory responses kick in. In the short term (acute stress) this reaction is helpful, but when it happens over and over again (chronic stress) it’s not.

What is anxiety—and how is anxiety different from stress?

Anxiety is a normal part of life. We all experience it. Like stress, it can become excessive and affect our lives.

Anxiety is different from stress because it involves anticipation of future difficulties. It evolved to help us avoid dangerous situations that could happen in the future. Worry, a common feature of anxiety, is a series of negative thoughts about future threats. Worry is different than fear, which is a response to a real, immediate threat that’s right in front of you.

Symptoms of anxiety include:

• difficulty sleeping or racing thoughts
• headaches and muscle tension
• irritability
• heart palpitations, sweating or trembling
• chest pain or discomfort
• nausea
• numbness
• lightheadedness
• feelings of unreality or detachment from yourself
• fear of losing control or going crazy
• chills or hot flashes

There are several psychological factors that play into anxiety, and differences between anxiety disorder and anxiety as a feeling or experience. Despite the differences, anxiety and stress often go hand in hand. 

We often avoid situations that make us feel anxious. Finding ways to actively cope with a cancer diagnosis, rather than avoiding things, is the best bet to combat stress and anxiety.

What causes stress and anxiety?

Your psychological stress and anxiety levels may fluctuate at different points in your cancer journey. This is also normal. Generally, as we cope with our cancer diagnosis, stress and anxiety begin to lessen. Research suggests that if cancer recurs, we tend to experience similar levels to when we were first diagnosed. But they go down more quickly than the first time.

For example, being stopped by a police officer may arouse a fight-or-flight response, but to fight or flee would only make matters worse.

Source: (med.stanford.edu)

Event-related acute stress

Many cancer patients experience periods of psychological stress in relation to an event. It’s important to understand that you may feel stress before positive events. This is a normal response! 

Many of us feel particularly stressed and anxious during these times:

• At the time of cancer diagnosis
• When we have side effects from cancer treatment
• At the start or end of treatments
• When we’re told our cancer is in remission
• When we go back to work, school, or “everyday life” and have fewer follow-ups with our medical team
• At follow-up scans
• At anniversaries, like the one-year anniversary after diagnosis

Chronic stress in the cancer journey

Many cancer patients also feel ongoing stress throughout the cancer journey. These stressors can be challenging to define, often tying into physical or existential concerns. 

Many of us feel particularly stressed and anxious about:

• Body changes related to cancer and cancer treatment
• Side effects of cancer treatment, like nausea, pain, or low energy
• Changes in relationships with loved ones, self-identity, or roles
• Uncertainty about the future or changes in goals and values
• Financial difficulties or challenges with health insurance
• Believing loved ones are impacted by the cancer diagnosis
• Communicating with children about a cancer diagnosis
• Fear of dying or facing a foreshortened future

Why is managing cancer stress and anxiety important?

Without proper management, the effects of stress and anxiety can become debilitating. According to the National Institute of Mental Health, chronic stress can compromise our immune, digestive, sleep, and reproductive systems. It can lead to headaches, sleeplessness, sadness, anger, and irritability, and make us more susceptible to getting a cold or the flu.

Cancer stress and the immune response

Stress has a proven impact on one’s immune response. Several studies have shown the effects of stress on the immune system. As many of us know, cancer treatments can also have a negative impact on our body’s immune response. Chemotherapy often diminishes white blood cells in the bone marrow microenvironment.  Stress can exacerbate this issue, making patients with cancer more susceptible to other illnesses. 

It’s within this lens that researchers are exploring immunotherapy treatments to boost cellular immunity, helping the body fight cancer better. Managing the effects of stress will help the body continue to produce white blood cells, giving the body what it needs to stay the course.

Cancer stress and insomnia 

Insomnia and sleep deprivation are other stressors that interrupt cellular processes. A lack of sleep also impacts the immune system, triggering inflammatory responses, increasing the production of stress hormones, and increasing blood pressure. A systematic review and meta-analysis of studies of correlations between insomnia and cancer risk even highlighted chronic sleep deprivation as a potential risk factor for cancer development. 

Unfortunately, stress and insomnia often create a vicious cycle. Stress begets poor sleep and vice versa. Taking care to cut stimulants (caffeine and alcohol) and practicing stress management can help you get the sleep you need to heal.

Cancer stress and mindset 

With chronic stress, our ability to be resilient in the face of stress weakens. It affects our behavior, emotions, and thoughts. It can also affect our relationships. When we have stress and cancer, it’s especially important to find ways to cope because it can take a toll on our immune system.

How can I manage cancer stress and anxiety?

You can start to manage cancer stress through intentional practice and developing coping skills. Try incorporating these techniques into your daily routine.

1. Distract your mind 

Our minds can race during activities that allow us to think and do something at the same time. Reading or going to a movie force your mind to focus and blocks it from ruminating on unpleasant thoughts.

2. Try progressive muscle relaxation

Stress and anxiety are incompatible with relaxation. When our bodies relax, stress and anxiety start to dissipate. Progressive muscle relaxation is a technique used in cognitive-behavioral stress management that involves gradually tensing and relaxing different muscle groups. This exercise is a powerful tool for interrupting the fight-or-flight response during periods of acute stress. Other powerful relaxation techniques include guided imagery, deep breathing, and listening to calming music.

3. Reframe negative thinking 

Reframing is another strategy used in cognitive-behavioral stress management. Research shows that reframing the way we think about a situation can help with stress and anxiety—especially if we’re thinking about the situation unrealistically.

For example: It is easy for patients with cancer to get into a negative spiral when thinking about their diagnosis and the road ahead. Identify which of your negative expectations you may be imagining which may not come to fruition at all. Rather than focusing on feelings of helplessness or lack of control, try focusing on the power you do have. Explore inspiring stories of others that have gone through similar situations or read about new therapies that make you feel inspired. 

4. Approach rather than avoid

Approaching and dealing with stressful and anxiety-provoking situations instead of avoiding them is called active coping. Research suggests active coping has the best long-term outcome. Avoidance only helps you feel better temporarily.

If you find yourself avoiding something—maybe it’s a call with your sister, an MRI scan, or your medication—ask yourself what steps you can take to approach rather than avoid the situation. Of course, as you’re going through treatment and recovery, it’s OK to mindfully avoid some situations (like that PTA meeting) to give yourself time to heal.

5. Practice mindfulness 

Being present in the current moment, without making judgments or trying to change anything, is called mindfulness. Mindfulness strategies include observing your breath or paying attention to sounds or sights around you, like noticing every sensation on your feet as you walk from one room to another or every sensation in your mouth as you suck on a peppermint. Your mind will wander. It helps us tune into the way things currently are, instead of worrying about the future. Scientific studies suggest mindfulness is an effective way to circumvent the role of stress and anxiety, especially in cancer.

6. Seek social support

Make time for activities with a wide variety of family and friends, if your energy allows. If you’re interested (not everyone is, and that’s OK), ask your medical team if they can recommend support groups for people diagnosed with cancer.

Mend Together has supportive communities for patients with cancer, caregivers, and family members. See our full list of Support Communities here. 

7. Prioritize movement

Exercise releases endorphins, which make us feel more positive, and offers a distraction from our pervasive thoughts. What’s the best exercise? An exercise you enjoy doing. (It can also be helpful to exercise with someone else.)

8. Enjoy positive physical touch

Hug your partner or pet a dog or cat. Touching is a means of communication that can be highly effective in reducing stress.

9. Make time for prayer or meditation 

Those of us who are not religious may find comfort in daily meditations. One daily meditation resource that may be helpful for Christians is the book Jesus Calling.

12. Explore talk therapy

Stress and anxiety after a cancer diagnosis is normal. However, if stress or anxiety persists, interferes with your life, or feels debilitating, consider talk therapy. The type of therapy with the most scientific support for treating anxiety is cognitive behavioral therapy (CBT).

CBT is an umbrella term for many variations of time-limited therapy that focus on helping you reframe your thinking and engage in active coping strategies. You may also consider a therapist trained in EMDR (Eye Movement Desensitization and Reprocessing), which is an especially effective treatment for people who’ve been through trauma.

13. Share your worries with others—with limits.

It can be a relief to confide in a friend but going over issues over and over can make things feel more overwhelming. Experiment with talking about your cancer for 10-20 minutes to see if shorter time frames help.

14. Bird watching

When we have stress and cancer but don’t have the energy to read or watch TV, birdwatching can offer a relaxing change of scenery. Set up a bird feeder in your yard or window and enjoy a bit of nature therapy.

15. Yoga

The benefits of yoga are not limited to the physical body. Yoga can be an excellent tool for managing stress and negative emotion. Two helpful books are Yoga for Cancer and Relax and Renew: Restful Yoga.

How can friends, family, and colleagues help?

Friends and loved ones can help someone with cancer manage stress and anxiety. Here’s how:

1. Engage in mindfulness activities

Read a progressive muscle relaxation script aloud to your friend or loved one. Remind them to listen to a guided imagery CD. Offer to join them for support.

2. Plan fun activities

Plan fun, time-limited social activities to match their energy level. Understand your friend may need to cancel sometimes—and that’s OK. Ideas:

• coffee at a fun, new spot
• a walk along a favorite route
• a movie or show
• brunch
• tai chi class, yoga session, or a gentle bike ride
• cooking dinner together
• phone or video chats
• volunteer work

3. Educate yourself

If your loved one’s medical facility offers education about side effects or recovery, suggest going together. Learning about cancer will help you be a better support person.

3. Help overcome avoidance

Help your friend cope with things they are avoiding but really needs to do, like scheduling a follow-up MRI or helping with shots.

4. Help with organization

Create a calendar to keep track of who, when, and how others will pitch in. Online calendars are free and make it easy to spread the word and keep everyone on the same page. Work with your friend to come up with ideas, like:

• bringing meals
• babysitting, taking children to school or pet walks
• doing laundry, washing dishes, house cleaning and grocery shopping
• driving to medical appointments
• taking care of healthcare paperwork
• mowing the lawn, weeding the garden or shoveling snow

5. Create an angel jar

If your loved one has a hard time asking for help, try an “angel jar,” where loved ones draw chores from a jar so they don’t have to ask.

6. Practice self-care

If you’re an ongoing caregiver, take good care of yourself. The stress and anxiety management strategies above are good for you, too. Remember, you can’t pour from an empty cup.

Figure out what works for you

For those struggling with anxiety or stress and cancer, it’s important to find what’s most effective for you. We hope these tips can reduce the anxiety in your life right now. We will never be able to eliminate stress from our lives entirely, but we don’t need to feel powerless to its effects.

---

Tammy Schuler has a PhD in Clinical Psychology from Ohio State and is a former Clinical Research Psycho-Oncology Fellow at Memorial Sloan Kettering Cancer Center.

Lisa Lefebvre is the Founder of Mend Together.  She has experience recovering from 8 cancer-related surgeries, chemotherapy treatments, radiation protocols, and hormone suppression therapy.

Information provided here is not a substitute for medical advice. Please consult your healthcare team for advice tailored to your personal diagnosis and treatment.