How Patients with Cancer, and Survivors, Can Manage Stress Through COVID-19 Uncertainty

March 27, 2020

Dr. Shelley Johns, a researcher with the Indiana University Melvin and Bren Simon Comprehensive Cancer Center and Regenstrief Institute, offers advice on how survivors and patients with cancer can recognize and manage the stress they may be experiencing as a result of the COVID-19 pandemic.

The recent and rapidly evolving developments surrounding the novel coronavirus — also known as COVID-19 – has led to significant uncertainties around the world. Those unknowns have led to panic and have subsequently increased the anxiety and stress some may be feeling, particularly those who have survived cancer or are currently in treatment.

“Fear is a natural human emotion. We all have fear during this pandemic, yet the higher risk for health complications from COVID-19 may heighten the stress faced by individuals with cancer. We all need to focus on actions we can take to reduce our risk of contracting the virus, such as social distancing. We can also take practical steps to cope adaptively with chronic stress because the fear is probably not going away anytime soon,” Dr. Shelley Johns, a researcher with the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, said in an interview with CURE®.

“Fear doesn’t have to blind us from taking actions that protect ourselves and our communities and connect us with our deeply held values.”

We spoke with Johns, a board-certified clinical health psychologist, about how people can recognize when they are experiencing anxiety, and what they can do to limit their exposure to stress related to the COVID-19 pandemic.

CURE: As concerns are heightened during times like these, how can people sense they are truly suffering from stress and anxiety?

Johns: Stress usually shows up in four aspects of our lives: our emotions, our bodies, our behaviors and our thoughts.

Some of the most common emotions right now with everything that is going on are fear, worry and sadness as well as feelings of confusion, frustration or anger. Some people may be experiencing loneliness due to social distancing. We can be observant of our emotions, accept them with grace and choose how we will use our emotions to our advantage. For example, fear of COVID-19 can motivate us to stay home to reduce our risk of contracting the virus. Loneliness can motivate us to call a friend or explore video chatting with family who live at a distance.

In terms of the effects of stress on our bodies, we may notice muscle tension, headaches, or more fatigue than usual. We may notice our heart racing or chest pain when we’re watching the news, or maybe getting a little short of breath and feeling unsettled or restless.

Some of the behavioral signs would be things like sleep disturbance, being irritable with others, appetite changes or exhibiting more nervous behaviors, such as nail biting, fidgeting, or pacing.

Stressful thoughts might include ‘the world is never going to be the same again,’ yet a more adaptive thought might be ‘this is an extremely challenging time with a great deal of uncertainty and adjustment, yet I can be resilient and take wise action in the face of COVID-19.’

How does stress and anxiety affect the health of a cancer survivor or someone recently diagnosed with cancer?

The most resilient people on Earth are people with cancer, because they are masters at adjusting to unwanted realities and uncertainty from the moment of diagnosis. People with cancer have looked death in the eye and are still finding their way.

One of my greatest concerns right now is for people with cancer whose immune systems may already be compromised. Chronic stress — which we’re all experiencing now – can have a negative effect on the immune system, which may already be depleted in individuals with cancer. I think it is essential for people who are immunocompromised, such as those with cancer, to be proactive to maximize their physical and emotional health during this COVID-19 threat. Social distancing, frequent and proper handwashing, keeping surfaces clean and disinfected, and calling your oncologist or primary care physician if you have a fever or cough are key strategies for physical health. For emotional health, I recommend a variety of research-supported stress management skills.

What kind of skills would you recommend?

One thing we can all do is decide what kind of person we want to be through this experience. In other words, what deeply held values do you want to embody during the COVD-19 crisis?

For instance, do you want to be compassionate and generous toward others? Do you want to deepen your faith or your connection with friends you’ve not spoken with recently? Do you want to be known as someone who maintains a sense of humor during stress? Letting our values guide our actions during uncertain times can be like a compass guiding our way through uncertain times.

Another suggestion is to find a practice that can help ground you. This could be deep breathing, prayer, or mindfulness meditation. Mindfulness is about being fully “awake” to this present moment rather than getting caught up in thoughts about the future or the past. Physical activity is also a healthy stress buster, and this can be as simple as taking a brisk walk while maintaining social distance or trying a few yoga stretches. Doing something to help others is also important. Everyone knows someone who lives alone, so keeping in close touch with that person by phone could give meaning to this experience for both of you. I also suggest keeping a gratitude journal. Making a list of three specific things you are grateful for each day can be a pleasant reminder that life is about more than cancer and COVID-19.

Would you recommend patients stick to a routine to help them with any stress and anxiety?

Absolutely! Maintaining a healthy routine and schedule for our day is one way we can exert some control over our lives. For example, going to bed and getting up at the same time each day and limiting nap time can help maintain energy and normalcy. Eating healthy, regular meals and limiting alcohol consumption is also key. Scheduling time for physical activity each day — to the extent possible for each person – is another great way to build endurance during COVID-19 stress. Other self-care strategies like meditation, prayer, and listening to mood-enhancing music could also be on the daily schedule.

What are some things that you would recommend people do to distract themselves from what’s going on?

I don’t think of it as a distraction, as much as choosing purposeful activities grounded in our values. Distraction is about turning away from what’s here, as where values-based action is more about turning toward what matters to us, which is much more meaningful and vitality-enhancing. For instance, you can text your family members, organize family photos, or learn something new online. Instead of feeling stuck at home, one of my patients has decided to take this opportunity to learn to speak Spanish using an online training program. Having purposeful activities scheduled into each day can help us maintain our sense of normalcy during this highly unusual time.

Is there anything that you would recommend against to help individuals avoid unnecessary stress and anxiety?

One thing I don’t find nurturing right now is too much news and social media. We all need to stay informed, yet too much media consumption can heighten our distress rather than reduce it. I have been limiting my news consumption to one hour per day, because research shows that during past public health crises, the more social media and news people consumed, the more anxious they felt. Consider replacing some of your news consumption with a funny movie or an hour with your favorite comedian instead.


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