The stress of a cancer diagnosis affects lives and treatment

People with cancer don't, for the most part, suffer from major anxiety or stress disorders, says psychologist Andrew Baum, PhD. But that doesn't mean their stress isn't clinically significant.

"There's not as much psychopathology as I, or many other people, would have expected given the challenge that cancer poses or the fear it evokes," says Baum.

"But that doesn't mean it isn't clinically significant distress," he says. "Many people say they never fully recover. From the minute they learn they have cancer, it's like having a child: Their life changes forever but in a bad way, not in a good way. They're introduced to a nightmare that doesn't go away."

Even people without cancer but who know they're at risk--because of a family history or some environmental exposure--show signs of chronic stress, researchers find. In a recent study, for example, Baum and his colleague Donna Pusluszny, PhD, found that over the course of one year, women at risk for breast cancer reported feeling more distressed and had more intrusive thoughts about the disease than women who weren't at increased risk.

Once people have cancer, psychological factors are now widely recognized to have a significant influence on treatment side effects, researchers find. Gary Morrow, PhD, and his colleagues at the University of Rochester for example, investigate how people develop conditioned responses to environmental cues associated with their cancer treatment. The most common, he says, occurs after chemotherapy, when many cancer patients become nauseated and vomit. After that experience, some patients will become nauseated and may even vomit if they enter a room, hear a noise or smell an odor that reminds them of the room in which they received chemotherapy.

Although many physicians assume that these conditioning responses have been eliminated by a new crop of anti-emetic treatments that reduce the likelihood that patients will vomit following chemotherapy, Dana Bovbjerg, PhD, and others find that chemotherapy still causes nausea in many patients, which for most people is as bad or even worse than vomiting.

Bovbjerg, head of the biobehavioral medicine program at the Ruttenberg Cancer Center at Mount Sinai School of Medicine, and his colleague clinical psychologist Guy Montgomery, have also found that people's expectations can influence their reactions to cancer treatment: Patients who expect to get nauseated or vomit are more likely to experience these side effects during treatment.

One way to diminish these problems is to expose patients to all the sights, sounds and smells of cancer treatment before they receive any treatment. This tends to desensitize them and prevent conditioning from taking root, says Morrow.

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