Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher
Nancy Hepp, MS, BCCT Project Manager
Last updated November 30, 2020.
The Oxford English Dictionary defines stress as “a state of mental or emotional strain or tension resulting from adverse or demanding circumstances.”1 Those adverse or demanding circumstances, called “stressors”, can disrupt your internal balance and call on your body to activate a stress response. This response is automatic and calls on every bodily system to bring the body back into balance.
A certain amount of stress is normal—in fact, we couldn’t survive without the stress response. However, a sustained stress response can be damaging. "Chronic stress results in glucocorticoid receptor resistance (GCR) that, in turn, results in failure to down-regulate inflammatory response."2 Sustained stress leads to inflammation, a known driver of cancer.
Remember that stress is not only the challenging situation—it’s also your response to the situation. Even if you cannot change the stressors in your life, you may still be able to manage your response. On this page, we explore many tools that can help you manage your stress. However, seek outside or professional help if needed. Responses such as posttraumatic stress disorder (PTSD) may be beyond self-help.
Your Body’s Stress Response
Even when people are getting the best of cancer treatment, they often feel like they need more help with organizing their care and managing symptoms and side effects. Helpsy empowers members to take control of their health through a real-time virtual nurse support service. This service is available via mobile devices, a Helpsy website and automated phone calls.
The physical stress response is driven by a complex cascade of nerve activation and hormones:4
The Stress Response and Cancer
Common Stressors in People with Cancer
Stress is our response to challenging situations in our lives. What is stressful for one person may not be for another. However, some events and environments are stressful for many cancer patients, survivors and caregivers:
How Stress Interacts with Cancer
When stressors and threats are frequent or constant, cortisol remains at high levels most of the time. When the stress response continues for a prolonged period, the constant bodily imbalance that it causes can be physically damaging. Over time, this delays restorative repair and pushes the body into pre-disease states.5 Stress hormones have been found to fuel cancer growth and spread.6
Can Stress Cause Cancer?
People sometimes ask, “Did stress cause my cancer?” No one has a simple answer to this question. We do not have good evidence that stress causes cancer. However, some research shows a connection.
Posttraumatic stress disorder (PTSD) symptoms are associated with increased risk of ovarian cancer. A large longitudinal study found that women with high PTSD symptoms had two-fold greater risk of ovarian cancer compared to women with no trauma exposure.10
PTSD and Cancer12
In addition to the stress from dealing with cancer, for some people with cancer and/or their caregivers, the experience can be traumatic and/or bring up past unresolved traumas. For these people, long-term problems may develop or resurface, such as adjustment difficulties, anxiety or depression. In addition to normal stress reactions, traumatic stress-like reactions may be seen in some people with cancer or their caregivers such as these:
- Intrusive upsetting thoughts
- Reacting to reminders such as follow-up scans
Integrative Approaches for Managing Stress
Research shows that quality of life is improved with use of stress management interventions. "A recent review found that after a breast cancer diagnosis, a formal mindfulness practice was associated with improvements in mood, anxiety, and physical symptoms."20
- Moving More
- Guided imagery
- In our Mind-Body Approaches summary:
- Deep breathing
- Music therapy
- In Creating a Healing Environment:
- Nature immersion, such as forest bathing
- Sleeping Well
Natural Substances for Managing Stress
Anticancer Lifestyle Program
Using expert videos, animation, text and interactives, the Mindset Module of the Anticancer Lifestyle Program guides you in developing a constructive mindset that will make it easier to make and maintain lasting beneficial lifestyle changes.
This course is offered on a “pay-what-you-can” basis for 90-day access to all course modules.
According to naturopathic oncologist Lise Alschuler, evidence shows several herbs and nutrients have antistress properties. These substances seem to work by either helping the body recover from stressful situations or supporting the body’s organs and tissues that are affected in the stress response:23
Integrative oncologist Keith Block, MD, also includes natural substances in his integrative plan for balancing stress hormones and creating healthier biorhythms. Block distinguishes among three patterns of stress adaptation:
- Hyperadapted or high-stress pattern with prolonged elevated cortisol
- Inverted stress pattern, in which the timing of cortisol and melatonin are reversed.
- Non-adapted pattern, in which cortisol levels are either consistently high or depleted, melatonin levels are low, and both hormones have no circadian rhythm
Products for Calming or Reducing Stress
Missy Hall conducts a sound bath meditation to calm the nervous system
The Relaxing Breath
Shanti Norris, a yoga teacher who works with people with cancer, explains: “One cannot feel anxious as long as one is breathing slowly and deeply.” Her instructions for managing stress with “The Relaxing Breath”:27
Many mind-body approaches, such as meditation, progressive muscle relaxation, tai chi and music therapy help with regulating breathing and heart rate, bringing on a calm state. These are discussed in more detail on these pages:
Theta Brain State
Theta brain state “is a state where tasks become so automatic that you can mentally disengage from them. The formation of thoughts and ideas that can take place during the theta state is often free flow and occurs without censorship or guilt. It is typically a very positive mental state.”30
Healthy Dozen Food Families
From Life Over Cancer:31
Manipulative and Body-Based Methods
Some studies have found that massage may help to alleviate stress in cancer patients.
Eating Well to Reduce Stress
Foods can support or undermine a healthy stress response and biorhythms.
Eating Well: Strategies
Dietary strategies for supporting a healthy stress response and biorhythms:
- Reduce use of caffeine and other stimulants.
- Avoid excessive alcohol consumption: alcohol as a nightcap or to relax can instead disrupt melatonin production as well as cause repeated awakening from sleep.33
- If you eat a late-night snack, keep it light and let it consist of protein and/or whole grains. Avoid eating during the hour before bedtime.34
- Include complex carbohydrates in your diet: whole grains, beans, and whole fruits and vegetables.
- Work with your doctor or dietitian/nutritionist to improve your ratio of omega-6 to omega-3 fatty acids.
- If diet, fitness and mind-body approaches do not completely manage stress chemistry and biorhythms, consider using a combined stress hormone support supplement in addition to a program of taking a cancer-specific multivitamin and fish oil supplements and also eating what Block calls the “healthy dozen food families” listed at right.
See Eating Well.
Pharmaceuticals for Managing Stress
A good integrative cancer care plan will include mind-body therapies, eating well, moving more, and possibly natural products to manage stress. Sometimes, however, these therapies may not be enough. If natural treatments alone are inadequate, then even more symptoms of stress can arise, causing needless emotional suffering.
Sleep and Managing Stress
Getting good sleep and rest is a key practice in creating a body that doesn’t encourage cancer. Poor sleep and stress can become a self-reinforcing cycle: unmanaged stress can disrupt biorhythms, including sleep. Stress hormones interact interact with sleep, with some contributing to nighttime wakefulness and others causing daytime sleepiness and fatigue.36
When sleep quality is poor, the stress response hormone cortisol rises at night when it should instead be lower. Because a chronic rise in blood cortisol can speed tumor growth and cause any number of increased health problems for people with cancer, consistently good sleep and rest are tools to combat stress. Effectively managing stress will improve the quality of sleep.
See Sleeping Well.
The loss of love causes intense feelings of helplessness in many people, perhaps by tapping into psychological wounds received in childhood through experiences of rejection and criticism.”
Stress Inventory: Creating a Stress Score
The Holmes-Rahe Stress Inventory assigns a score to the top stressors in people’s lives to allow people to assess their risk of developing a stress-induced breakdown. Of the 25 biggest stressors, 14 relate to changes in relationships and social support.38 The Holmes-Rahe Inventory makes a profound statement about the importance of relationships in influencing one’s health.
Mediating the stress response with social support is an important part of an integrative cancer care plan. “The effect of social support on life expectancy appears to be as strong as the effects of obesity, cigarette smoking, hypertension, or level of physical activity.”39
Medical acupuncturist Janet Spitzer, MD, and Keith Block, MD, inform us about foods and natural substances that can promote a stress response.42
Foods and Natural Products
Anything that is a stimulant increases heart rate, anxiety and the stress response:
- Caffeine in coffee, tea or chocolate
- Other stimulants, including ginseng and bitter orange
- Spicy foods
In addition, some eating patterns can promote stress:43
- Low-carb, high-fat diet
- Low-carb, high-protein diet
- High ratio of omega-6s to omega 3s
Eating Habits That Are Stress Offenders
Dr. Keith Block lists eating habits that can promote a stress response:44
- Timing of snacks and drinks (eating within one hour of bedtime; eating a heavy evening meal or snack)
Reducing stress offenders is an important step in managing stress.
Several of the therapies mentioned on this page come with cautions about interactions with other therapies or with medical conditions. For example, ashwagandha may increase testosterone, so use is not recommended by people with prostate cancer. Use is also contraindicated in patients with hemochromatosis.45 Please review cautions listed on therapy summaries or outside linked pages and consult your integrative physician before use.
Integrative Programs, Protocols and Medical Systems
|For more information about programs and protocols, see our Integrative Programs and Protocols page.|
- Programs and protocols
- Alschuler & Gazella complementary approaches46
- Block program47
- Cohen & Jefferies Mix of Six anticancer practices48 Anticancer Living. New York: Viking. 2018.
- Geffen Seven Levels of Healing49
- Lemole, Mehta and McKee protocols50
- MacDonald breast cancer program51
- McKinney’s guidelines for stress management52
- Ornish Lifestyle Medicine
- Servan-Schreiber anticancer way of life53
- Traditional systems
Janet Spitzer, MD, April 16, 2018: “According to the Chinese 5 Element Theory, it would be helpful to ‘cool’ or at least not overheat the Fire element (heart, pericardium). Salty flavor would help cool the heat, while sour and excessive bitter flavors would tend to aggravate the heart. Alcohol also powerfully ‘heats’ the Heart-fire element.
I generally aim more at supporting/nourishing the adrenals when someone has chronic stress (ashwaganda, holy basil, Siberian ginseng, etc.) and decreasing oxidative stress with antioxidants (vitamin C, vitamin E) and decreasing inflammation (fish oil, turmeric/curcumin) and nutrients that help soothe the nervous system and support biochemical pathways (like magnesium, CoQ-10, Ribose, etc.).”