Stress during Chemotherapy
No one enjoys receiving chemotherapy. Some women have a harder time, physically or emotionally, than others, and it is often impossible to predict how any one of us will do. The physical reactions can vary cycle to cycle, so it can seem impossible to figure out how best to manage them. I often hear from women that, about the time they feel competent at chemo, the treatment is done.
Obviously, women who are being treated for Stage IV (metastatic) breast cancer have a different situation as their treatment is not time-limited. Generally, our doctors pay a lot of attention to side effects and quality of life during treatment for advanced breast cancer. If a woman is going to be receiving treatment for the rest of her life, it matters a lot how well she feels. On the other hand, when a woman is receiving adjuvant chemotherapy for three or four or six months, the general feeling is that it is more important to deliver the high/appropriate doses and just get through it.
A recent study by Maria Browell and her colleages at Gotenburg University in Sweden explored the impact of stress and stressful experiences during adjuvant chemotherapy. Here is a summary of that study:
Physical problems stressful during breast canceradjuvant chemotherapy
By Laura Dean
17 September 2009
Eur J Cancer Care 2009; 18: 507-516
MedWire News: Physical symptoms are reported three times more often than psychosocial problems as the most stressful daily event experienced by women undergoing adjuvant chemotherapy for breast cancer, a Swedish study shows.
To identify the stressful events experienced by postmenopausal women with breast cancer receiving adjuvant chemotherapy and to examine the coping strategies used, Maria Browell (Göteborg University) and colleagues asked 75 women scheduled to undergo adjuvant chemotherapy to complete a Daily Coping Assessment diary. The women recorded the most stressful event of the day on the first 5 days of treatment during the first, third, and last treatment cycles.
In total, 755 diary entries were completed and almost 30% recorded no stressful event. Six categories of stressful events were identified: nausea and vomiting, fatigue, other symptoms, isolation and alienation, fear of the unknown, and being controlled by the treatment. The first three categories were classified as physical problems and the latter three as psychosocial problems.
Physical problems were mentioned almost three times as often as psychosocial problems, at34% versus 14%. The most common stressful event was nausea and vomiting (21.6%). Isolation and alienation (8.7%) and fear of the unknown (5.7%) were relatively rare, but were rated, on average, as the most distressing when they did occur.
Several different coping strategies were used to manage each stressful event, with an average of 3.3 coping strategies reported per stressful event. The most commonly used strategies were acceptance (17.5%), relaxation (16.6%), and distraction (16.4%). The least used strategy was religion (1.7%). Acceptance was the most frequently used coping strategy for physical problems, whereas distraction was the most frequently used strategy for psychosocial problems.
The fact that nausea and vomiting was the most common stressful event observed, despite the availability of anti-emetic medication programs suggests the need for more research on this well-known symptom, remark Browell et al in the European Journal of Cancer Care.
They add that further research is also needed to better understand the relationship between stressful events and the different coping strategies used by these women.