Stress and anxiety with metastatic breast cancer

When you first learn that you have metastatic breast cancer, you are likely to feel all sorts of emotions: shock, disbelief, fear, anger, sadness, worry, grief, and more. If you were treated for early-stage breast cancer in the past, your new diagnosis may have happened a few months to many years after initial treatment. The recurrence may be an even bigger surprise if you are years past your diagnosis, because you might have thought you put cancer behind you.

If this is the first time you are dealing with breast cancer, you may know little about cancer. Everything might seem to be happening fast. No matter what your situation, your world has changed and with that comes anxiety and stress. You may feel physical, mental, or emotional tension.

It’s common to focus on just one question after a diagnosis of metastatic disease: “How long will I live?” Mortality is no longer an abstract thought but a real issue. That singular focus will probably lessen as you learn about the treatments that are helping people lead longer and more productive lives.

Stress and anxiety as normal experiences

Everybody responds differently to stressful events. How you react depends on your previous experiences, personality, life situation, support system and other factors.

Your stress might be caused by treatment or side effects, worries about your children or other loved ones, uncertainty about the future or financial pressures. Remember that stress and anxiety did not cause your initial cancer or recurrence. Studies do suggest, though, that high stress can affect your immune system, so taking care of yourself is important. Finding effective ways to reduce stress and anxiety will help improve your quality of life.

Types of stress

Knowing a bit about the different kinds of stress will help you be prepared:

• Acute stress is intense and is usually a reaction to a specific event. It may last for only a few days or sometimes for weeks. You may feel acute stress when you first get your diagnosis or if you learn that a treatment has stopped working. You may be unable to think of little else than the situation you are facing. Often, this kind of stress subsides once you have a new treatment or other action plan in place.
• Chronic stress is less intense than acute stress, but it tends to be more continuous. Often, chronic stress results from the ongoing nature of treatment for metastatic breast cancer. The physical evidence of treatment, such as hair loss and fatigue, can be a constant reminder of your health status. Even if you are not currently in treatment, the anxiety around regular scans or doctor’s visits can stress you. Personal, financial, and work worries and fear for the future can cause chronic stress.

If you feel overwhelmed by an ongoing sense of sadness or restlessness, then you could be experiencing depression, anxiety, or both. These can be addressed with professional help. Some prescription medicines may promote anxiety, so talk with your providers about nervousness that doesn’t go away.

No matter what kind of stress you feel, self-care methods can help.

Situational triggers

Certain events may cause you stress or anxiety. Possible triggers include:

• Making treatment decisions: which to choose or whether to join a clinical trial
• Side effects and symptoms: worrying about whether they can be controlled, how they will affect your lifestyle, which ones you can tolerate
• Scans and other tests: these happen often and may cause anxiety as you await results
• Being asked about the breast cancer or when your treatment will be “over”: You may not want to talk about it or feel intruded upon or want to protect the person asking from certain information
• News articles or public events: these may focus on people who have been “cured” of breast cancer, perhaps making you feel alone or like a failure, or keep others from understanding the ongoing nature of metastatic disease
• Discussion of hospice: it may be a difficult subject for you or a loved one
• Friend’s illness: when someone dies or has progression, it may hit you hard
• Other stress: something stressful happens not related to breast cancer