Distress
Topics covered on this page:
What is cancer-related distress?
Feelings of loss, worry, sadness and fear are normal reactions to a diagnosis of cancer. Cancer-related distress is when these same unpleasant feelings are more intense and persistent, and may affect your ability to cope with cancer and its treatment. Cancer-related distress affects close to half of all cancer patients.
Distress is often differentiated based on what is experienced. For instance, emotional distress often refers to the experience of anxiety and depression. Whereas physical distress is about physical symptoms such as pain and fatigue. General distress not only includes emotional and physical distress but also includes difficulty coping with daily activities, feeling overwhelmed, social and practical issues, and religious or spiritual concerns.
- How does it affect me? When you are distressed, you may find it difficult to keep negative thoughts from your mind. You may feel like you have no control over your life and even question your faith or spiritual beliefs. You might find it difficult to continue social and daily activities.
- Does it get better? For many people with cancer, feelings of distress come and go, and often get better over time. If you feel stuck, there are strategies to help (see strategies in the section What can I do to manage distress?). You should never hesitate to talk to a member of your healthcare team.
What causes distress?
While there is no single cause of distress, you are probably at greater risk if:
- You have a history of mental health issues or substance abuse.
- You have bothersome symptoms that aren’t controlled well.
- Your cancer is difficult to treat.
- You do not have social support you can depend on.
- You are living in a difficult family situation.
- You have financial concerns.
- You are younger.
- You are a woman. (On the whole, women are more likely to experience distress.)
- You are single, separated, divorced or widowed.
What are the signs of distress?
Symptoms of distress can differ between people and change over time. If you are experiencing some of these symptoms, there’s a good chance you have distress:
- You have strong negative emotions such as sadness, anger and fear.
- You are very tired.
- Your appetite has changed significantly.
- You find it difficult to understand your illness or make treatment decisions.
- You have trouble concentrating and/or carrying out routine activities.
- You feel isolated and alone, or worry that you are a burden to others.
- You find it difficult to speak about your diagnosis with family or friends.
- You have frequent thoughts of “why me” and focus on the unfairness of life.
- You question the purpose of your life or of life in general.
When should I get help for my distress?
Depending on the nature and level of your distress, you may benefit from outside help, such as peer support, counselling, psychotherapy, or medical treatment (see Getting support). If your distress is affecting your day-to-day function or quality of life, talk to your oncologist, nurse or pivot nurse. For more information see Talking to your healthcare professional about your symptoms or concerns.
Talk to someone in your healthcare team immediately if:
- You feel like you are in a state of crisis.
- You cannot function or carry out daily activities.
- You feel highly confused.
- You want to harm yourself or others.
- You have suicidal thoughts or plans.
What can I do to manage my cancer-related distress?
Managing distress is an important part of your overall cancer care. The strategies offered below can help. Try strategies that have worked for you in the past, while keeping your mind open to new approaches. If you need extra help, do not hesitate to talk to the members of your healthcare team. They are there to listen and to help you.
Write down your feelings of distress and what is happening at the time in a diary. This can help you work through your feelings and reduce your stress levels.
- Write down:
- When did it start?
- What seems to make it worse?
- What makes it better?
- For more information see Symptom Diary.
Stress and distress have a lot in common, and it’s almost impossible to feel distress without also feeling stressed out. By managing your stress, it is very likely you will also reduce your distress. Here are some ideas:
- Check your thinking: remind yourself that your worries do not necessarily reflect reality. They might just be thoughts that your mind produces when it’s anxious.
- Focus on one thing at a time—one problem, one solution. Training yourself to stay focused will keep you from getting overwhelmed.
- Manage your time: Make a realistic list and tackle one task at a time. Just like your thoughts, your activities will feel less overwhelming if you do one thing at a time.
When you do not understand your medical situation, your thoughts can run wild and focus on worst-case scenarios. You might find it difficult to face your diagnosis and treatment. Having some information will likely reduce your distress. Consider these suggestions:
- Let your oncologist know how you prefer to receive information: all the facts at once or a little at a time. A shared understanding of how you want to communicate can protect you from distress.
- Knowing more about your cancer, your treatment options, and the side effects of treatment can help you feel more in control and less anxious.
- In between appointments, keep your questions in a checklist to ask your oncologist (or radiation oncologist) at your next visit. You may worry less if you feel more prepared.
- Before undergoing a cancer-related procedure (such as surgery), ask for materials such as handouts or videos to read or watch before the procedure. The more information you have, the less anxious you are likely to feel.
Try to take care of yourself and participate in life. Even if you don’t feel like it, this can distract you from feelings of distress. Start with the basics:
- Eat well: good nourishment provides energy and helps you feel more emotionally stable. Limit junk foods and drink plenty of fluids. Avoid alcohol.
- Move your body: Physical activity also boosts energy, while reducing the negative effects of stress. Even if you cannot be very active, every little bit helps. Walking, swimming, or yoga are excellent ways to keep moving while being treated for cancer.
- Talk to your healthcare team about how much you should exercise. It is generally fine to exercise during treatment, but check with your healthcare team before starting any physical activity.
- Schedule pleasant activities in your day. Examples include cooking a favourite dish, visiting a museum or library, having a relaxing bath, and playing with pets. For extra motivation to get out of the house, join a community centre or hobby group.
- Sleep better: Improving your sleep will also improve your distress. The following can help:
- Have only short naps during the day, less than one hour. Avoid naps after 3:00 p.m.
- Find relaxing activities to do before bedtime: Drink a cup of herbal tea, have a warm bath, or listen to a meditation tape.
- For more information see Looking After Yourself.
Even if it is outside your comfort zone, reaching out to friends and family members in times of distress can lighten your burden. There are many ways of connecting, and different approaches may work at different times. Some thoughts to keep in mind:
- Some people are better at providing practical help, while others know just how to listen. When building your support network, consider the strengths and skills of each person.
- Be specific about the help you need. It might be mowing the lawn or someone to sit with you in the doctor’s waiting room. Many people want to help, but don’t know how.
- When you open up to people, feel free to express feelings of sadness and fear. It’s healthy to express feelings, and it often becomes easier with practice.
- Sometimes, you may want to spend time with people without thinking or talking about cancer. Let people know when you are not in the mood for such discussions.
- For more information see Getting Support.
If you can’t manage your distress on your own, more formal support or treatment could help you feel better. Talk to your oncologist, nurse or pivot nurse to discuss your options, which could include:
- Focused therapies such as mindfulness-based stress reduction or cognitive behavioural therapy.
- Face-to-face or online support groups.
- One-to-one conversations with trained volunteers who have gone through cancer. To find out more, visit match.cancer.ca or call 1 888 939-3333.
- Telephone support, Info-Social (8-1-1, option 2)
- Oncology social workers, who can provide counselling and refer you to other community resources.
- Ask your healthcare team about other resources that may be available to you like a spiritual counsellor or a music therapist.
- For more information see Getting Support.
⚠ Important information about cannabis
Some patients do use cannabis to reduce pain, help with relaxation or as a sleeping aid. However, the research is still unclear about the use of cannabis to manage cancer-related symptoms, including distress. It is important to talk to your doctor before trying cannabis. For more information on what cancer patients should know about cannabis, go to: www.bccancer.ca/health-info/coping-with-cancer/medical-cannabis.
Resources
For more information on cancer-related distress, self-management strategies and support organizations, check out the resources below.
Acknowledgement of sources
The content of this document has been adapted from the following sources:
- BC Cancer. Managing stress. 2019.
- BC Cancer. Symptoms of depression. 2018.
- Canadian Cancer Society. Coping when you have cancer. 2019.
- Canadian Psychological Association. “Psychology works” fact sheet: cancer in adults. 2019.
- Cancer Care Nova Scotia. Cancer-related distress in adults (guideline). 2015.
- Cancer Care Ontario. How to manage your depression. 2016.
- Cancer Care Ontario. Provider-patient communication: evidentiary base. 2008.
- CAPO. Practice guideline (emotional distress, depression, and anxiety). 2015.
- CAPO. The emotional facts of life with cancer. 2012.
- Coping together: a practical guide for couples facing cancer. Dealing with stress and worry.
- Cyr C et al. Cannabis in palliative care: current challenges and practical recommendations. Ann Palliat Med 2018;7:463-477.
- OncoLink. What is cancer-related distress? 2018.
- TEMPO. Feeling sad, lonely or depressed.
Healthcare professional endorsement
The content of this document has been reviewed and approved by a team of healthcare professionals and clinical experts.
Disclaimer
Please note that this fact sheet is not intended as a substitute for consultation with a healthcare professional. Rather, it was designed to complement interventions by your treating team. If you have questions about your health, or any medical issue, you should contact a healthcare professional right away. You should not delay seeking medical advice, or disregard professional medical advice, because of information in this fact sheet. Before beginning any health treatment, always consult your doctor. All care has been taken to ensure that the information contained in this document is accurate at the time of publication. e-IMPAQc is not responsible for any injury or damage to persons or property arising out of, or related to, any use of the fact sheet, or because of any errors or omissions.
Reproduction and copyright
Any reproduction or distribution, in whole or in part, of this webpage is prohibited without obtaining prior written consent of the e-IMPAQc project lead. Permission can be obtained by writing to e.impaqc.comtl@ssss.gouv.qc.ca.
