Patients diagnosed with terminal cancer undergo dramatic changes physically
and psychologically. Sometimes these changes directly impact a patient's
health by spurring cancer growth. Several factors influence cancer progression
such as side effects from therapy, immunosuppression, and even stress,
which has both emotional and physical components.
Dr. Robert Cameron, Chief of Thoracic Surgery at UCLA Medical School in
Los Angeles, California warns patients about the effects of stress: "Known
physical stressors associated with cancer include: pain, surgery, chemotherapy,
radiation, loss of appetite and weight loss, shortness of breath, anemia,
exhaustion, medication, nausea, dehydration, nutritional status, loss
of muscle tone, fatigue, and decreases in both functional status and capacity."
Patients should be aware of their physical stress and address those needs
accordingly. Take appropriate pain medication if available or seek therapy
to reduce pain. Even though loss of appetite and weight loss can be a
common side effect following some cancer treatments, it is important to
maintain a healthy diet. Eating nutritional foods and staying hydrated
nourishes the mind and body. Each person is unique and maintaining one's
health should fit every one differently and appropriately.
Dr. Cameron lists known emotional stressors for terminal cancer patients:
"Fear, anger, anxiety, excitement, self-esteem, body image, intimacy,
sexuality, depression, dependency, adjustment disorder, phobia, sadness,
disbelief, despair, worthlessness, loss of pleasure, abandonment, adjustment
and panic disorder, diminished concentration, suicidal ideation, and immanency
Certainly not every patient will experience such a range of emotional stress.
Nonetheless, it is important to be aware of situations that might induce
emotional stress so they can be avoided or dealt with properly.
"Stressors create and escalate stress. Many types of stress activate
the body's endocrine (hormone) system, which in turn can alter the
way the immune system (the body's defense against infection and disease,
including cancer) functions. As one example of the immune system's
soldiers, natural killer cell (NK cells), often are important in the body's
first defense against abnormal cells, including cancer cells that threaten
one's health, serving to destroy these cells," says Dr. Cameron.
Biology of Stress
Dr. Cameron says, "Stress can influence the responses of the body's
NK cells. Uncontrolled emotional stress may lead to fatigue and lower
the cancer patient's already compromised immune system, inhibit NK
cells, disrupt the body's metabolic pathways, and hasten tumor proliferation
and tumor metastasis. Stress may also alter the risk of infection and
other immune-related diseases, especially among patients receiving chemotherapy.
When confronted by emotional or physical stress, the brain produces catecholamines,
which are neurotransmitters that produce the "fight or flight"
response. It directly suppresses the NK cell function and other aspects
of cellular immunity that relate to innate immunity."
Additionally when the body releases the stress hormone norepinephrine,
it also stimulates production of three compounds that contribute to aggressive
tumor growth. Norepinephrine causes the tumor to produce two "metalloproteinase"
compounds which break down part of the tumor structure to which the cancer
cells adhere. Once these cells are no longer bound to the primary tumor,
the cells spread throughout the body and metastasize elsewhere, causing
rapid tumor growth. Norepinephrine also increases production of the compound
vascular endothelial growth factor, or VEGF. VEGF stimulates the growth
of new blood vessels that feed cancer cells. Increased blood supply to
the cancer cells directly accelerates the spread and growth of the tumor.
Fatigue is a common a physical feeling that many cancer patients experience.
However, Dr. Cameron suggests that "fatigue is a major psychological
symptom that corresponds with low NK cell function, as well. Fatigue is
the most common and distressing symptom associated with cancer and cancer
therapies. Fatigue has been identified as significantly interfering with
quality of life (QOL) in people of all ages who have cancer, regardless
of diagnosis, treatment or prognosis. Although there are established medical
interventions for most cancer-related symptoms, there are only limited
medical treatments for fatigue. Physical and emotional stress both contribute
to a cancer patient's fatigue."
Prolonged stress can be detrimental for cancer patients physically, emotionally,
and mentally. Skills such as learning, memory recall, and performing small
daily tasks may become affected. It is important to keep stress at a minimum
to avoid some of these indirect problems.
*Dr. Robert Cameron's quotes are taken from his declaration in the
Michael Mikul vs. BONDEX INTERNATIONAL, INC., et al. July 13, 2005. For
the County of Los Angeles.