Psycho-oncologist Professor Dame Lesley Fallowfield on how breast cancer patients and caregivers can curb anxiety.
As the country navigates COVID-19, cancer patients are facing tremendous stress and anxiety. Managing that stress can be overwhelming.
BCRF investigator Dame Lesley Fallowfield, DBE, BSc, DPhil, FMedSci, is a professor of psycho-oncology at Brighton and Sussex Medical School in the United Kingdom whose work focuses on the psychological wellbeing of cancer patients, caregivers, and healthcare workers. Fallowfield is the recipient of The Estée Lauder Companies' Brands Award in Memory of Evelyn H. Lauder.
We spoke with Fallowfield about what stressors breast cancer patients and caregivers are dealing with right now—and how they can relax and unwind in spite of the barrage of news. Watch her video interview above or read what she had to say below.
How is this pandemic affecting cancer patients right now?
Lesley Fallowfield: I think it's fair to start by saying that the anxiety and uncertainty surrounding COVID-19 is worrying enough even if you don’t have cancer. But there are quite a few things that we need to consider that are specific to patients with cancer.
Newly diagnosed patients are likely to be deeply stressed by the fact that many of their treatments will now be on hold [depending on where you live]. It’s important that particularly patients who are at early stages of the disease focus on the fact that breast cancer, generally speaking, is more of an emotional emergency rather than a direct medical emergency. I don't think they should feel unduly panicked about the fact that they might have, for example, surgery or radiation delayed for a little while.
As far as the patients who are already being treated, this has got its own stresses. Some treatments compromise the immune system, so it really isn't safe to continue in the current climate.
People who are on treatments to try and keep the cancer at bay—because they've got a more advanced disease—are probably in a more troubled situation. Visits to hospitals have been curtailed for the same sorts of reasons that we've just been sort of exploring. It's not just the fact that people are not having their treatments or normal monitoring. Contact with many of our healthcare providers is very reassuring. If you're unable to actually have that sort of contact with professionals who know you and understand your treatment, I can understand why many people must be feeling especially alarmed at the moment.
What advice do you have for patients right now to manage stress and anxiety?
LF: One of the problems with being in a constant state of stress, as we've seen with some of our BCRF-funded research, is that stress causes the body to produce an excess of stress cortisol. One of the worries is that this can cause the cancer to grow a little more quickly. Anything we can do to reduce anxiety and stress is going to be good. The good news is that we know that there are lots of techniques for reducing stress.
It could be yoga, exercise, or meditation, and there are masses of these programs that are available online and easy to download and get. There isn't so much traffic or overhead airplane noise where I am because of the lockdown. I started to hear birds singing again, which is therapeutic and relaxing in itself. People have to know their own bodies, and what helps you feel less stressed. Then program it into your day.
Pay attention to a sensible diet. If you're on lockdown and stuck inside your house, it's even more tempting to go and find the cookie jar, but concentrate on eating well, avoiding alcohol, and trying to get as much sleep as possible. Also, if you're used to seeing lots of friends, this isolation is going to be difficult. But again, aren't we lucky that we live in an age where social media allows us to connect a little more?
The other thing from a psychological point of view that's really quite important is that all of us like to have things to plan and look forward to, and a lot of that is being curtailed enormously. Drawing up a little plan of actually achievable, fun things to do is important. Don’t dwell too much on the things that we're not going to be able to do––the holidays, the visits to see friends and family. If you can, replace those thoughts with things that will be achievable, even if it's only looking forward to watching another episode of a TV show. Try and plan a future of things that are likely to be realizable.
A lot of evidence shows that people who are able to make downward social or emotional comparisons fare better than those that make upward ones. What that means is that let's say, for example, you feel that everybody else in the world has got more money and a better house than you. You're going to feel fed up and unhappy about that. If you focus instead on what great things you've got, and make a downward emotional comparison, you're going to feel much better. That sounds sort of rather trivial, but it often helps some people.
What advice do you have for caretakers?
LF: Caretakers have an invaluable role to play. In addition to keeping spirits up, allow the partner/friend/family member who has cancer to express their fears and worries. People should have faith that healthcare providers will know if it's not safe to visit the cancer center or have treatment. Any caregiver or informal caregiver living in the same house as someone with cancer should be reinforcing all the things we’ve just mentioned. Try and relax, try and actually do exercise programs or their own silly version of meditating, yoga, etc. Eat healthfully and create things to look forward to that are likely to be realized.
Fallowfield's top 5 ways you can do to reduce stress:
- Don’t dwell on canceled plans
- Draw up a list of things to look forward to—even if they are small
- Focus on what you have—not what you lack
- Schedule meditation, yoga, exercise, or any activity you know makes you calm
- Eat healthfully, reduce alcohol, focus on a good night’s sleep