Tears flowed from emotions Julio Monsalve didn’t even realize he had.
Treatments by his medical and surgical teams at Sylvester Comprehensive Cancer Center at the University of Miami Health System had given him a new chance at life after a cancer diagnosis, and he was relieved, but these new tears didn’t come from joy.
“Even though I was doing great physically, I still felt anxious and depressed. One day I found myself driving and crying, but I didn’t know why,” says Monsalve, who had moved from New York to Miami in 2017 – just before learning he had prostate cancer.
He already was dealing with a high-pressure job and a back injury, but he was moving on and taking care of himself.
“I did the right things in terms of going to the doctor, getting a cancer screening, and making lifestyle and diet changes,” says Monsalve, now 68, a native of Colombia. His cancer care went well, and after his treatment he was free of the disease. Still, he couldn’t shake those residual feelings of despair.
But then an email arrived – about a year after the surgery took place – inviting Monsalve to join a cancer survivors’ group at Sylvester, part of a large study evaluating the role that stress can play in survivors’ lives as well as the potential benefits of facing that stress head-on.
“From the moment they’re diagnosed and well into survivorship, cancer patients face many emotional challenges, including anxiety, depression and distress,” says Michael Antoni, Ph.D., a lead investigator in Sylvester’s Cancer Control Research Program, professor of psychology, and the first author of a paper recently published in Annual Review of Psychology on how stress reduction approaches can improve outcomes for cancer patients.
“Some work has suggested that chronic distress can affect neuroendocrine signaling, producing stress hormones that could promote poorer cancer outcomes,” Antoni says, adding that stress-activated hormones have been shown to impair the immune response to cancer, increase inflammatory signaling and potentially hasten metastasis.
Patricia Moreno, Ph.D., Sylvester’s lead of evidence-based survivorship care and assistant professor in the Department of Public Health Sciences, has studied stress management techniques for patients with cancer, focusing primarily on those with breast cancer and prostate cancer. Intervention strategies include relaxation techniques, such as deep breathing and meditation, and cognitive behavioral therapy (CBT), which aims to help patients actively change thoughts and behaviors.
“We teach patients to discern between controllable and uncontrollable stressors,” Moreno said. “For controllable stressors, CBT techniques help them become aware of how they respond to stress and develop adaptive coping strategies. For uncontrollable stressors, relaxation techniques and social support help them manage their emotional responses.”
The researchers say psychological interventions reduce stress and promote emotional well-being, which may prolong survival. Patients receiving the interventions have increased antiviral immunity signaling and decreased inflammatory signaling – important benefits because cancer treatments themselves can increase inflammation.
Sylvester and University of Miami researchers have for years conducted interventional and survivorship research studies, such as Encuentros de Salud, to support patients with chronic conditions. Avanzando Caminos is a new study of Hispanics and Latinos who have completed cancer treatment that can help tailor future evidence-based cognitive behavioral stress management interventions for Hispanic and Latino cancer survivors.
Monsalve said the survivors’ group he joined as part of the NCI-funded Encuentros de Salud trial led by co-Principal Investigators, Frank Penedo, Ph.D., and Antoni, was “fantastic!”
“I am very happy after completing the stress management program,” he says. “I’m no longer depressed, and I’ve made lifestyle changes that include a healthy diet and regular exercise.”
He and other group members received journals in which to log feelings and note questions. When they met, they shared experiences and sought answers to their concerns. He found himself counseling other members, especially new immigrants – something that has given him new meaning in life. He recalls sitting next to one group member and encouraging him to ask lots of questions, explaining that cancer can sometimes be hereditary, and urging him to pass on to his kids the information he was learning.
“Latinos in general do not believe in going to the doctor,” he says. “I’m trying to change that. I was scared when I was first diagnosed, but now I share my experiences on Facebook and Instagram and encourage other Latinos to see their doctor regularly and to get screened for cancer and other health problems. I want to help everyone I can.”
(Newswise/ DPK)
