Proposed Methods for Improving Cancer Patient Communication

Chronic Stress In Cancer Patients

Improving cancer patient health literacy can lead to better outcomes for cancer patients by reducing their chronic stress. To improve outcomes in treating patients with cancer, providers need to be aware of the potential negative effect inadequate communication with patients has on chronic stress. While acute stress can enhance the human immune system by preparing it to defend against disease (Dhabhar, 2002), chronic stress tends to suppress immune function, resulting in increased susceptibility to disease (Cohen et al., 1995). Not all stressors are negative; some are positive (Rudland et al., 2020). For example, a job promotion would be considered a positive stressor (eustress), and the reactions to positive stressors do not produce the same responses in the body as negative stressors (distress).

Human response to stress is natural and necessary. The stress hormone, cortisol, is essential to physiological processes in the human body (Chan & Debono, 2010). Cortisol levels are rhythmic and are regulated by the hypothalamus gland, located in the brain. The brain perceives stress to be a threat, warns the body, and enables organisms to take action accordingly. After this fight-or-flight response subsides, the HPA axis (the hypothalamus, pituitary gland, and adrenal glands) stays active as long as a perceived threat remains (Dhabhar, 2002).

During this period, a series of hormonal messages causes the release of cortisol. Once the brain determines the threat has passed, cortisol levels drop, and the parasympathetic nervous system (PSNS) becomes active and energizes the rest-and-digest response (Moreno-Smith et al., 2010; Harvard Health, 2018). However, everyone lives among constant stressors and is unable to disengage from stress much of the time. This interferes with the rest-and-digest response. The HPA axis remains activated whenever the body perceives even lower levels of chronic stress. In time, this seems to contribute to health problems (Lee & Rhee, 2017). Whenever individuals are unable to disengage from stress, it becomes chronic as explained earlier (Elliot & Eisdorfer, 1982).

Seppa (2015) reported that chronic stress changes immune cell behavior. The ability of the immune cell to do its job is limited when cortisol levels remain elevated (hypercortisolism), a consequence of chronic stress. Cortisol levels in the body are not consistent; there is a diurnal or daily rhythm. There is a rise in cortisol levels about an hour after people wake up, which is referred to as the cortisol awakening response (CAR) (Powell & Wolf, 2012). This rise in cortisol levels adds to the increase in cortisol that occurs before one awakens in the morning. According to Wüst et al. (2000), chronic stress increases CAR. Cortisol levels do not drop to normal after the morning peak if the body is under constant stress. The immune system becomes impaired, and the natural defense against cancer and other diseases is reduced.