How guilt, anxiety and distress may help fight cancer

Having cancer would make anyone scared, stressed and angry. In some cases, that might be a good thing.

Recent research suggests that negative emotions may improve the health of cancer survivors by motivating them to behave in healthier ways.

"Negative emotions get a bad rap," says Andree Castonguay, who studies the psychological factors that influence health and make people want to be physically active. "If they're used in the right way, by helping someone set a new goal, they can act as a driving force."

Castonguay, a postdoctoral research fellow in kinesiology at Montreal’s Concordia University, led a recent study of 145 breast cancer survivors. She and her colleagues at Concordia and the University of Toronto recorded how much the women exercised and levels of the stress hormone cortisol in their saliva.

They also collected demographic data and administered questionnaires to evaluate their "high-arousal negative affect,” a measure of intense emotions such as fear, anxiety and guilt.

Such bad feelings were associated with higher cortisol levels, which can have a negative impact on health. But among certain women, they were also associated with increased levels of exercise — suggesting, counterintuitively, that being upset may be just the boost some need to get well.

The researchers also surveyed the women to measure their goal adjustment capacity, which reflects an individual's ability to jettison old goals and embrace new ones.

That trait turned out to be key. Women who were not good at goal adjustment and reported negative affect did not exercise as much and had elevated cortisol. Over time, high levels of cortisol may contribute to disorders such as heart disease and diabetes.

On the other hand, women who experienced intense negative emotions and were good at setting — and sticking to — new goals exercised more and did not have elevated cortisol.

The take-away: Negative emotions were associated with both good and bad health effects, depending on the individual. The study was published in April in the journal Health Psychology.

"People tend to hear about the link to poor health," Castonguay says. "We're trying to understand the double-edged sword."

Getting a better handle on this could benefit survivors of all kinds of cancers, she argues. Doctors, nurses and therapists have tools to identify people who have trouble setting new goals and could easily give such patients extra guidance during recovery — channeling emotions like fear or guilt into positive health behaviors.

Convincing cancer survivors to get more exercise is a persistent challenge for physicians. Authorities such as the World Health Organization recommend that most people get 150 minutes of moderate exercise, or 75 minutes of vigorous exercise, per week.

In Canada, Castonguay says, only 15% of the general population meets this threshold. Among breast cancer survivors, it’s even lower. This is in spite of evidence that physical activity reduces the risk of a wide range of health woes related and unrelated to their disease, including obesity, cardiovascular disease and immunity problems.

As more and more breast cancers are treated successfully — five-year survival for women with Stage I breast cancer is nearly 100% and is greater than 70% for Stage III breast cancer — researchers are devoting more effort to improving the survival phase of the cancer trajectory, she adds.

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