A recent study has objectively demonstrated that the severity of distress experienced immediately after a diagnosis of colorectal cancer correlates with a higher risk of recurrence, underscoring the significance of stress management for patients with colorectal cancer.

Stress management is especially important for stage four colorectal cancer, as the disease gets more serious and the treatment period can be longer, an expert said.

"I have confirmed that stress is not just an emotional problem but directly contributes to cancer recurrence and death," said Professor Kim Hee-cheol of the Department of Colorectal Surgery at Samsung Medical Center on the YouTube channel “Samsung Medical Center.” Professor Kim explained that he started the study after seeing many colorectal cancer patients and realized that patients who were stressed, depressed, or unhappy were not treated well and had poor cancer treatment outcomes.

Kim analyzed the correlation between stress levels at initial diagnosis and colorectal cancer survival among 1,362 patients diagnosed with colorectal cancer and undergoing surgery at Samsung Medical Center between July 2014 and July 2021 and found that 76 percent of patients had a stress score of for points or higher. About 60 percent of patients reported very high stress, and about 15 percent reported extremely high stress.

"Surprisingly, patients with moderately high stress had a 30 percent higher recurrence rate, and those who said they were very stressed had an 84 percent recurrence rate, almost twice as high as those who said they were not stressed," Professor Kim said. "In particular, for stage four, the recurrence rate was almost 153 percent, or almost two and a half times higher among those with very high stress than for those with low stress."

At what level of stress does the risk of cancer recurrence skyrocket, then?

The study used a distress thermometer (0-10 scale) and checklist developed by the U.S. National Comprehensive Cancer Network (NCCN) and asked cancer patients to rate and score their overall stress over at least a week, including today, and check off items if they were experiencing stress.

A score of less than four on the stress thermometer categorized the group as not very stressed, four to seven as moderately stressed, and eight or more as very stressed.

"You need to manage stress from a score of four or higher, but if you score six or higher, sleeping is uncomfortable, and if you score eight or higher, you can't do anything," said Professor Cho Ju-hee, director of the Cancer Education Center at Samsung Medical Center.

How does stress work in cancer patients?

"We don't clearly know, but there are various hypotheses. One theory is that stress itself affects the body's various hormones and autonomic nervous system, which helps cancer grow,” Professor Kim said. “Stress can also cause patients not to finish chemotherapy or recover well from surgery, leading to more recurrences. To cope with stress, people may change their lifestyle and dietary habits, which may lead to more recurrences."

There is a reason why stress management is especially important for patients with stage four colon cancer.

"When the cancer has metastasized, it's called stage four, and it's inevitably more stressful. There will be a lot of psychological conflicts, and there will be relatively more cancer symptoms. There are also cases where more treatment is needed. In a way, they are the ones who need stress management the most," Kim said.

He continued, "If you're in stage four, you have to go through chemotherapy, surgery, and radiation, and you need a healthy body to keep up with it, but you also need a healthy mind. The more severe the disease, the more severe the symptoms, and the more stressful it is. Conversely, the more treatment these people need, the more doctors and families need to manage the patient's stress and each other's mental health."

The problem is that most cancer patients do not have time to think about their mental health when they are faced with the biggest crisis of their lives, and mental health is often overlooked by cancer patients, their families, and medical staff.

"Stress can be controlled through counseling. I think it's very important to tell you this,” Professor Cho said, pointing out the importance of managing distress in cancer patients.

There are many ways to manage distress. Professor Cho proposed “finding one’s own stress relief method.”

"You might have felt upset in the past due to your husband or exam failure. How could you escape from the stress? Recall the experience and find your own way to relieve the stress,” Cho said.

She continued, "Talk to people you love and chat with them, meditate calmly, listen to your favorite music, travel, or do something that calms you down. It's really good to be as active as possible, not just in bed or at home, because you have cancer. Moderate exercise, especially walking, can make you feel more energized and physically fit."

Writing also could be helpful.

"It's good to write down your state of mind, thoughts, and feelings in a diary or journal. By writing down what you feel, you can stabilize yourself a little bit, and it's also good to express these things to others," Professor Cho said.

When you feel like you’re the “unhappiest person in the world.” it's very helpful to find and join a patient support group or mentoring program with people with similar conditions or experiences, Cho said, adding that it’s also very helpful to turn to religion.

Above all, the first thing cancer patients should do is check their stress levels. The first step in managing stress is to check their stress levels and communicate them to loved ones or the medical team treating them. Recognizing that they are in a stressful environment can help them manage it properly.

"When you are in a state of acceptance, your healthcare team and family can help you," Kim said. "You can think that feeling sad right now is a natural process. Doing so can help you get through treatment safely and even reduce recurrence.”

In conclusion, Professor Kim reiterated the importance of actively coping with stress immediately after a cancer diagnosis to improve cancer outcomes.