When it comes to life stresses, cancer is certainly one of the most traumatic. Over time, the strain of coping with your diagnosis and the realities of treatment will probably be compounded by other stresses, such as keeping up with work and dealing with the worries of family and friends. If left unchecked, your body's reaction to these stresses -- through increased blood pressure, a more rapid heart rate, decreased digestion, increased muscle tension and higher levels of stress hormones like adrenaline -- can lead to impaired immune function and an assortment of troubling stress symptoms. Preventing these effects requires planning, an awareness of your needs and limitations, and a mastery of stress-reduction techniques that can stop your body's "stress response" before it gets out of hand.

Avoiding Stress
Obviously, the best way to prevent the negative effects of stress is to avoid getting stressed in the first place. While some sources of stress are unavoidable, others are surprisingly predictable and can be prevented with a few evasive maneuvers.

AT HOME

Let People Know What You Need
When family and friends say they want to help, believe them. Delegate chores that you don't feel up to doing - whether it's doing the laundry, cleaning the bathroom, or making dinner.

Cut Yourself Some Slack
No one expects you to be Martha Stewart and maintain a picture-perfect home while dealing with cancer. 

Don't Be Afraid to Say No
It's OK to opt out of activities if you're feeling fatigued, ill or just want to be alone.

Schedule Lots of Leisure Time
Now, more than ever, you need lots of downtime to relax, recover from treatment side effects, or just process your feelings about your illness. Make it a priority by scheduling time for stress-reducing activities such as attending a support group, meditation, gardening, exercise or just taking a long hot bath.

Listen to Your Body
As your treatment progresses, you'll be able to predict when you are likely to feel unwell. Pay attention to the patterns and adjust your schedule accordingly. Let friends and family know when you are most likely to need help around the house, and plan "must do" chores for the days when you tend to be feeling your best.

Be Honest About Your Feelings
Although you may not want to burden others with your fears, keeping them bottled up will only increase your stress level. If you are feeling scared, or depressed, or anxious, let others know. Be sure you have a place to discuss these feelings openly - whether it's with a therapist, a member of your treatment team or a support group.

  AT WORK

Delegate
If you're someone who likes to do everything yourself, it's time to get over it! Look over your workload for the next several months to determine what requires your personal attention and what can be distributed to others. Keep in mind that you can provide guidance and direction without being on-site.

Keep the Lines of Communication Open
If you decide to tell your colleagues, be as open as possible with them about your needs -- and possible limitations -- as your treatment progresses. (More on American Art Therapy Association, Inc. (1-888-290-0878), which has chapters throughout the country).

Get a Massage
Everyone feels great after a massage. But the benefits of a good rubdown go beyond that immediate feeling of relaxation. In addition to relaxing tense muscles, massage also stimulates the nerves, increases lymph circulation, and enhances blood flow to tissues that have been deprived of oxygen by unrelenting stress. In fact, research has shown that the amount of oxygen reaching the body's cells increases by 15 percent after a massage. If your treatment team can't suggest a massage therapist, you can find one through the American Massage Therapy Association.

Relaxation Strategies

Effective Breathing

1. Sit up straight in a comfortable chair, feet flat on the floor, neck and shoulders relaxed.
2. Take a deep breath through your nose, with your mouth closed. Use your diaphragm when inhaling - consciously pushing your belly outward as you inhale. Put one hand on your abdomen, if you like, to feel how it rises and falls.
3. Exhale slowly through your mouth, with your lips pursed as if you were whistling (or about to give someone a peck on the cheek). Make your exhalation twice as long as your inhalation, pulling your diaphragm in as you empty the air from your lungs.
4. Repeat three or more times, until you feel yourself relax.

Progressive Relaxation

1. Remove your shoes and any uncomfortable or restrictive clothing, including eyeglasses.
2. Remove any possible distractions. Turn off the television, radio and phone, and dim the lights to a comfortable level.
3. Sit in a comfortable chair, head and neck relaxed, with your hands at rest in your lap, palms up. (You can lie down if you prefer, just don't fall asleep!)
4. Close your eyes and breathe deeply.
5. Keeping your eyes closed, focus your mind on your feet and toes. Slowly tighten the muscles in your feet, hold for a beat, and slowly relax.
6. Repeat this tightening and relaxing pattern with each of the muscle groups in your body, gradually working upward. Move your focus from the calves to the thighs to the glutes, through your back, chest and head, including your face. Don't forget your hands and arms.
7. Continue to breathe deeply until you feel relaxed and calm. You can test your level of relaxation by putting your hands against your face or neck. Warm hands mean a relaxed body. If they're still cool, continue the exercise until they warm up.

Visualization

1. Remove your shoes and any uncomfortable or restrictive clothing, including eyeglasses.
2. Remove any possible distractions. Turn off the television, radio and phone, and dim the lights to a comfortable level.
3. Sit in a comfortable chair, head and neck relaxed, with feet flat on the floor and your hands resting in your lap, palms up. (You can lie down or sit on a mat if you prefer - just be sure you are comfortable enough to stay in this position for ten to 20 minutes.)
4. Close your eyes and picture yourself in a pleasant, restful place - a green meadow by a cool lake, the soft sand of a Caribbean beach, a warm rock by a clear mountain stream.
5. Fill in every detail as you breathe in deeply through your nose and exhale slowly through your mouth.
6. With each breath, slowly let the tension ease out of your body's muscles. Allow the muscles in your feet, your legs, your back, shoulders, arms, hands and feet to relax as you sink further into the restful world of your inner picture.

Additional Resources

Books
The Art Therapy Sourcebook, by Cathy A. Malchiodi (Lowell House)
Creative Visualization, by Shakti Gawain (New World Publishing)
Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness, by Jon Kabat-Zinn (Delacorte)
Healing Essence: A Cancer Doctor's Practical Program for Hope and Recovery, by Mitchell L. Gaynor (Kodansha International)
Living Beyond Limits, by David Spiegel, M.D. (Ballantine Books, 1993)
Minding the Body, Mending the Mind, by Joan Borysenko, Ph.D. (Bantam New Age Books)
The Relaxation and Stress Reduction Workbook, by M.M. Davis, M. Eshelman, and E. Eshelman (New Harbinger Publications)
Staying Well With Guided Imagery, by Belleruth Naparstek (Warner Books)
Stress Blasters, by Brian Chichester and Perry Garfinkel (Rodale Press)
Stress Remedies, by Carl Sherman (Rodale Press)
Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life, by Jon Kabat-Zinn (Hyperion)
Yoga For Dummies, by George Feuerstein, Ph.D. and Larry Payne, Ph.D. (IDG Books Worldwide, Inc.)

Videotapes and Audiotapes
TouchStar Productions, of Seattle Washington (1-800-759-1294), carries a range of audio and videotapes that can help you with guided imagery, creative visualization, positive affirmations and other stress-reduction techniques. Some of the best are by veteran stress researcher Bernie Seigel, M.D., and pioneering cancer doctor Carol Simonton, M.D. (www.simontoncenter.com; 1-800-459-3424).

For help with meditation, try the Mindfulness Meditation Practice Tapes by stress reduction expert Jon Kabat-Zinn, Ph.D.

Web Sites For more information on creativity and coping, check out Stanford University's Cancer Supportive Care Program.