It’s no surprise that getting through cancer is stressful. There are worries galore that the disease will come back, not to mention all the physical and social changes due to treatment with drugs, radiation, or surgery.

But now a new study suggests that psychological distress—even years later—is almost twice as common among cancer survivors as those untouched by the disease.

The study, released Tuesday in Boston at the annual meeting of the American Society for Therapeutic Radiation and Oncology, included 4,712 Americans diagnosed with cancer five or more years earlier, the majority of whom had breast cancer. Another 126,841 people who didn’t have cancer were polled as well.

It didn’t matter how many years had gone by; the survivors were about twice as likely to say they felt nervous, hopeless, worthless, or that “everything was an effort.”

What to do about all this stress? Researchers at the Harvard Radiation Oncology Program at Harvard Medical School recommend incorporating “quick, low-cost psychological screening tests” into cancer survivors’ follow-up visits.

Here’s some other advice Health.com has collected from experts in the field:

3 Ways to Fight the Fear Your Breast Cancer Will Come Back

The End of Cancer Treatment Doesn’t End the Need to Talk

Starting Over After Breast Cancer—It May Not Be What You Expected

5 Tips for Living Well if You’ve Put Breast Cancer Behind You

Also check out these stories from women who have struggled with the stress of surviving this disease:

A Mountain Climber Finally Walks Away From Breast Cancer

4 Breast Cancer Survivors Who Grappled With Grief

How Breast Cancer Taught Me Not to Worry About Recurrence

By Sally Chew

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