As a nurse in a busy urban hospital, I often had patients with breast cancer who underwent breast reconstruction surgery as part of their treatment. I remember clearly the day I was giving discharge instructions to a double mastectomy patient who had her husband and twenty-something daughter at bedside. This nervous and quiet woman asked me to step into the bathroom with her. She asked in a calm, stoic voice that I show her how to care for her drains and incisions, because she did not want her husband or daughter to “have to see them or do any of this.” I had been caring for this patient for several hours during which both family members had genuinely expressed desire to help her. In that moment, I decided to level with her and suggested that she allow herself to feel her feelings and let her family help her. I told her she should not feel like she has to be strong for everyone all the time. Her face fell into her hands as she sobbed quietly for a moment, then she looked me in the eyes, hugged me, and said, “thank you.” In that moment, what she needed was to be given permission by someone she trusted, in this case her nurse, to be vulnerable and accept help. Obviously, not everyone with a breast cancer diagnosis will receive or process the news and treatment in the same way as this particular patient. Every person is an individual, and there are an infinite number of back stories, as well as the impact of various religious and cultural influences.
This patient was experiencing distress, which is common with a breast cancer diagnosis. The National Comprehensive Cancer Network recommends that patients be screened for distress periodically from diagnosis to remission.1 Distress can come not only as a result of getting the initial news but also because of surgery as well as radiation and chemotherapy treatments that may be recommended.1 Distress may manifest as any negative feeling or emotion, sometimes resulting in physical symptoms, such as increased blood pressure, heart rate, and respiratory rate, among others. Depression and anxiety are common forms of distress in cancer patients of all types.2
Women diagnosed with breast cancer who are younger than 40 years, those with young children, and male patients are at higher risk for distress related to a cancer diagnosis.1 Young women tend to have more serious forms of breast cancer that are often more advanced, requiring aggressive treatment with more negative side effects.1 These young patients also tend to have greater concern about sexual function and body image. Women with young children have the additional pressure of the responsibilities of caring for children at home.
For ethnically diverse women, a breast cancer diagnosis can more significantly negatively impact emotional well-being, including depressive symptoms and impaired social functioning.3 These women tend to report feeling more socially isolated.3
Educating patients at the time of diagnosis about their particular breast cancer diagnosis and discussing possible treatments and potential side effects of these treatments are key to relieving distress.1 Allowing patients to be part of the discussion and decision-making can also help address feelings of helplessness and distress.1 There is even hope that a breast cancer diagnosis may result in psychological growth and adjustment, particularly if a person copes with it by directing attention toward the problem rather than avoiding thinking about it.2 Utilizing education about diagnosis and participating in decisions about treatment are powerful ways to direct attention to the issue rather than choosing to be in denial.
A breast cancer diagnosis affects not only the individual being diagnosed, but their family as well. Preparation for and aftermath of treatment affects the day-to-day rhythm of life, leaving every individual in the household at risk for loneliness and isolation.4 Family members often experience anxiety and depression, and may endure physical displacement if a move is required for treatment, or even potential financial strain.2
If you or someone you care about has been diagnosed with breast cancer, one promising way to relieve psychological stress is to strengthen social support.3 Medical treatment may also prove to be more effective with a patient’s perception of strong social support.5 This may be accomplished by reaching out to existing social groups, such as one’s fellow church members. Some patients may feel more comfortable speaking frankly about their fears and concerns with others who are going through, or have completed, a similar cancer journey. Allowing help and support from those who may offer it may prove beneficial not only mentally, but practically and physically as well. This allows for more energy while juggling medical appointments, recovering from treatment, and effort required for daily tasks. What kind of social support is incorporated and found to be helpful is dependent upon each individual, as not everyone will find all methods beneficial. The most important thing is to focus on increasing your social support to reap the benefit of less negative psychosocial impact.2
- Mehra K, Berkowitz A, Sanft T. Psychosocial Consequences and Lifestyle Interventions. In: Bland KI, Copeland EM III, Klimberg VS, et al, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018.
- Costa DS, Mercieca-Bebber R, Rutherford C, et al. The impact of cancer on psychological and social outcomes. Australian Psychologist. 2016;51(2):89-99.
- Tejeda S, Stolley MR, Vijayasiri G, et al. Negative psychological consequences of breast cancer among recently diagnosed ethnically diverse women. Psychooncology. 2017;26:2245-2252.
- Vrontaras N. Cancer patients’ views on the family changes and the family social support. Journal of European Psychology Students. 2018;9(1):16.-27
- Chang HA, Barreto N, Davtyan A, et al. Depression predicts longitudinal declines in social support among women with newly diagnosed breast cancer. Psychooncology. 2019;28:635-642.