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Psychological and Social Distress Among Breast Cancer Patients and Survivors

Network - Fall 2010

By Mary Brolley

After the shock and fear of a breast cancer diagnosis, and once the often-difficult treatment is complete, patients expect to resume their lives and routines with a clear sense of gratitude and relief.

Wait — not so fast.

While certain side effects of breast cancer treatments — for example, lymphedema and the loss of mobility that may be experienced by those who’ve lost axillary lymph nodes — are well documented, there are other reactions that are less expected.

Psychological and social distress is a response that Jennifer Litton, M.D., assistant professor in the Department of Breast Medical Oncology at MD Anderson, sees often. There are two distinct sets of emotional reactions: one just after diagnosis, one after treatment ends, she says.

“At first, some women are angry or in denial. They ask, ‘How can I have breast cancer? I have no family history of it,’ ” she says. “I tell them it’s OK — even appropriate — to feel that way.”

For a number of women, new worries may appear about six months after treatment ends. After months of focus on getting through no matter what, feelings of anxiety and depression may surface.

Women diagnosed in their 30s and 40s may be most likely to suffer psychological and social distress. They may worry about caring for young children or that they’ll become infertile as a result of chemotherapy or radiation.

One issue is front and center

“Fear of recurrence,” says P.K. Morrow, M.D., assistant professor in the Department of Breast Medical Oncology and director of the Breast Cancer Survivorship Clinic. Like Litton, Morrow works with many younger breast cancer patients.

“They may also have financial worries, suffer from fatigue or be concerned about infertility. But fear of recurrence is the main thing,” she says.

Add to that the fact that women are increasingly involved in choices about their treatment, and it’s understandable that they might become anxious about making the right choices and juggling responsibilities over a long period of time.

At MD Anderson, physicians and health care teams do their best to make sure psychological and social issues are addressed as thoroughly as medical issues. The survivorship clinics take this into account, too.

Litton has learned to ask questions about psychological and social issues even if women don’t bring them up. “I might say, ‘Many women are depressed. Is that something you’re dealing with?’ ”

If they are depressed or anxious, she recommends that they arrange an appointment with social workers in the Department of Social Work or advanced practice nurses in the Department of Psychiatry.

Managing anxiety in the information age

Breast cancer treatments have changed a great deal in the last 50 years, when radical mastectomies were routine and caused a lifetime of physical problems, such as loss of mobility, pain and lymphedema.

Today’s surgeries are less disfiguring, but the combination of different treatment modalities may cause new side effects. Survivors often face issues like threats to bone health, hot flashes, early menopause, chronic fatigue and decreased libido.

So much more is now known about a person’s individual tumor, and this adds another layer of concern for patients.

Anxiety and worry may be especially acute for women who’ve gone in and out of treatment because of recurrences.

Cheryl Jolly of Sugar Land, Texas, was diagnosed with a stage IIb ductal carcinoma in late 2006. She remembers learning that her tumor was of the “triple-negative” subtype, meaning that it was clinically negative for the hormones progesterone and estrogen and for HER2. She quickly discovered that this made several promising therapies ineffective.

“They tell you not to Google, but I don’t care who you are, you’re going to do it,” says Jolly, the mother of two young sons. “And it’s terrible, looking through all that stuff.”

Now in a clinical trial under the leadership of Litton for patients with triple-negative disease, Jolly is close to her medical team and feels free to be open with them about her feelings of stress, anxiety or depression.

Both Litton and Morrow try to reassure patients and survivors of any age that their feelings are understandable and that the health care team is ready to help.

“I advise them to reach out to others,” Litton says. “That might mean talking to a Pink Ribbon volunteer, joining another support group or volunteering themselves.”

© 2015 The University of Texas MD Anderson Cancer Center