THE diagnosis and treatment of breast cancer can be devastating for patients. Psychological reactions include the initial shock of learning one has been diagnosed with a life-threatening disease, fear of its recurrence, as well as anxiety, depressive symptoms and post-traumatic stress reactions.
"The magnitude of these reactions varies depending on a number of factors - such as the time from surgery, the age of the patient, her prior life history of psychological problems and experiences dealing with life stressors, her support system and her coping strategies," said Dr Sharon Lyn Manne, director of the PscychoOncology program at the Fox Chase Cancer Centre in Philadelphia.
Manne was speaking at the 1st Asia Pacific Reach to Recovery International Breast Cancer Support conference in Kuala Lumpur recently. The majority of women, she added, report anxiety reactions and depressive symptoms in the first few months after diagnosis. However, these anxiety reactions decline significantly several months after diagnosis.
"The majority of women do not report levels of anxiety and depressive symptoms that would indicate the need for psychological or psychiatric services after one year. "A very small percentage of women, between two and 18 per cent, have symptoms of post-traumatic stress several years after post-diagnosis."
There are a number of factors that have been identified that may place patients at risk of severe psychological reactions. These factors, said Manne, include disease characteristics - women who have more side effects after treatment (such as bodily pain or lymphedema, fatigue or sleep disorders) are more likely to develop severe distress. In terms of individual factors, younger women, less-educated women and minority women, report more concerns and distress. In terms of coping and support, the studies to date suggest patients who use denial or avoidance, and do not use active problem-solving approaches in dealing with cancer, are more likely to develop persistent distress.
"Social support, especially empathy from one's husband, is beneficial," Manne stresses. According to her, many psychological forms of intervention have been developed. "Therapies include peer support groups, medical education and information, coping skill training/relaxation skills, and family-based intervention.
"Most forms of prevention, especially the provision of medical information, have shown benefits. Promising new therapies include teaching women to keep journals to write about concerns and feelings and therapies which involve the spouse in therapy," she explained.
Summarizing, Manne notes that research shows the majority of women diagnosed with breast cancer will not have long-term psychological distress. "Many women report that cancer has been a growth experience that has given them a new appreciation for life. "Patients who are young, have prior psychological problems, and less family support, are more likely to develop distress reactions." She added that many promising forms of intervention have been developed which need to be disseminated to oncology program across the world. "Our challenge is to provide psychosocial support to women who are most at risk of adverse psychological effects of breast cancer."
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