Too Young For This: young survivors of breast cancer
While cancer affects a person’s quality of life at any age, a recent study in The Journal of the National Cancer Institute reports that women under the age of 50 who survive breast cancer are more adversely affected psychologically and physically. The study noted that, “these women suffer from severe psychological distress, infertility, premature menopause, a decrease in physical activity and weight gain.”
Of the estimated 288,130 new cases of breast cancer in 2011, five percent were women under 50 years of age. Because these women are more adversely affected, we asked Wayne Bardwell, PhD, president of the American Psychosocial Oncology Society and director of Patient & Family Support Service at Moores Cancer Center three questions about addressing these patients’ psychological needs.
Question: When does psychological counseling become part of the treatment for breast cancer or does it?
Answer: There are various points in the cancer trajectory where psychological counseling can be helpful. These include the time of diagnosis, the time during active treatment, and during the transition from treatment to “survivorship.” Receiving a cancer diagnosis can be a shocking experience for many patients. The process of treatment, while greatly improved over treatments in the past, can still be an arduous process that may result in fatigue, insomnia, anxiety, pain and other symptoms. Psychotherapy can be helpful in coping with treatment and its side effects. At the completion of treatment, it is not uncommon for a patient’s support system to “breathe a collective sigh of relief” and go back their usual lives. During treatment, many patients use a certain amount of denial to cope (“I’m going to beat this; treatment will not be difficult for me”). Once treatment is over, it is not uncommon for patients to experience a variety of feelings that have been held at bay only to find that their support system is no longer mobilized.
Q: Anxiety and stress are cited as a negative contributing factor in a diagnosis, especially in young women. Why does stress have a more negative effect on younger patients?
A: Cancer strikes younger patients at times in their lives where they may be seeking a partner, raising a family or in the midst of a budding career. Thus, they may have much on their plates and much that they are looking forward to in their lives. For some patients, cancer may present the major adversity that they have faced. Older patients, by virtue of having lived longer, have likely faced more difficulties along the way than a younger patient. Facing and surmounting challenges teaches us coping strategies that are helpful in meeting future challenges.
Q: How can friends and family help improve a patient’s outlook?
A: Friends and family are key in the support system for any patient dealing with cancer. Support can take several forms. The best emotional support involves listening to and accepting the patient as they are in the moment. While an optimistic outlook can be helpful, patients don’t always feel positive, and it is not uncommon for them to feel guilty about this. They may sometimes feel sad, anxious, fearful or angry. Rather than trying to change the patient’s feelings, it is best to convey some sense of understanding why they are experiencing whatever feeling they may express. Tangible support involves helping with logistical issues (e.g., childcare, housecleaning, rides to appointments). I often encourage patients to make a list of things that need to be done. If someone asks “How can I help,” they can be directed to the list and encouraged to sign up for a task. And sometimes, the patient wants to hang out with a good friend and achieve as much normalcy as possible.