Addressing Psychosocial and Physical Fallout From Breast Cancer

TON - January/February 2014 Vol 7 No 1

Advances in breast cancer diagnostics and treatment have led to improved survival for patients with breast cancer. However, survivors still face psychosocial and physical challenges.

“Progress does not come without cost. Breast cancer patients experience considerable psychosocial and treatment related harms, and some of these effects can be acute and long-term,” said Lesley Fallowfield, DPhil, BSc, Professor of Psycho-Oncology at Sussex Medical School, United Kingdom.

“Patients will experience a plethora of physical, functional, emotional, financial, and social challenges. Furthermore, patients do not live in a vacuum and their problems affect everyone in their milieu,” she told listeners at the 2013 San Antonio Breast Cancer Symposium.

Fallowfield credited formal and informal support groups established over the past decades with helping patients through the journey from diagnosis to treatment and posttreatment. Also, clinical nurse specialists have been extremely helpful in navigating the patient through treatment and beyond, she said.

Anxiety and depression may be the most common emotional reactions to a diagnosis of cancer; about 30% of patients are reported to experience one or both. In a 2013 analysis, anxiety was the biggest emotional issue patients faced.

“But I have a problem with these percentages, because the diagnostic criteria for anxiety and depression were developed for psychiatrically ill individuals. Many women with breast cancer confront the very real threat that cancer will come back, so anxiety is not an inappropriate response and our management strategies should consider that,” she told listeners. “In a recent study of 3000 long-term breast cancer survivors, 47% said they had constant anxiety related to the threat of recurrence.”

Anxiolytics and/or antidepressants are effective. Nonpharmacologic interventions may appeal to patients who do not want to take additional drugs: these include yoga, aromatherapy and massage, visualization, expressive therapeutic writing, and art and music therapy. Recent studies have shown that mindfulness-based stress reduction workshops can reduce anxiety and depression, Fallowfield noted.

Fatigue has now replaced nausea and vomiting as one of the biggest problems for survivors. “5-HT antagonists help nausea and vomiting, but many women report persistent and unremitting fatigue,” she said.

Fatigue has a multifactorial etiology, and it contributes to inactivity, impaired concentration, and poor health-related quality of life.

“Telling patients with fatigue to rest is obviously wrong. Many studies have shown that aerobic exercise, not resistance training, improves mood and fatigue. We need to make sure patients know about this,” she said.

Lymphedema is another common long-term problem in up to 20% of patients, and it is related to the extent of surgery and number of nodes removed. Standard therapies include compression therapy and complex decongestive therapy (massage, exercise, skin care). Prevention of lymphedema with optimum surgery is vital, she said.

Adverse effects of endocrine therapy also plague breast cancer survivors who take these drugs for 5 to 10 years. The effects can include vasomotor symptoms, sexual problems, and joint pain.

“Self-reports from patients show that these quality-of-life–threatening side effects are underrecognized, underreported, and undertreated,” she stated.

Antidepressants can relieve hot flashes, and so can relaxation exercises. Moisturizers, pelvic floor exercises, and relaxation exercises can also improve sex.

The economic burden of a cancer diagnosis encompasses indirect costs related to work disability. Indirect costs are estimated at $16,000 for the first year and then $4500 per year afterward.

Communication and information can help patients cope with their problems, she continued. “Without appropriate information, patients worry and can be anxious. One study showed that when informational needs were unmet, patients were anxious, but when they got more information, the anxiety lessened,” Fallowfield said.

“Googling can be dangerous. There is a lot of incorrect information on the web. But there are also good web-based options, YouTube videos, and DVDs that address treatment uncertainties and clinical trial enrollment. Providing these resources helps patients make better-informed decisions,” she stated.

Reference
Fallowfield L. Psychsocial/survivorship issues: are we doing better? Presented at: San Antonio Breast Cancer Symposium; December 13, 2013; San Antonio, TX.

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