Other than skin cancer, breast cancer is the most common cancer among women worldwide. Current assessments indicate nearly 1 in 8 women will be diagnosed with invasive breast cancer. Although the chance of dying from breast cancer has dropped significantly due to early detection and treatment (74 percent rate of survival in 1980 versus as high as 99 percent survival rate today, according to the National Cancer Institute) more than 40,000 women and over 400 men will die from breast cancer this year.
Fear and Waiting
Although there are nearly 3 million breast cancer survivors in the United States, receiving a diagnosis of cancer can be extraordinarily frightening. Psychologically, it is very normal to react with fear, anxiety and even denial. Many patients report feeling numb and overwhelmed. More often than not, patients describe a sense of derealization (a feeling the event is not real) or de-personalization (this isn’t happening to me) when their physicians first share the news. Other patients have reported feeling as if time stands still. In my experience with cancer patients, one of the most distressing things is waiting. Consider this: First you wait for the appointment, then you wait for results, then you wait for a diagnosis, then you wait for treatment, then you wait for support, then you wait to feel well again, then you wait… five years to see if the disease returns. Then, in the back of your mind, you continue to wait because you remember being told, “recurrences always remain a possibility.” Fortunately, there are many things a person can do to alleviate anxiety. It is very important to have an open and honest relationship with your physician. Additionally, it is important to take care of your mental and physical health and it is extremely important to surround yourself with support.
Your Medical Team
So, how do patients want to hear bad news? They don’t! Nobody wants to hear they have cancer. A complaint frequently voiced by patients is that their physicians and/or nurses appear disinterested in them as a person or seem detached when discussing a cancer diagnosis. Patients ache for compassion, time and information. Dr. Lewis Thomas, past president of Memorial Sloan-Kettering Cancer Center, believed touching patients was an essential skill and possibly “the most effective act of doctors.” He believed that human contact was essential to demonstrating compassion and empathy for another human being’s suffering. Patients often tell me they sense the attitude of nurses by the way they speak to them, roll them over or even begin IVs. I encourage patients to be direct with their medical providers and ask for what they need. For example, it would be perfectly appropriate to say, “Dr. Jones, would you please sit down for a moment and explain that again?” I explain to physicians, who have the difficult task of sharing bad news, that it is essential they address their feelings of avoidance, fear, guilt or even failure, because these emotions may be projected onto patients and add to their suffering. Paradoxically, when a physician reaches out and touches a patient’s arm, makes eye contact and says, “I feel terrible for you; I know this is difficult,” patients report less anxiety and fear, greater trust and a sense of well-being. Human contact and compassion go a long way.
Psychological and Physical Well-Being
A combination of group and individual treatment seems to be most effective. Speaking about your illness changes anxiety and fear. Surrounding yourself with others with similar diagnoses reduces loneliness and isolation. It is also a valuable place to learn from others. These treatments have been found to reduce levels of the stress hormone norepinephrine, which has been linked to metastasis and a tumor’s ability to grow. Cancer diagnosis can also lead to depression. If patients are depressed, they may sleep more, eat less nutritiously, exercise less and fail to take advantage of support services. At times, feelings of helplessness or hopelessness can become so severe that patients fail to follow through on surgery, chemotherapy or radiation treatments. A licensed mental health provider can guide a patient, as well as his or her family, through recovery with a variety of effective techniques. For example, relaxation training, biofeedback and mental imagery can reduce the experience of pain as well as the negative effects of treatment, and increase tolerance and compliance. Cognitive therapy is particularly helpful for patients. The central theme in cognitive therapy is the examination of our perception of an experience or event. Our perception affects our thoughts, mood and behavior, as well as our physiological responses to the event. If you are able to view your cancer as a challenge and not a threat, for example, stress and cortisol levels go down. I’ve even had patients who have voiced gratitude, yes gratitude, for their cancer because it leads them to live every day as if it is their last.
By Susan L. Shackelford, Ph.D.