Breast Cancer and Mental Health

Introduction 

Breast cancer is the most common cancer among people assigned female at birth (AFAB) globally, representing about a quarter of all cancer cases in people AFAB. The diagnosis, treatment, and aftermath of breast cancer can significantly impact a patient's mental health.¹ When surgical interventions are the only way forward, the person may suffer deeply from mental distress and a lack of belief in one's ability to move forward from this awful disease. But even though it sounds a bit scary, an entire community backs you to accept yourself and move forward without fear.

Psychological impact of breast cancer diagnosis

A diagnosis of breast cancer can be shocking and cause a tumultuous range of emotions. Common psychological reactions may include shock, denial, fear, anxiety, depression and stress.^1,2

Shock and denial 

Initially, many patients experience shock and denial. This coping mechanism can be temporary, but if prolonged, it may hinder timely treatment and emotional processing.

Fear and anxiety

Fear of death, fear of the unknown, and anxiety about treatment outcomes are prevalent. Patients will likely suffer from stress at some point during treatment.

Depression 

Depression is a significant concern as it affects up to 25% of breast cancer patients. The impact of a life-threatening diagnosis, changes in body image, and the potential loss of life roles can contribute to a patient’s depressive symptoms.

Stress 

The stress of diagnostic procedures, awaiting results, and the uncertainty of prognosis can worsen mental health issues. Chronic stress may also impair the patient’s immune system and potentially influence their disease progression. 

Mental health during treatment

Treatment for breast cancer, which includes hormone therapy, radiation, chemotherapy, and surgery, has its unique psychological difficulties.

Impaired body image

Disorders related to one's body image can occur following surgery, particularly mastectomy, a procedure to remove one or both breasts. For a patient assigned female at birth (AFAB), their perception of their femininity and attractiveness may be negatively impacted following mastectomy. Impaired body image can also affect patients assigned male at birth (AMAB).

Depression and cognitive shifts 

Radiation and chemotherapy frequently cause exhaustion and cognitive issues such as memory loss and difficulty focusing. This is often called ‘chemo brain’ or ‘brain fog’. 

Side effects of treatment

Pain, nausea, and other adverse effects can lower life quality and worsen mental distress.

Financial strain

An already stressful health condition can become much more difficult due to any financial strain experienced by a patient if they’re unable to work.

Long-term psychological effects

Survivors of breast cancer may face long-term mental health challenges such as PTSD, fear of cancer recurrence, persistent fatigue and sexual dysfunction.

PTSD: Post-traumatic stress disorder

Some breast cancer survivors experience an anxiety disorder called post-traumatic stress disorder (PTSD), causing nightmares, flashbacks, and extreme anxiety. It is estimated that 10% of breast cancer survivors experience PTSD.

Fear of cancer recurrence

Survivors frequently and persistently worry about this. The fear the cancer may return can cause persistent anxiety and hypervigilance, impairing patients’ quality of life.

Persistent fatigue 

Many survivors report persistent exhaustion, even after they have completed their treatment, which can worsen depressive symptoms and limit day-to-day functioning.

Sexual dysfunction 

Sexual dysfunction can result from early menopause/menopausal symptoms brought on by cancer treatment, hormonal fluctuations and problems with body image. This can affect close relationships.³

Importance of mental health support

The psychological burden of breast cancer underscores the need for comprehensive mental health support and we, as a society, must stand by patients, providing them with unwavering support. 

The following are methods of different types of support that can help patients and survivors of breast cancer with their mental health. 

Psychological counselling

Individual and group therapy can provide emotional support, helping patients process their emotions and develop coping strategies. Cognitive-behavioral therapy (CBT) is particularly effective.

Support groups

Peer support groups offer a sense of community and understanding, helping patients feel less isolated. These groups provide a platform to share experiences and gain practical advice. These groups are also easily accessible online.

Psychoeducation

Educating patients about the potential psychological effects of cancer and its treatment can decrease the stigma surrounding mental health and empower them to seek help when needed.

Mind-body interventions

Mindfulness, yoga, and relaxation techniques can reduce stress and improve well-being.

Pharmacological interventions

Antidepressants and anxiolytics can be beneficial for managing severe depression and anxiety that breast cancer patients may experience. However, these should be used under the guidance of a healthcare professional, considering their potential interactions with cancer treatments. Additional care must be taken so that these medications aren't overused as it may lead to an overdose.

Integrating mental health care into oncology

Integrating mental health care into oncology practices is crucial for holistic cancer care. This can include:

Routine screening

Regular screening for psychological distress using validated tools can help identify patients in need of mental health support. These tools can be:

• A Distress Thermometer which involves asking a patient to select a number from 0 to 10 that reflects how much distress they currently feel and how much distress they felt over the past week. The highest level of distress imaginable is scored as a 10 and no distress is zero
• Questionnaires 
• Surveys 

Multidisciplinary teams 

The collaboration between oncologists, psychiatrists, psychologists, and social workers ensures comprehensive care. These multidisciplinary teams can develop individualised treatment plans that address all of their patient’s physical and psychological needs.

Training healthcare providers

Educating oncologists and nurses about the psychological aspects of cancer can enhance their ability to support patients effectively. Frequent reassurance from the healthcare team will do wonders in the patient's recovery.

Patient-centred care

Adopting a patient-centred approach that respects patients' preferences, needs and values can improve treatment adherence and outcomes.

FAQs

How does breast cancer impact mental health?

Breast cancer has a great impact on the mental health of individuals as it challenges their day-to-day functioning and can impact their self-esteem. Patients can experience anxiety and depression due to difficulty in adapting to their new self. Survivors may also be plagued by the fear that the disease might return.

What are the early signs of mental distress associated with breast cancer?

The early signs of mental disturbances include:

• Changes in sleep patterns, which might include difficulty falling or staying asleep
• Noticeable changes in your overall mood
• An absence or lack of interest in activities you normally enjoy
• Appetite may fall or rise, owing to weight loss or gain

Summary

• The interplay between breast cancer and mental health is complex and multifaceted. Addressing the psychological impact of breast cancer is as crucial as treating the physical disease
• Common psychological reactions following a breast cancer diagnosis include shock, denial, fear, anxiety, depression and stress. During breast cancer treatment, patients may also encounter psychological difficulties related to impaired body image, depression, side effects of treatment and financial strain
• Comprehensive mental health support integrated into oncology care can significantly enhance the quality of life for breast cancer patients and survivors
• Through routine screening, multidisciplinary collaboration, and patient-centred care, the mental health needs of breast cancer patients can be effectively met, leading to better overall outcomes