A breast cancer diagnosis can have a profound impact on a patient’s mental and emotional wellbeing. It’s common to feel overwhelmed with emotions like anxiety and fear upon receiving such news. The uncertainty surrounding treatment options and the future can intensify these feelings. Additionally, the thought of mortality can weigh heavily on the mind.

Depression is another significant psychological effect experienced by many breast cancer patients. Coping with the diagnosis, undergoing treatment, and dealing with potential physical changes can lead to feelings of sadness and hopelessness. The impact on body image and self-esteem due to treatments like mastectomy or lumpectomy can further contribute to psychological distress.

Relationships with family and friends may also be strained, leading to feelings of isolation. Patients may struggle with disclosing their diagnosis and navigating social situations related to their illness. This can be compounded by societal stigma against cancer.

Some patients may even develop symptoms of post-traumatic stress disorder in response to the traumatic experience of diagnosis and treatment. Despite these challenges, many patients find ways to cope and seek support from healthcare professionals, support groups, and loved ones to navigate their emotional journey.

At the initial stages of diagnosis, patients often grapple with questions like “Why me?” and “I don’t want to die!”. Physical and hormonal changes can also affect sexuality and functionality, leading to unspoken concerns. Patients undergoing treatment may face discrimination and social isolation, disrupting their social engagements and inducing loneliness.

Despite the association of cancer with death, many patients are able to undergo treatment smoothly and lead fulfilling lives thereafter. It’s possible for people to continue their daily routines and overcome the stigma associated with cancer.

It’s often discussed in therapy how cancer is often not an individual diagnosis and illness, but faced by the entire family. Individuals experience emotional changes and upheavals from the time of diagnosis through treatment processes, and often recovery as well. Many late and long-term side effects also add to familial conflicts arising due to changed roles and responsibilities, unrealistic expectations, lack of healthy communication of needs and desires and so on.

Supporting a loved one emotionally and psychologically during their treatment can significantly impact their well-being. Here are some ways family members and caretakers can provide the best support:

•  Open Communication – Encourage open and honest communication. Let them know that they can talk about their feelings and concerns without judgment.
• Active Listening– Practice active listening by giving your full attention and showing empathy. Sometimes, people just need someone to listen to them without trying to solve their problems.
• Provide Reassurance- Offer reassurance and encouragement regularly. Remind them of their strengths and that you believe in their ability to cope with the challenges they are facing.
• Respect Autonomy– Respect their autonomy and decisions regarding their treatment. Offer support without being overbearing or controlling.
• Educate Yourself– Take the time to educate yourself about their condition and treatment options. This will help you better understand what they’re going through and how you can support them effectively.
• Be Patient– Understand that they may have good days and bad days. Be patient and supportive, even when they’re struggling.
• Be Flexible– Be flexible and willing to adapt to their changing needs. What they need from you may vary depending on how they’re feeling and what stage of treatment they’re in.
• Provide Practical Support– Offer practical support with daily tasks such as cooking, cleaning, or running errands. This can help alleviate some of their stress and allow them to focus on their recovery.
• Encourage Self-Care– Encourage them to prioritize self-care activities that promote their well-being, such as getting enough rest, eating healthily, and engaging in activities they enjoy.
• Seek Professional Help if Needed– If you notice signs of depression, anxiety, or other mental health issues, encourage them to seek professional help. You can also offer to help them find a therapist or support group.
• Take Care of Yourself- Remember to take care of yourself as well. Supporting a loved one through treatment can be emotionally draining, so make sure to prioritize your own well-being and seek support when needed.

For the caregiver, the intensity and burden of fear, worries and trauma associated with the illness can take a toll. Such distress, if ignored or prolonged, can result in ‘caregiver-burden’. So emphasizing that the key is to be there for your loved one, listen to their needs, and provide support in a way that respects their autonomy and promotes their well-being.

Psycho-oncology is a speciality within the field of health and medical psychology which combines psychological support with cancer care. A psycho-oncologist has a unique role to play in dealing with the psychological responses to cancer, such as the initial trauma, denial, anxiety, depression, fear, anger, etc. The focus is on psycho-social aspects of patients and caregivers along with compliance building, supportive and grief counselling, dealing with loss, coping strategies, resilience building, pre- and post-operative counselling and lifestyle changes.

Psycho-oncologists play a crucial role in the holistic care of breast cancer patients by addressing the psychological and emotional aspects of their diagnosis, treatment, and survivorship. Here are some key roles we can play:

1. Assessment and Support- Psycho-oncologists can assess the emotional and psychological needs of breast cancer patients through interviews, standardized assessments, and observation. They provide support and counseling to help patients cope with the emotional impact of their diagnosis, treatment, and side effects.
2.   Emotional Support– Breast cancer patients often experience a wide range of emotions, including fear, anxiety, sadness, anger, and uncertainty. Psycho-oncologists offer a safe and supportive environment for patients to express and process these emotions. They provide coping strategies and tools to help patients manage stress and improve their overall well-being.
3. Crisis Intervention– In times of crisis, such as receiving difficult medical news or experiencing significant treatment side effects, psycho-oncologists offer immediate support and intervention to help patients navigate the emotional challenges they are facing.they may also work alongside psychiatrists in times of need of pharmacological interventions.
4. Communication and Decision-Making– Psycho-oncologists help facilitate communication between patients, their families, and their healthcare providers. They assist patients in understanding their diagnosis, treatment options, and prognosis, empowering them to make informed decisions that align with their values and preferences.
5. Pain and Symptom Management– Chronic pain and other physical symptoms can significantly impact a patient’s quality of life and emotional well-being. Psycho-oncologists work collaboratively with medical providers to address these symptoms and provide psychological interventions, such as relaxation techniques and cognitive-behavioral strategies, to help patients manage their pain and improve their overall functioning.
6. Supportive Care– Psycho-oncologists collaborate with multidisciplinary teams to provide comprehensive supportive care to breast cancer patients. This may include addressing issues related to body image, sexuality, fertility, relationships, and spirituality.
7. Survivorship and Palliative Care– Psycho-oncologists continue to provide support to breast cancer survivors as they transition from active treatment to survivorship. They help survivors navigate the physical, emotional, and social challenges of life after cancer and address any ongoing psychological concerns. In cases of advanced or metastatic breast cancer, psycho-oncologists work closely with palliative care teams to provide holistic care that focuses on symptom management, quality of life, and end-of-life issues.

Psycho-oncologists play a critical role in the holistic care of breast cancer patients by addressing their emotional and psychological needs throughout the cancer journey, from diagnosis through survivorship or end-of-life care. They contribute to the overall well-being of patients and help improve their quality of life during and after cancer treatment.

 Given the extent of stigmatization of cancer in our country, there is a dire need to address risk factors, and perceptions which shape the attitudes of individuals towards cancer.

In the Indian context, there are indeed some misconceptions and stigmas surrounding the psychological aspect of breast cancer treatment. Here are a few that are commonly encountered:

Stigma Around Mental Health- In many Indian communities, there is still a stigma associated with mental health issues. Some people may view seeking psychological support as a sign of weakness or as something to be ashamed of. This stigma can prevent breast cancer patients from seeking the emotional support they need.

Belief in Traditional Healing Practices– While modern medical treatments for breast cancer have advanced significantly, there is still a strong belief in traditional healing practices in many parts of India. Some individuals may prioritize traditional remedies over psychological support or may believe that mental health issues can be resolved solely through traditional methods.

Cultural Expectations of Strength and Resilience– There is often a cultural expectation for individuals, especially women, to be strong and resilient in the face of adversity. Breast cancer patients may feel pressure to suppress their emotional struggles and put on a brave face, which can hinder their ability to seek help for psychological distress.

Lack of Awareness and Education- There may be a lack of awareness and education about the psychological impact of breast cancer and the importance of addressing mental health needs as part of comprehensive cancer care. This can result in misunderstandings and underestimation of the emotional challenges faced by breast cancer patients.

Fear of Being Labeled as “Crazy”–  There is a fear among some individuals that seeking help for psychological issues may lead to being labeled as “crazy” or “mentally unstable.” This fear can discourage breast cancer patients from seeking professional support for their emotional well-being.

Addressing these misconceptions and stigmas requires a multifaceted approach that includes raising awareness, providing culturally sensitive education about mental health, challenging stereotypes, and promoting access to mental health services. It’s important for healthcare professionals, caregivers, and community leaders to work together to create a supportive environment where breast cancer patients feel comfortable seeking the psychological support they need.

Additionally, there is a need to be reassured that the patient and their families are not accountable in any way for this illness. Educating oneself, families and friends is of utmost importance. The medical causes underlying their condition needs to be explained by the treating oncologists. Sometimes patients tend to get irritable and angry and they need to realise that ‘It’s OK’ to experience these feelings. These emotional reactions of irritability and anger also need to be normalized and also need to be recognized by the caregivers.

There are several coping techniques and mindfulness practices that can help breast cancer patients manage stress and anxiety. Here are some recommendations:

• Deep breathing exercises, progressive muscle relaxation, guided imagery journaling
• Seeking social support
• Self-care or set aside ‘Me Time’ for yourself
• Adopt healthy lifestyle choices including exercise, sleep and healthy eating Encourage a problem-solving approach
• Connect to others through support groups
• Be open to reaching out for help through psychologists etc

It’s important to emphasize that different techniques work for different people, so encourage patients to explore and find what resonates best with them. Encourage consistent practice and remind them that managing stress and anxiety is a process that takes time and patience.

Build a Supportive Network: Foster connections with friends, family members, support groups, or other breast cancer survivors who can provide understanding, empathy, and encouragement. Having a supportive network can help survivors feel less isolated and more empowered as they navigate life after treatment.

Set Realistic Goals: Set realistic and achievable goals for the future, whether they are related to work, relationships, hobbies, or personal growth. Breaking larger goals into smaller, manageable steps can help survivors stay motivated and build a sense of accomplishment.

Practice Mindfulness and Stress Reduction Techniques: Incorporate mindfulness meditation, deep breathing exercises, yoga, or other stress reduction techniques into daily life to promote relaxation, reduce anxiety, and enhance overall well-being.

Practice Self-Compassion: Be kind and compassionate toward oneself, recognizing that it’s normal to have ups and downs during the transition into life after treatment. Treat oneself with the same care and understanding that would be offered to a friend facing similar challenges.

Recreation– Keeping yourself engaged can help your mind stay occupied and keeps negative thoughts aside.

Stay Informed and Empowered: Stay informed about survivorship issues, long-term effects of treatment, and strategies for maintaining health and well-being. Empower oneself by advocating for personalized survivorship care and making informed decisions about healthcare choices.

Engage in Self-Care Practices: Prioritize self-care activities that promote physical, emotional, and mental well-being, such as getting enough rest, eating healthily, exercising regularly, and engaging in activities that bring joy and relaxation. Have ‘Me Time’- Do not forget to give adequate attention to yourself and your needs because the most important person here is ‘YOU’!

Healthy Lifestyle Choices– Stay active, refrain from smoking and alcohol consumption, and eatwell. This can help reduce the risk for recurrence of cancer and can lead to longer survival.

Patients and survivors should always be encouraged to go for regular medical checkups to their treating doctors, because like they say, ‘prevention is better than cure’. Make an effort to be aware of your symptoms (physical, mental and psychological), do not hesitate to educate yourself about the illness and also encourage your family members to seek regular checkups.

Support groups are known to be effective with both patients as well as their family members, thereby creating shared spaces for common experiences, a sense of connectedness and empathy. Such experiences allow catharsis and open spaces for self-expression and exploration.

Experiencing anxiety or fear of recurrence after completing breast cancer treatment is a common concern for many survivors. It’s important for survivors to acknowledge and validate their feelings of anxiety or fear, recognizing that these emotions are normal and understandable given what they’ve been through.

Seeking support from friends, family members, support groups, or mental health professionals can provide validation, understanding, and practical coping strategies. While staying informed about breast cancer and following up with healthcare providers is important, survivors should also be mindful of limiting exposure to triggers that exacerbate their fears.

Engaging in mindfulness and relaxation techniques can help calm the mind and reduce anxiety, allowing survivors to stay grounded in the present moment. Encouraging survivors to focus on what they can control, challenge negative thoughts, and prioritize self-care activities can empower them to manage their anxiety and promote their overall well-being.

Creating a survivorship plan that outlines ongoing healthcare needs and strategies for managing physical and emotional health can provide a sense of control and reassurance. If anxiety significantly impacts a survivor’s quality of life, seeking professional counseling or therapy can offer personalized support and strategies for coping with anxiety and managing intrusive thoughts.

Above all, survivors should remember that they are not alone in their feelings, and it’s okay to seek help when needed. With support, coping strategies, and self-care, many survivors find ways to manage anxiety and live fulfilling lives beyond cancer treatment.

To briefly explain, breast cancer survivors should be aware of the following signs or symptoms of psychological distress and should seek help for anything that feels unusual. Some signs could be:

1. Persistent Sadness or Depression– Feeling persistently sad, hopeless, or empty for an extended period, beyond what might be expected as a normal reaction to the challenges of cancer survivorship.

2. Anxiety or Panic Attacks- Experiencing intense feelings of worry, fear, or panic that interfere with daily functioning or quality of life.

3. Changes in Sleep Patterns– Significant changes in sleep patterns, such as difficulty falling or staying asleep, or sleeping excessively.

4. Changes in Appetite or Weight- Significant changes in appetite or weight, such as loss of appetite and unintentional weight loss, or increased appetite and weight gain.

5. Fatigue and Low Energy- Persistent fatigue, low energy levels, or lack of motivation that is not alleviated by rest or sleep.

6. Social Withdrawal– Withdrawing from social activities, hobbies, or relationships that were previously enjoyable, and isolating oneself from others.

7. Irritability or Anger- Feeling easily irritated, agitated, or angry, and having difficulty controlling emotions or reactions.
8. Difficulty Concentrating or Making Decisions– Difficulty concentrating, remembering details, or making decisions, which may interfere with daily tasks and responsibilities.

9. Physical Symptoms without Medical Cause- Experiencing physical symptoms such as headaches, stomachaches, or muscle tension, without a clear medical cause.

10. Thoughts of Self-Harm or Suicide– Having thoughts of self-harm, suicide, or a desire to escape from overwhelming emotional pain.

Breast cancer survivors or their caregivers should seek professional support if they experience any of the above signs or symptoms and if these symptoms:

•  Persist for more than a few weeks.
•  Interfere with daily functioning, relationships, or quality of life.
• Cause significant distress or impairment in social, occupational, or other important areas of life.
•  Impact physical health or lead to thoughts of self-harm or suicide. 

Seeking professional support from a mental health professional, counselor, therapist, or psychiatrist can provide survivors with the tools, support, and coping strategies they need to manage psychological distress and improve their overall well-being. It’s important for survivors to remember that seeking help is a sign of strength and courage, and it can lead to improved emotional health and quality of life.

There was a 38 year old woman diagnosed and recovering from breast cancer. She was a married woman with two young children who were greatly impacted by her ongoing treatment and side effects. She was referred by her oncologist to undergo psychotherapy sessions with a psycho-oncologist for her ongoing mood-related changes. During the course of the sessions, she opened up about her worries and inability to manage her daily routine like she did before. She was facing concerns around guilt for not being an able mother or an able wife, and also fear of recurrence and death.

Therapy allowed her to express these concerns, enhance existing coping mechanisms with an emphasis on communication skills and delegation of responsibilities within the family. Post multiple sessions with both patient and her husband, we were able to avoid conflicts, keep a check on her mood fluctuations, establish new rituals for self-care and regain a sense of lost control.