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Metastatic Breast Cancer
Emotional and Psychologic Effects
 Any cancer diagnosis causes substantial emotional reactions, and the thought of living with metastatic disease can be especially overwhelming. As you begin your life with metastatic breast cancer, you will experience a wide range of potential emotions, from fear and uncertainty when dealing with treatment decisions, to anger at the loss of control, to joy when hearing positive test results. Allowing yourself to express your emotions freely, no matter what they are, is important to maintaining emotional health.
Identifying and Treating Depression
For some women, the emotional distress of living with metastatic breast cancer becomes more serious, and depression may develop. Depression is more complex than feeling sad or hopeless; rather, it is a disorder consisting primarily of a depressed mood and loss of interest or pleasure in normal activities. A diagnosis of depression requires that at least five of the following symptoms occurred every day for at least 2 weeks:
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Persistent sad, anxious, or “numb” feeling
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Loss of interest or pleasure in once-enjoyed hobbies and activities
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Feelings of hopelessness
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Feelings of guilt, worthlessness, helplessness
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Fatigue and loss of energy
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Difficulty concentrating, remembering, making decisions
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Sleep problems
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Changes in appetite and/or weight
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Thoughts of death or suicide or suicide attempts
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Restlessness, irritability
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Social withdrawal
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Repeated episodes of crying
Women with mild depression may find benefit in counseling alone (without medications). Moderate or severe depression is typically managed with a combination of psychologic treatment and medication (antidepressants). Many antidepressants are available, and the ones used most often for people with cancer belong to a class known as selective serotonin reuptake inhibitors (SSRIs). These drugs include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), among others. Each antidepressant drug has different side effects, which can usually be managed by adjusting the dose or switching the medication. Your doctor will work with you to find the antidepressant that works best for you with minimal side effects. Antidepressants do not take effect right away; SSRIs take about 2-4 weeks to become effective, and others may take 3-6 weeks.
Psychologic treatment for depression may include individual psychotherapy (counseling to explore emotional issues that contribute to depression) and cognitive-behavioral therapy (counseling to help a person change his or her negative thought patterns and behaviors). Counseling, especially in a group setting, can improve your quality of life by helping you improve your communication with family members and friends, face fears about death and dying, and help control pain and other symptoms. Cancer support groups may also be helpful (discussed in more detail later).
Depression can occur any time, but it is most likely to occur during times of unrelieved symptoms or side effects. The pain, extreme fatigue, and nausea and vomiting associated with cancer or its treatment can have a substantial impact on your daily activities and a subsequent negative effect on your emotional health. It is important to talk to your doctor about ways to relieve these side effects.
Maintaining a Healthy Lifestyle
Maintaining your physical health can help boost your mental health. An adequate amount of sleep, regular exercise, healthy eating, and effective stress management can help you feel better both physically and emotionally, allowing you to better cope with the day-to-day matters of living with metastatic breast cancer.
Although it sounds counterintuitive, physical exercise is sometimes the best treatment for fatigue. Studies have shown that women with breast cancer who exercise regularly feel less tired and have more energy. Think about what physical activity you enjoy most and engage in it daily, as often as you can tolerate it. You may have to modify your favorite form of exercise because of pain or discomfort.
It may be a challenge to maintain proper nutrition if you have side effects such as loss of appetite or nausea and vomiting. But a healthy diet will help you gain strength, which is especially needed during treatment cycles. Nutritionists recommend that you eat a wide variety of foods, including vegetables, fruit, low-fat milk and dairy products, whole grains and legumes, and healthy snacks, such as yogurt or nuts.
Discovering the ways to best manage stress will enhance your mental health by strengthening your coping abilities. You should explore various ways to reduce stress to find the one that best meets your needs. Some possibilities are meditation, guided imagery, muscle relaxation, and yoga. Some women have found that yoga also helps relieve some of the discomfort associated with metastasis. Ordinary “escapes,” such as reading, television, and games can also help you relax.
Setting Priorities
At no other time is it more important to think about all that you have in your life and set priorities. Priorities differ among women, and you should listen only to yourself in setting them. Some women find comfort in maintaining their current routine and may choose to continue working. Other women choose to devote more time to hobbies, traveling, or spending time with family and friends. Many women with metastatic breast cancer have noted the importance of “finding joy in life,” whether it be spending time having fun in ordinary ways or seeking adventure in new ways. Becoming a volunteer in the community helps some women gain perspective as well as a sense of purpose, and many women find support and comfort in spirituality. Think about what matters most to you and spend most of your time doing it.
Maintaining Relationships
Maintaining strong relationships with others is another key element in emotional well-being. This may be difficult, as you may feel like others don’t understand what you’re going through. Your friends may avoid seeing you or talking with you because they don’t know what to say or are afraid they will say the wrong thing. Reach out to family and friends. Tell them about your fears—and happiness—so they can better understand your journey. Also, admit that you may need help some times, and let your friends and family help.
Intimate relationships may also present a challenge. Cancer and its treatment affect how you feel about yourself and your body and how you relate intimately to your spouse or significant other. Lack of sexual desire is the most common sexuality issue among women with cancer. The anxiety of coping with metastatic disease, along with such side effects as fatigue and pain, affect how you feel sexually. Management of side effects that interfere with intimacy can help you feel better overall, which may help you feel more desirable and more interested in sex.
Open communication with your spouse or significant other is essential to maintaining a good intimate relationship. You and your partner should share concerns and fears. Talk with each about ways to be intimate other than with sexual intercourse. You should both understand that it is safe to have sex during cancer treatment (unless your doctor tells you otherwise). Counseling (individual, couples, and/or sex therapy) may also be helpful.
Getting Support
Coping with metastatic breast cancer is a challenge no woman should have to face alone. In a survey of 700 women with the disease, more than three-quarters of the respondents said that support groups were important to them. Talking with other women with the disease helped them to learn more about the disease, treatment options, resources, and how to cope; provided emotional support; and made them feel less alone. Support groups provide a wide variety of benefits for women living with metastatic disease:
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Feeling of belonging
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Place to express feelings
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Sense of acceptance through sharing a common experience
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Avoidance of social isolation
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Discovery of resources
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Enhancement of knowledge about disease and related issues
Various kinds of support groups are available. Some groups are held in local community centers or hospitals. Your doctor or nurse should be able to provide you with a list of local support groups in your area. Many online support groups and listservs are also available; online support offers the advantage of being available all the time and is preferred by women who would rather not talk face-to-face or who do not feel well enough to go to a local group meeting.
No woman wants to hear a diagnosis of metastatic breast cancer. But when faced with this challenge, most women are determined to live their life to the fullest for as long as they can. Be one of them.
Additional Sources of Information
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