Breast cancer diagnosis and treatments are often associated with significant psychological distress impacting psychosocial adjustment to the disease process and health outcomes. This distress has been linked to poorer physical and mental health during treatment. The diagnosis of breast cancer can be profoundly distressing, creating enormous stress for patients who must navigate treatment choices, undergo testing, understand prognoses, manage treatments and side effects, and face uncertain futures. This process can also lead to or exacerbate existing psychological symptoms, such as anxiety and depression, and significantly impact psychological health and well-being, including quality of life and treatment compliance. Common psychological symptoms in breast cancer patients include anxiety, depression, impaired cognitive function, pain, sleep disturbances, sexual dysfunction, and fatigue. These symptoms can trigger fear of death or recurrence, altered body image, and diminished well-being. Psychological distress is particularly high at transition points in treatment, such as diagnosis, awaiting treatment, during and post-treatment, at follow-up visits, recurrence, and treatment failure [1,2].
Patients diagnosed with breast cancer often face multiple modalities of treatment, and the type of cancer treatment impacts psychological symptoms. Surgical procedures, radiotherapy, and chemotherapy are associated with significant psychological dysfunction. Anxiety, depression, and other psychological symptoms are prevalent and can persist long after treatment completion of these treatments.
The link between psychological and physical health in breast cancer patients is well-documented. Anxiety and depression can manifest as physical symptoms, impacting overall health outcomes. Addressing psychological symptoms can improve treatment adherence and quality of life, as well as reduce mortality rates in patients with depressive symptoms. Thus, screening for psychological distress and symptoms is crucial to comprehensive care for breast cancer patients. Screening and assessing psychological stressors are crucial for planning appropriate treatment approaches. Tools like the Distress Thermometer and Problem List, Hospital Anxiety and Depression Scale (HADS), and other standardized psychological assessments help identify and address psychological symptoms. The Institute of Medicine and the National Comprehensive Cancer Network emphasize the importance of distress screening as part of standard oncology care [3-5].
Research shows variability in psychological symptoms among breast cancer patients, influenced by factors like socioeconomic status, social support, and cultural background. Adjustment disorders, anxiety, depression, cognitive impairment, sleep disturbances, body image disturbances, sexual dysfunction, and post-traumatic stress are common psychological issues in this population.
Effective psychotherapeutic interventions for breast cancer patients include psycho-education, cognitive-behavioral therapy (CBT), mindfulness-based therapy, supportive-expressive therapy, meaning-centered psychotherapy, and acceptance and commitment therapy (ACT). These interventions address various psychological symptoms and improve coping skills, quality of life, and overall well-being. Research on psychosocial interventions in diverse populations is limited. Tailored, culturally informed assessments and treatments are necessary to address unique stressors faced by underrepresented groups, such as Black women, who experience higher mortality rates and distinct psychosocial challenges. Psychotropic medications play a crucial role in treating psychiatric symptoms in breast cancer patients. Medications must be carefully selected to avoid drug interactions with cancer treatments, such as tamoxifen.
Breast cancer diagnosis and treatment are associated with significant psychological distress, impacting overall health outcomes and quality of life. Routine assessment and targeted psychotherapeutic interventions are essential for managing psychological symptoms in breast cancer patients. Tailored treatments, including psychotropic medications and culturally informed approaches, can improve patient well-being, quality of life, and treatment adherence.
References
- Dinapoli L, Colloca G, Di Capua B, Valentini V (2021) Psychological aspects to consider in breast cancer diagnosis and treatment. Current Oncology Reports 23(3). [crossref]
- Chiriac VF, Baban A, Dumitrascu DL (2018) Psychological stress and breast cancer incidence: a systematic review. Clujul Med 91(1). [crossref]
- Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67(6). [crossref]
- National Comprehensive Cancer Network (2012) Clinical Practice Guidelines in Oncology (NCCN Guidelines) Distress Management.
- Institute of Medicine (2008) Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs.