A diagnosis of breast cancer often comes as a shock, and adjusting to the news and coming to terms with treatment decisions are very difficult. A patient may go through a range of emotions, including disbelief, anger, anxiety and fear. While these are all natural responses, for some, the fear can be so extreme that it poses a barrier to seeking or accepting treatment.

I see that for many of my patients, however, the most difficult time may be after active treatment ends and it is time to return to “normal” life.

A recent study has shown that mental health diagnoses, including anxiety, depression, and neurocognitive and sexual dysfunction, may be more common in breast cancer survivors more than one year after their diagosis compared with women with no prior cancer.

It can be difficult after spending so much time actively doing something to fight the cancer to transition into the follow-up phase. This can be especially difficult when patients don’t feel or look like their normal selves. After surgery, radiation and sometimes chemotherapy treatments, there can be lingering physical effects like fatigue or pain that are barriers to returning to social and family life or the workplace. Also, mental and emotional symptoms such as brain fog, depression, anxiety, sleep disturbance and apprehension about social interactions also can persist.  Certain medications used to treat breast cancer, such as hormone-blocking treatments, also may affect the mood. It is important to discuss your mood with your health care provider, as there may be other options or treatments available that could help.

Returning to a new normal can be challenging and take time. Seeking mental health care can be extremely helpful during this time to understand that this is a common experience and to help create strategies to cope with these challenges, set reasonable expectations and celebrate progress.

The fear of a cancer recurrence also can come during this time. After a cancer diagnosis, any physical symptom — even a cough or minor pain —  can trigger the fear of a cancer recurrence. It is important to notify your doctor of any new concerning physical complaints. However, sometimes the fear or recurrence can be out of proportion to the physical complaint or thoughts become intrusive or distressing. Working with a mental health professional can help break negative thought patterns.

Connection between mental health and physical health

I believe that it is as important to address mental and emotional health as it is to address physical health. There is a strong connection between physical and the mental health. In fact, studies have suggested that addressing depressive symptoms may improve outcomes for patients with breast cancer.

Seeking professional support can be extremely helpful during these times. For some people this can mean counseling, and others may also benefit from medication.

What is behavioral oncology?

At Norton Cancer Institute, the Behavioral Oncology Program consists of mental health providers who focus on patients with a cancer diagnosis. They help patients address their emotional needs, develop coping mechanisms to deal with medical treatments and help adjust to the changes in their lifestyle caused by the cancer diagnosis.

Some patients diagnosed with breast cancer may have young children, and talking to kids about a parent’s cancer diagnosis is difficult. A behavioral oncology provider can provide support and assistance in talking to kids of different ages about a cancer diagnosis and responding to their emotional needs.

More resources for breast cancer patients

For some, support groups or social media connections can provide a community of people who may understand what they are going through. For others, it can be overwhelming to hear other’s stories about breast cancer. If you recognize that, it’s OK to take a step back.

Many find solace in turning to faith-based support.

Exercise is an important way to help both the physical and emotional recovery. For example, yoga has been shown to improve the mood, reduce pain and improve sleep in breast cancer patients. Other resources such as massage therapy, acupuncture and music therapy can be very helpful for both physical and emotional symptoms.

Mental health concerns and resources for the family

The person diagnosed with cancer may not be the only one who could benefit from mental health support. A spouse or loved one also may experience severe emotional distress, anxiety or depression associated with the diagnosis. Support services are also available for the loved ones of a person diagnosed with cancer.

While a diagnosis of cancer can be scary and distressing, there are many resources for both the patient and family to help guide them through their treatment and beyond.

Laila S. Agrawal, M.D., is a hematologist and oncologist with Norton Cancer Institute.

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