The experience of being diagnosed with, and treated for, breast cancer is often described as an emotional roller-coaster because of the ups and downs that happen along the way.
Changes in body image or self-esteem, fear of breast cancer coming back, and anxiety and depression are just some of the emotional effects reported by people who have had breast cancer.
It’s not uncommon to feel that your emotional and mental health take a lot longer to recover than your body does. This can be worse if you are dealing with other life challenges at the same time.
Emotional issues
Having a changed body shape, weight gain or loss, hair loss and memory difficulties can all affect your confidence and self-esteem. Some people also have to deal with other issues. Young women, for instance, may have to come to terms with the fact that treatment may have reduced their fertility and so their ability to have a baby, or may be dealing with early onset of menopause. Complex emotional, spiritual and existential issues can also arise. It’s normal to feel anxious, scared or even depressed when treatment ends.
If you need support to work through the emotional impact of breast cancer, it is important to know that there is help available. Your GP, specialist or breast care nurse may be able to give you some strategies to help you cope or refer you to a psychologist or counsellor. You GP can provide you with a Mental Health Treatment Plan, which will give you up to 10 Medicare-subsidised sessions per calendar year with a psychologist, social worker or counsellor.
You can also call Cancer Council 13 11 20 for information and support.
BCNA's Online Network is available 24 hours a day if you feel that talking to someone in a similar situation will help.
Concerns about breast cancer coming back
The fear that breast cancer will come back (recur) is very common and can sometimes affect emotional wellbeing and the ability to cope with life after active breast cancer treatment is completed.
While people who have been diagnosed with breast cancer do have a higher risk of developing breast cancer in their other breast than people in the general population, it’s reassuring to know that most people will never have breast cancer again.
Friends or family may tell you that being positive is important to stop the cancer coming back, or that being negative may even have caused your cancer in the first place. At present there is no evidence that the way you think or feel caused your cancer or will affect your outcome (prognosis).
Emotions like anger, frustration and sadness are normal, so don’t feel guilty if you experience these. They are a part of coming to terms with what you have been through.
Being diagnosed with cancer is a trauma and it is likely you will experience some grief around this. Again, this is a normal reaction to a major life event.
Some people want a lot of information about the chance that their breast cancer may come back and how they might recognise the signs. Others prefer not to know. Many doctors take their cue from you, assuming that if you want information you will ask for it. Make sure you ask as many questions as you want to get the information you need.
It’s important to remember that you will still get aches and pains from time to time, and may develop other medical conditions as a normal part of ageing. The problem is that once you’ve had a breast cancer diagnosis, you tend to be much more aware of your body.
When you feel like an ache or pain hasn't subsided after a number of days and you are concerned about it, make an appointment to see your GP.
For more information, listen to Episode 13 of BCNA's Upfront About Breast Cancer podcast series. In the episode, host Kellie Curtain talks to breast surgeon Professor Bruce Mann and psychologist Jane Fletcher about how to manage the fear of cancer recurrence, and at what point you should seek further help and advice.
Check-up stress
As time passes, some people are able to put aside their fear of breast cancer returning. Others experience high levels of worry and anxiety especially before their check-ups.
If you notice you are feeling overly anxious, it may be a good idea to seek advice from a medical professional. This could be one of the medical professionals on your treating team, your GP, practice nurse, counsellor or social worker. They may suggest relaxation techniques, refer you to a counsellor or psychologist, or prescribe medication to get you through a difficult patch.
If you are feeling anxious about your check-up appointment, it can help to plan to do something nice after your appointment. This could be meeting your partner or another family member or friend for a coffee, or booking yourself in for a massage.
Finding emotional support
Cancer support groups, Cancer Council volunteer peer support programs and online forums such as BCNA's Online Network all offer emotional support. Some people also find individual, couples or family counselling helpful.
Many people are glad they sought professional support to help them work through their emotional issues. Your GP can refer you to a counsellor, social worker, psychologist or psychiatrist with expertise in counselling people with cancer. Your GP can give you a GP Mental Health Treatment Plan which gives you up to 10 Medicare-subsidised sessions per calendar year with a psychologist, social worker or clinical occupational therapist.
Dealing with cognitive impairment as a result of treatment
Cognitive changes (i.e changes to your thinking) that sometimes follow cancer treatment, such as feelings of fogginess and not being able to think clearly, and problems with memory and attention, are often referred to as ‘chemo brain’ or ‘chemo fog’. Experts in the field now talk about cancer fog.
These changes can be frustrating and distressing. They can affect your confidence at home, work and in social situations, and they sometimes last for months or even years.
Cognitive changes following cancer is an area of ongoing research. At present there are a small number of interventions that have been shown to help, including using online ‘brain training’ apps such as BrainHQ.
Other strategies that may help you feel more in control and confident in your thinking include:
- writing things down and keeping lists
- doing one task at a time
- reducing distractions
- planning and pacing yourself rather than rushing
- keeping a diary or journal
- setting up reminders on your phone or computer
- developing new skills such as learning a musical instrument, new language or a handicraft.
The eviQ fact sheet Memory changes and chemotherapy provides more information about the memory changes you might experience during and after chemotherapy and tips on how to manage them.
Things you can do to help your emotional wellbeing
- Many people find support from talking to others who have ‘been there’, for example through BNCA's Online Network.
- Sharing how you feel with your family and friends could help them understand your feelings and how to best support you.
- If you prefer to talk to someone outside your circle of family and friends, you can phone the BCNA Helpline on 1800 500 258 or call Cancer Council 13 11 20 for information and support.
- Some people find it helpful to keep a journal or diary of their experiences, or record them in some other way, such as voice memos on their phone or through social media. Writing about how you’re feeling or taking photos at specific time points can provide a powerful release for emotions.
- Relaxation or meditation can help to keep your emotions in balance.
- Giving yourself time to do things you enjoy, such as reading, listening to music or spending time in the garden.
- Treat yourself to regular massages, manicures, facials or visits to the cinema or galleries – whatever you can manage and afford that brings you joy.
- Regular physical activity has been shown to help improve emotional wellbeing. Things like going for a walk, yoga, gentle stretching or any other physical activity you enjoy can help you feel relaxed and distract you from worries.
- Whatever the strategy, research suggests that as quality of life improves, negative feelings often diminish.
Anxiety and depression
Stress, sadness and anger are common feelings for people with breast cancer. However, if these feelings are intense or continue for a long time, if you don’t feel joy in the things that used to make you happy and if you’re struggling to function from day to day, you may be experiencing symptoms of something more serious such as anxiety or depression.
Research shows that anxiety and depression are common among people with breast cancer. One study found that up to 50 per cent of people with early breast cancer may experience anxiety and/or depression in the year after diagnosis.
Side effects of treatment such as tiredness and pain can put a person at greater risk of developing anxiety and depression. It can also make anxiety and depression difficult to recognise as they can be masked by the side effects of treatment.
In addition, some breast cancer treatments, such as chemotherapy and hormone-blocking therapies, can cause chemical changes in the brain. This can also put a person at greater risk of anxiety and depression.
Sadly, many people find that these symptoms are overlooked or dismissed, so problems with mood disturbances are sometimes underdiagnosed and undertreated.
For more information about the symptoms of anxiety and depression and how to manage them, read the article on anxiety and depression.
Mindfulness and meditation
Relaxation techniques such as mindfulness, meditation and guided imagery can help you manage the side effects of treatment, deal with stress, and relax. You can learn relaxation and meditation techniques even if you’ve never tried them before.
Here are some suggestions if you’re not sure where to start:
- Ask your treating centre if one of their social workers, occupational therapists, psychologists or other professionals is trained in relaxation techniques or can direct you to an appropriate service.
- Check with your local council or community health centre to see whether there are any group relaxation classes in your area.
- The Cancer Council has produced two CDs – Relaxation and Mindful Meditation – for people with cancer, their families and carers. You can order them online or by calling the Cancer Council on 13 11 20.
- Search iTunes for free mindfulness podcasts – for example, Zencast.
- YouTube has a wide selection of relaxation and mindfulness exercises. Try searching for ‘mindfulness’ and look for one you feel you can connect with. There are many guided meditations, guided relaxation sessions and deep breathing meditation exercises but meditation is very personal and what’s right for one person may not be right for another. Take time to choose a voice, music and length of time that suits you.
