Psychological Concerns in the Aftermath of a Breast Cancer Diagnosis and Treatment for Young Adults
Receiving a breast cancer diagnosis and undergoing treatment as a young adult takes a physical and emotional toll.
With advancements in early detection and treatment for breast cancer, including new clinical trials, the prognosis for women with breast cancer has significantly improved over the last few years.1 However, with improvements in survival rates for patients with breast cancer come new challenges.
Receiving a breast cancer diagnosis and undergoing treatment as a young adult (aged 20-39 years) takes a physical and emotional toll. From the surgical removal of breasts to potential infertility, to drastic changes within their daily routine, the young adult with breast cancer can experience multiple losses throughout their cancer journey. Because of the urgency of treatment and the reality of finances and physical health concerns, patients are often not given the space they need to emotionally process these changes. Further, psychological resources be either limited, not offered, or not sought out by patients. As a consequence, young adult patients with breast cancer can have a difficult time coping in the aftermath of their treatment.
Following their cancer treatment, women often express experiencing PTSD and bereavement-like symptoms, including depression, anxiety, mistrust, flashbacks, and avoidance. Dealing with these symptoms as a young adult brings additional unique challenges as young adults are also developing their identity at this time in their lives. They may be working on establishing a career, raising a family or dating, and discovering who they are. Campbell-Enns and Woodgate (2015) highlight how younger breast cancer survivors tend to have a harder time coping with their prognosis compared to older survivors because of a lower perception of their quality of life.2
Young adults also tend to have a more aggressive type of cancer, which results in more intense treatments.3 As a result, these patients may encounter many physical changes and symptoms from their treatment such as premature menopause, infertility, and sexual dysfunction, which further impact how they cope with their prognosis.
Addressing Psychosocial Concerns
Psychological symptoms that arise following treatment are often ignored, dismissed, or remain unknown to health care providers and patients’ loved ones. Some reasons for this include the common misconception that patients in the posttreatment setting should be grateful that they are alive or that life is easier now that the patient is no longer in treatment. It is also possible that patients from different backgrounds and cultures may not always feel comfortable sharing their feelings with or trusting their health care professionals. Additionally, there are limited resources and literature provided to young breast cancer survivors, especially within their treatment centers.
Young adult breast cancer survivors often proceed to feel lost, ashamed, or misunderstood, which can negatively impact their relationships with others. For example, a young adult may not be able to relate to peers who have experienced milestones such as motherhood or a job promotion while they were in treatment, resulting in their feeling excluded or missing out.
They may struggle to adapt to their life post treatment, and their new quality of life due to their body changes, lingering side effects, and their shifted perception of how they see themselves.
Women after breast cancer treatment also tend to struggle with their self-esteem including not feeling beautiful enough or “woman” enough due to their losses. Even women who opted for reconstruction surgeries still have severe challenges coping with the loss of their natural breasts and often compare their new breasts to their former ones. Young women’s difficulties with being unable to cope effectively in post treatment can often hinder a woman’s recovery including their overall prognosis, treatment compliance, social functioning, and even survival rate.4
Health Care Providers’ Role
There are ways health care providers can help young adults navigate through the psychosocial impacts in the aftermath of breast cancer treatment. Such interventions can help increase the prognoses of young adult patients with breast cancer as well as their quality of life. Below are steps all health care providers can incorporate into their daily practice to ensure a successful transition following treatment.
Ask questions and get to know your patient:
Towards the end of treatment and during follow-up appointments, explore how patients are coping mentally or if they experienced any recent challenges. Further inquire whether they feel have enough physical and mental support.
Refrain from dismissing feelings:
When a patient expresses a feeling or concern, avoid minimizing their feelings. For example, if a patient expresses she is sad about losing her breasts, validate her feelings rather than telling her, “It is going to be OK.”
Gather the proper resources:
Learn about different resources that may be available to your patients if they express psychosocial concerns. This includes knowing if your treatment center provides support groups or counseling services as well as local resources such as fertility preservation.
Point them to national resources:
American Cancer Society: Reach To Recovery
References
- Nardin S, Mora E, Varughese FM, et al. Breast cancer survivorship, quality of life, and late toxicities. Front Oncol. 2020;10:864. Published 2020 Jun 16. doi:10.3389/fonc.2020.00864
- Campbell-Enns H, Woodgate R. The psychosocial experiences of women with breast cancer across the lifespan: a systematic review protocol. JBI Database System Rev Implement Rep. 2015;13(1):112-121. doi:10.11124/jbisrir-2015-1795
- Partridge AH. Cancer survivorship and the young breast cancer patient: addressing the important issues. Oncologist. 2013;18(8):e19-e20. doi:10.1634/theoncologist.2013-0300
- İzci F, İlgün AS, Fındıklı E, Özmen V. Psychiatric symptoms and psychosocial problems in patients with breast cancer. J Breast Health. 2016;12(3):94-101. doi:10.5152/tjbh.2016.3041
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