Breast cancer treatment is over. Now what?

Breast cancer messes with your body, but also your mind.

First, there’s the shock of diagnosis.

“The news can be quite devastating. There are so many thoughts that begin to surface for people, and, at times, it can be very difficult to focus or to comprehend the information that the medical team is reviewing with them,” said Judith Pregot, LICSW, OSW-C, MSW, M.ED, CGCS, a certified oncology social worker (OSW-C) with Davenport-Mugar Cancer Center in Hyannis. “Just hearing the word ‘cancer’ takes a person down a path that is often not helpful to follow.”

When someone initially receives a diagnosis of cancer, the news can be devastating, she said.

“There are so many thoughts that begin to surface and this makes it difficult to focus or to comprehend the information that the medical team reviews with them. If you have a history of anxiety, stress or depression prior to receiving a diagnosis of breast cancer, you are now adding an additional level of stress or anxiety onto your already full plate.”

Next comes the stress of treatment, she said.

“I often try to remind each patient that we are here to help them in the best way that meets each person’s needs. I always remind them that, today, we are in such a better space in terms of how we treat cancer. There has been tremendous progress in terms of a diagnosis and the recommended treatment plan.”

Post Treatment

But even the period after treatment can be hard. Some patients miss the comforting attention and diligence of clinicians and oncology staff. They may suffer cancer-related fears, post-traumatic stress disorder or depression, Pregot said.

“Post-treatment, there is always that little concern or thought in the back of someone’s mind with regard to their status,” she said. ‘Many people always have the thought, ‘Has my cancer been addressed? Am I now cancer free? How do I know if they got it all?”

And, if a patient is already struggling with mental health issues, such as anxiety or depression, cancer can complicate their emotional state even more.

The Davenport-Mugar Cancer Center and the Cape Cod Healthcare behavioral health department developed a program specifically designed for people who have a history of anxiety, stress and depression and who are struggling with the new diagnosis of cancer, Pregot said. The staff at the behavioral health department developed a six-week support group that focused on people who were dealing with their long-term struggle and now were trying to deal with a cancer diagnosis.

Only Patients Understand

Cancer also causes stress in ways that non-patients might not understand, said Elizabeth Leach, MSN, RN, FNP-C, the lead nurse practitioner at Cape Cod Healthcare’s Cuda Women’s Health Center in Hyannis. Leach recalls a patient who even struggled to feel entitled to sympathy, saying, “I only needed a little surgery and I didn’t have to go through what everybody else [did]. I don’t feel like I had breast cancer quite as bad.”

Leach took that as a reminder to check in with cancer patients even if treatment was one-step or is long over.

“We need to be sensitive about it, and we need to encourage friends, family and healthcare providers to continue to check in,” she said. “We should still be checking in with women in primary care settings, knowing they had breast cancer five, six, seven, 10 years ago. It’s a long-term body image thing, too. We forget to check in about that.”

Leach also warns about the triggering language of cancer, such as “you’re a fighter,” or “how are you on your journey with cancer?”

“Women often don’t feel like a fighter, and it certainly isn’t a ‘journey’ for most women. It’s a nightmare,” she said. “So, one of the things I get all the time is that women want to teach [people] how to talk about breast cancer with them.”

Reducing Anxiety

Cape Cod Healthcare takes steps to try and reduce anxiety among breast cancer patients.

“Our imaging center, as a whole, always tries to be sensitive to the fact that our breast cancer patients require a different level of care than just another patient here for, say, a screening mammogram. That's the reason the waiting rooms are separate,” said Leach.

In addition, CCHC has other resources to help patients navigate the mental challenges of breast cancer.

• There are two breast cancer support groups at Falmouth Hospital, 9 to 10:30 a.m. on the first Tuesday, and 5:30 to 7 p.m. on the third Wednesday of every month.
• Leach runs an education and support group in Hyannis from 5:15 to 6:30 p.m. on the second Monday of the month (holidays excepted). She invites speakers to the first half of the meeting and then opens it up for discussion.
• Patients can access integrative therapies and support through the Cape Wellness Collaborative, which connects patients with providers, such as massage therapists, and provides other services, including meals. Pregot encourages patients to stick with any programs they start during treatment and to continue to focus on a healthy diet, among other strategies. “It’s been found that if one follows a diet of whole (not processed) foods, there seems to be a decrease in the level of stress and anxiety,” she said.
• If cancer-related fears or PTSD is affecting the quality of someone’s life, Pregot may recommend behavioral health interventions such as cognitive behavioral therapy. If symptoms persist, a patient may be referred to a clinician who can assist with medication and/or talk therapy.

Information on services is available by contacting the Cuda Women’s Health Center at 508-957-1700.