The fear of recurrent cancer is a common experience for breast cancer survivors. Learn how to support them through this difficult time.

The Fear Of Recurrent Cancer – How To Support Breast Cancer Survivors

One of the worst things about breast cancer is it never ends.

Introduction

Despite treatment. It&rsquo;s not just the physical trauma; a patient&rsquo;s survival also depends on their<a href="https://merisehat.pk/wellness/mental-health-sleep"> mental health</a> and how well their mind copes with it, something most people overlook or do not pay much attention to. 
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Understanding the Recurring Breast Cancer

Recurrent cancer is one that comes back. Breast cancer, in particular, can recur in the same or the opposite breast. It can also spread to other parts of the body. Moreover, it can recur months or even years after the initial treatment has ended. 
&nbsp;

It&rsquo;s pertinent to mention here that even though breast cancer may be more common in women, men can have it, too. As per the CDC, 1 out of every 100 cases diagnosed in the US occurs in a man<a href="#accordion">[1]</a>. Also, the most common types of breast cancer in men are the same as those in women, including invasive lobular carcinoma, invasive ductal carcinoma, and ductal carcinoma in situ. 
&nbsp;

A loved one can develop breast cancer again depending on multiple factors, like the type of tumor, the stage of the original breast cancer, and the type of treatment they received. 
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<ul>
	<li>Generally, anyone who has had breast cancer is at risk of recurrence.</li>
	<li>Women who develop breast cancer before the age of 35 are at a higher risk of getting it again compared to those who develop it later in life.</li>
	<li>Aggressive cancers, such as triple-negative breast cancer and inflammatory breast cancer, are hard to treat and more likely to return.</li>
	<li>If the cancer did not spread to the surrounding lymph nodes, the individual has a 6% risk of recurrence in the same breast within five years<a href="#accordion">[2]</a>.</li>
	<li>If the cancer spreads to the surrounding lymph nodes, the chance of recurrence is 1 in 4<a href="#accordion">[3]</a>. This risk increases to 23% if they had a mastectomy without radiation therapy<a href="#accordion">[2]</a>.</li>
	<li>In the case of estrogen-receptor-positive breast cancer, there is a constant risk of recurrence &ndash; 20 years at least &ndash; after the original cancer diagnosis.</li>
	<li>A study involving women aged 35 and younger noted that the risk of recurring regional breast cancer was smaller compared to that of recurring local breast cancer<a href="#accordion">[2]</a>. 
	&nbsp;</li>
</ul>

While one study in 2014 stated that a local recurrence of breast cancer increases the risk of dying, a recent study established that survival rates have improved to a great extent over nearly four decades<a href="#accordion">[2]</a>. 
&nbsp;

Factors that influence a patient&rsquo;s survival include:

<ul>
	<li>Being younger than 45 when it recurs</li>
	<li>How early the recurrence is diagnosed</li>
	<li>How long after initial cancer the recurrence occurs</li>
	<li>The treatments used</li>
	<li>The type of breast cancer 
	&nbsp;</li>
</ul>

Study shows alarming distant breast cancer recurrence survival rates<a href="#accordion">[3]</a>:

<ul>
	<li>Metastatic breast cancer: 27% survival after five years</li>
	<li>Regional breast cancer: 86% survival after five years</li>
	<li>Localized breast cancer: 99% survival after five years 
	&nbsp;</li>
</ul>

&ldquo;Why me?&rdquo;

&ldquo;What&rsquo;s next? Is it ever going to go away?&rdquo;

&ldquo;Who&rsquo;s going to pay for the treatment? How will my child(ren) cope with my illness?&rdquo;

&ldquo;How do I move on from cancer, be cancer-free, and have my life back?&rdquo; 
&nbsp;

Ideally, beating cancer once should be reason enough for you to celebrate. At the same time, it&rsquo;s natural to feel angry, afraid, stressed, and depressed after diagnosis and subsequent treatments for recurring cancer.

According to a recent study, the fear of cancer recurrence (FCR) is a common psychological phenomenon among cancer patients. Family history of cancer, depression, anxiety, stress, and pessimism are responsible for high FCR levels<a href="#accordion">[4]</a>. 
&nbsp;

Also, younger age and physical comorbidities influence FCR levels. For instance, younger breast cancer survivors display an increased FCR during the first 18 months post-surgery compared to older survivors with stable levels during the first six months that later decline. According to studies, difficulties in coping and childhood severe illness experiences (past trauma) may contribute to higher FCR<a href="#accordion">[4]</a>. 
&nbsp;

Most patients spend their entire life living by &lsquo;certain&rsquo; rules to avoid another breast cancer diagnosis even though they do not experience a recurrence.

This fear can stem from: 
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<ul>
	<li>
	<h5>Potential Surgeries</h5>
	</li>
</ul>

Usually, the same therapy is not effective in treating recurrent breast cancer. Some tumors tend to develop a tolerance to treatments like chemotherapy. 
&nbsp;

If the original tumor is treated with radiation and lumpectomy, local recurrence may require a bigger surgery like mastectomy to be controlled. On the other hand, if the original tumor is treated with mastectomy, then a local resection, usually followed by radiation therapy, is considered.

Note: Breast cancer that spreads to other body parts is still treated like breast cancer. E.g., breast cancer cells that move to the lungs will not be lung cancer; it&rsquo;s simply breast cancer in the lungs. 
&nbsp;

<ul>
	<li>
	<h5>Medical Treatments</h5>
	</li>
</ul>

Chemotherapy has numerous short- and long-term side effects. These include hair loss, skin and nail changes, chemo brain, and infertility. Moreover, hormonal therapy (e.g., tamoxifen) can affect mood and cause early menopause. Consequently, the individual starts to feel sad and isolated. 
&nbsp;

<ul>
	<li>
	<h5>Radiation</h5>
	</li>
</ul>

Some types of radiation therapy in the chest or neck area impact the thyroid&rsquo;s ability to work effectively, causing hypothyroidism. 
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While the prevalence of psychological and emotional issues varies among breast cancer patients, a study shows that cancer diagnosis leads to<a href="#accordion">[4]</a>:

<ul>
	<li>41.9% experiencing anxiety</li>
	<li>32.2% experiencing depression 
	&nbsp;</li>
</ul>

People diagnosed with breast cancer may also experience at least one of the following:

<ul>
	<li>Fatigue</li>
	<li>Addiction</li>
	<li>Insomnia</li>
	<li>Mood swings</li>
	<li>Memory loss</li>
	<li>Post-traumatic stress disorder 
	&nbsp;</li>
</ul>

FCR can be overwhelming and affects the patient&rsquo;s quality of life, presenting as persistent dysfunctional behaviors like over-vigilance for symptoms of recurrence or avoidance. Even physical symptoms like difficulty swallowing, chronic chest pain, and numbness in the arm/shoulder can definitely reduce the quality of life. 
&nbsp;

<ol>
	<li>
	<h5>Know The Symptoms</h5>
	</li>
</ol>

It&rsquo;s best to consult a mental health professional if the individual seems to be struggling with:

<ul>
	<li>A lack of interest or joy in activities they normally enjoy</li>
	<li>Sleep disturbances, such as difficulty staying asleep or falling asleep</li>
	<li>Difficulty focusing or concentrating</li>
	<li>Changes in appetite resulting in weight gain or weight loss</li>
	<li>Mood changes, such as constantly stressed or anxious</li>
	<li>Difficulty getting out of bed due to lack of energy</li>
	<li>Increase in body aches</li>
	<li>Using drugs or alcohol to reduce stress 
	&nbsp;</li>
</ul>

Often, these symptoms are intensified if the patient:

<ul>
	<li>Belongs to a low socio-economic class</li>
	<li>Lacks access to higher education</li>
	<li>Has a history of mental illness</li>
	<li>Is diagnosed with breast cancer at a young age</li>
	<li>Has a previous history of trauma</li>
	<li>Lacks social support from family and friends 
	&nbsp;</li>
</ul>

<ol start="2">
	<li>
	<h5>Get Help</h5>
	</li>
</ol>

The first step was to help them accept their emotions. The second is to take control of their health.

When people are less stressed or upset, they are more likely to stick to their treatment plans and show up to appointments. Yes, the earlier the diagnosis and intervention, the better. However, that doesn&rsquo;t mean they cannot talk to a counselor or join a support group any time later after their diagnosis. 
&nbsp;

Talking to a professional or even other people who share a similar recovery trajectory can be beneficial in:

<ul>
	<li>Alleviating feelings of depression, anxiety, and chronic stress</li>
	<li>Improving sleep patterns</li>
	<li>Promoting feelings of happiness, optimism, and contentment</li>
	<li>Strengthening relationships with family and friends</li>
	<li>Learning coping skills 
	&nbsp;</li>
</ul>

Encourage them for individual counseling, group counseling, family counseling, grief counseling, and support groups &ndash; in person or online &ndash; whichever option works. 
&nbsp;

<ol start="3">
	<li>
	<h5>Complementary Therapy</h5>
	</li>
</ol>

Also known as alternative therapies, they have proved to be effective in managing stress and anxiety after a breast cancer diagnosis. These include:

<ul>
	<li>Art therapy</li>
	<li>Journaling</li>
	<li>Acupuncture</li>
	<li>Biofeedback</li>
	<li>Meditation</li>
	<li>Yoga 
	&nbsp;</li>
</ul>

<ol start="4">
	<li>
	<h5>Lifestyle Changes</h5>
	</li>
</ol>

Small changes, like proper hydration, getting at least seven hours of sleep each night, and quitting smoking and alcohol, can actually help reduce the symptoms of anxiety and depression. Moreover, being active also lowers the risk<a href="#accordion">[1]</a>. 
&nbsp;

<ol start="5">
	<li>
	<h5>Plan Ahead</h5>
	</li>
</ol>

If you&rsquo;re familiar with the side effects of cancer treatments, you can help them prepare accordingly. For instance, you can get a head covering or a wig to help them cope with hair loss. Similarly, it&rsquo;s possible to store eggs, sperm, and embryos for the future.

You can also make arrangements at home and work on their behalf before they begin treatment again. 
&nbsp;

Talk to a doctor to get a fair idea of the timing and frequency of their visits. For instance, depending on their health, chemotherapy can go from once a week to once every three weeks. Moreover, each session is followed by a recovery period.

Note: Remind them as often as possible that recurring cancer IS NOT their fault! There is no evidence exactly why it recurs. But a recurrence is not because a patient fails to do something or does something wrong. 
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Conclusion

In conclusion, the emotional well-being of breast cancer survivors is crucial for their recovery. Understanding the impact of late recurrence and providing holistic support can lead to improved health outcomes. Encouraging strong relationships, mental health services, and group therapy can enhance their quality of life. Adhering to treatments and maintaining a healthy lifestyle lowers the risk of recurrence. By addressing survivors&#39; psychological needs, we can offer empathetic and comprehensive support during this challenging journey. 
&nbsp;

Key Takeaways

<ul>
	<li>According to the American Cancer Society, 1 in 4 people diagnosed with breast cancer experiences depression<a href="#accordion">[5]</a>.</li>
	<li>10-30% of breast cancer patients experience anxiety due to uncertainty about the future, anticipation of negative outcomes, worry about the side effects of treatment, and concern over recurrence<a href="#accordion">[6]</a>.</li>
	<li>Elderly women may be less inclined to seek medical help for any breast symptom, including psychological help.</li>
	<li>Older survivors diagnosed with recurrent breast cancer may not be affected as much as younger survivors because they are usually retired from work and are not responsible as primary caregivers to their parents, partners, or children. </li>
	<li>Older people also cope better with medical crises.</li>
	<li>A recent review described &ldquo;scanxiety&rdquo; as anxiety that patients feel when undergoing imaging scans following treatment for their cancer<a href="#accordion">[7]</a>. For instance, flashbacks of a particular treatment at a particular place can lead to a kind of Pavlovian response. </li>
	<li>According to a study, breast cancer survivors are more prone to psychological issues, like depression and anxiety, compared to those who have not been diagnosed with cancer<a href="#accordion">[7]</a>.</li>
	<li>According to a study, women who overestimated their risk of recurrence had higher distress scores and lower mental health<a href="#accordion">[8]</a>. This is important because it influences informed decision-making and management of the disease.</li>
	<li>The risk of recurrence is highest during the first two years following the initial diagnosis of breast cancer. Over time, this risk gradually decreases. </li>
	<li>The majority of survivors who do not have a recurrence during the first five years after diagnosis have a relatively low risk of recurrence. </li>
	<li>Some may present with a late recurrence of breast cancer, i.e., cancer that recurs after five years.</li>
	<li>The risk of late recurrence increases if survivors have progesterone receptor-positive tumors, estrogen receptor-positive tumors, or HER2-negative tumors. </li>
	<li>Premenopausal survivors who had a high number of involved lymph nodes or a tumor bigger than 2 cm are also at greater risk of late recurrence. The same goes for postmenopausal survivors younger than 60. </li>
	<li>Postmenopausal survivors older than 60, however, with a high number of involved lymph nodes, low levels of estrogen expression from the tumor, and who received adjuvant hormone therapy (e.g., aromatase inhibitors) for a short time can also have late recurrent breast cancer. </li>
	<li>Treatment should not be just about surviving. It&rsquo;s also about improving the patient&rsquo;s overall health. Develop strong personal relationships and seek mental health services to manage stressors.</li>
	<li>Good nutrition, moderate physical activities, taking hormone therapies as prescribed, and sticking with follow-up care and other screenings are also important steps to lower the risk of recurrence. </li>
	<li>Group therapy for patients with breast cancer reduces tension, depression, mood disorders, and confusion, improving their overall quality of life. 
	&nbsp;</li>
</ul>

[1] Breast cancer in men. Centers for Disease Control and Prevention.

[2] Breast cancer recurrence: Statistics, symptoms, and more. Medical News Today.

[3] Breast cancer recurrence: Symptoms &amp; treatment. Cleveland Clinic.

[4] Yuan Yang a 1, a, 1, et al. Predictors and trajectories of fear of cancer recurrence in chinese breast cancer patients. Journal of Psychosomatic Research.

[5] How breast cancer can affect mental health

[6] Dinapoli L, Colloca G, Capua BD, Valentini V. Psychological aspects to consider in breast cancer diagnosis and treatment - current oncology reports. SpringerLink

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