April 2017 Ask the Expert: Breast Cancer and Your Emotions
Being diagnosed with breast cancer can turn your world upside down. Many aspects of having cancer, including treatments and their side effects, telling people about your diagnosis, and financial worries can be emotionally overwhelming.
In April, Living Beyond Breast Cancer expert Hester Hill Schnipper, LICSW, BCD, OSW-C, answered your questions about breast cancer and your emotions, like how complementary therapies can help you feel better, how to talk to family and friends about what you’re going through, when to see a mental health professional and how to find one, and more.
Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare provider because treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counseling or medical advice.
I am so glad you asked this question, as it gives me an opportunity to promise you that NO, stress and anxiety and anger and sadness and any other “negative” emotions won’t make one bit of difference in your cancer health. Of course those feelings impact your quality of life and can result in some difficult days, but your mood will never make a direct impact on a cancer cell.
I am aware that many people will tell you otherwise, and that you can read lots of books or articles in the popular press that suggest that emotions can make your cancer worse. Don’t believe it. Ask any of your doctors, and they will give you the same reassurance.
Talking with our children about our cancer is one of the most difficult parts of the whole experience. The short summary is that you need to be always honest and to give them age-appropriate information. Clearly, you tell a 5-year-old something different than a 15-year-old. Use the real words – cancer, not a boo-boo. Your child will overhear your conversations, and it is more unsettling if the language does not match. Remember that children are excellent observers and terrible interpreters of what is going on around them. Be clear and specific.
This will be more than one conversation. Think about it as being similar to discussing sex with your kids. You raise the topic and give them the necessary information for the moment. Then you come back to it as necessary. This way, you have indicated the topic is open and acceptable. As time passes, mention the cancer in casual conversation: “I am having a check–up with my cancer doctor today” or “I am really dreading the next chemo as I know I will be tired for a few days and not able to do everything with you that I would like to do.” The more that cancer can be just one more detail of your family’s life, the more comfortable it will be.
If you have early-stage disease, there is one very helpful statement that I always recommend. Tell your children: “This is not the time to worry. I promise that if the time ever comes, I will tell you.” Then, if the day does eventually arrive when you must talk about advanced illness, you must talk with them then. For now, the worries can stay with the adults.
The basic rules about giving children honest, age-appropriate information apply here, too. With a diagnosis of metastatic disease, the first explanation can be something like: “We had really hoped that the cancer was gone forever. But it has come back, and I need to start treatment again.” For some kids, that will be enough. Some women do well with oral hormonal or targeted treatments for a long while, and family life may not seem very different to the children. It is reasonable to say that you will always be on treatment, and that the cancer will be part of the rest of your life. As time passes and the cancer becomes more prominent or treatments become more difficult, it will be necessary to say more.
The hardest moments are answering a question like: “Mommy, are you going to die?” or needing to tell children that the end is in sight. Being honest, using real words, and reassuring them that they will be loved and cared for become vitally important. I work with a lot of women who lost their mothers to breast cancer and now have the disease themselves. Those who were included in their mothers’ illnesses, who had a chance to talk about it and to help in her care (even with little things like getting a cup of tea or rubbing her back) did best. Women who were never honestly told that their moms were dying until, suddenly, they were in the hospital or were gone, struggled for much of their lives.
When the time has come to worry, tell your children. Love them, include them, talk with them, and encourage them to also talk with other trusted adults.
It would be unusual to have paralyzing anxiety a decade or more later unless there have been recent triggers. If an old cancer buddy has just died or you are worried about a pain or symptom or it's the day before an annual mammogram, the anxiety may come roaring back. If, years later, you are worrying daily, awakening with cancer anxiety, or feeling impaired by these concerns, it is past time to find the right therapist to help you settle the fears.
Most insurance policies cover mental health, but there is a great deal of variability in the coverage. Most companies require that you meet with a therapist who is on their list of approved providers. There likely will be a dollar limit to the coverage, and there will be a copay for each appointment. Your insurance company can give you a list of approved social workers, psychologists and psychiatrists. When you are making the important choice of whom to see, think first about competence, but factor in geography/convenience. Therapy is supposed to make your life easier, not add another challenge. Always ask a potential therapist about his/her experience in working with people who have had cancer. You want someone who is knowledgeable and comfortable with your issues.
A good support group can be the most helpful source of healing and recovery. In addition to finding a group that meets at a time and place that is possible for you, ask about the facilitator. You want someone who is experienced with cancer support groups and issues. I worry about peer-led cancer groups, as feelings can become very overwhelming unless someone knows how to manage them. Ask who attends the group. Some support groups are very specific, catering only to women who have completed active treatment or women living with stage IV (metastatic) breast cancer, and some are diverse. I lean toward recommending people find groups with similar experiences to them, but finding one may not be possible. You do want to attend a group whose membership feels comfortable, not scary, to you. When you have made a choice, commit to attending at least twice as the first meeting might be unusual for unknown reasons. After going twice, you will know whether or not the group is a good fit.
I suspect that all of us have had that reaction after a funeral. One immediate suggestion is to try to normalize your feelings. Of course death feels more possible when we have had a cancer diagnosis, but plenty of healthy people feel the same way after a funeral. Per the old saying, no one leaves this world alive.
A little time generally helps, too. If after a week or two, you are still experiencing this sense of doom, it may be time to start talking about it. Begin with your family or a trusted friend, and tell them that you don’t want reassurance, and you don’t want advice, you just want them to listen. Saying the words aloud and sharing your fear usually diminishes the intensity of the feelings. If not, this could be a good time to find an experienced therapist. It is possible that the funeral has stirred up feelings that you had been repressing or denying. They were bound to surface some time, and you will feel better once you begin to process them.
These are excellent and important questions. There have been some studies that suggest that certain antidepressants may reduce the effectiveness of tamoxifen. If you are taking tamoxifen, it will be important to tell your psychiatrist or other prescriber so other equally good medicines can be chosen to treat your depression.
Otherwise, there are no connections among cancer drugs and medicines used to treat depression and/or anxiety.
Isn’t it nice that the answer is “no”? It makes no difference if you run or work out at the gym or play tennis or swim. If the activity is enjoyable, it probably will help even more with your mood. If it feels more like exercise and less like having fun, the endorphins may still improve your mood. I think it also helps that we generally feel physically better when we engage in regular mild to moderate exercise, and we surely can be proud of our self-discipline and motivation.
Everyone feels sad about cancer. I would worry much more about anyone who didn’t! It can be tricky to tease out the differences between a normal human reaction to a cancer diagnosis and a depression that may be helped with medicines. Beyond the expected sadness and worry, feelings of hopelessness, despair, an inability to enjoy family, friends or activities, and changes in sleep, appetite, energy, and concentration may signal depression. If these feelings persist for more than 6 weeks or so, and if they are preventing you from enjoying life, it is time to talk to a therapist.
A good common sense rule is this: If you think you may be depressed, get help. I usually find that my patients can diagnose themselves very accurately.
A major benefit of talking to a therapist who is experienced with cancer patients or survivors (and finding such a therapist is an absolute necessity) is that you don’t have to censor your words or feelings and you don’t have to worry about the therapist's feelings. People with cancer know that their family and friends are upset, too, and I often hear that everyone is so busy protecting everyone else that no one is speaking freely.
The right therapist will normalize your experience, share strategies that have helped other people, and help you consider your own best ways to move forward with your life.
In addition to being sure that your therapist has experience with cancer issues, it is important to just plain like him or her. The relationship itself is very important.