Managing emotional side effects

These are completely normal responses to what’s really an abnormal situation! No one plans on getting breast cancer, and it can be emotional to try to process all the information coming at you. And sometimes, treatments themselves can cause emotional side effects.

The experience of diagnosis and treatment can feel overwhelming, and there may be times when you feel unable to cope. For some people, constant concerns about cancer, treatments, survival, or family can interfere with daily life. The mind can go into overdrive, revisiting the same thoughts over and over and making it hard to concentrate or sleep.

On this page, you can find guidance for recognizing feelings as they come up, and strategies that can bring a greater sense of control.

Depression and anxiety

As you go through diagnostic tests, appointments, and treatments, it’s not uncommon to feel anxious. For some people, feelings of depression can arise. It can help to recognize these feelings if they come up and let your healthcare team know.

Anxiety and depression are very common responses to a cancer diagnosis.

• Anxiety is a stress response of fear and uneasiness.
• Depression can be a combination of sadness, despair, and loss of energy that interferes with daily life.

Many of the symptoms of anxiety and depression are directly caused by treatment. They may also point to an underlying anxiety or mood disorder. Knowing the difference can be challenging, but your care team will be able to help.

Anxiety can include the following symptoms:

• You feel as if you are in a constant state of nervousness, tension, or worry.
• Your worries shift from one problem to another.
• You have trouble managing your worries and concerns.
• You feel restless, keyed up, or edgy.
• You feel fatigued or become tired easily.
• You have trouble concentrating.
• You feel irritable.
• You have trouble falling or staying asleep or wake up feeling as if you have not slept well.

A person does not have to have all of these symptoms to be diagnosed with an anxiety disorder.

It’s also understandable if you feel sadness about cancer and treatment. Some people feel as though they will always be stuck where they are, that certain parts of breast cancer and treatment will be constants in life. Sleep cycles can be affected, too. It’s not uncommon to have trouble sleeping, or find yourself sleeping too much. In day-to-day life, feelings of irritability, impatience, or numbness can happen.

Not all people who feel sad are depressed. If thoughts and feelings of sadness begin to interfere with your daily life, a trained mental health provider might diagnose depression. Some people have major depression during the course of treatment. Different from a few days of feeling down or blue, major depression means that sadness lasts for weeks or months, interfering with daily quality of life. If you feel this way, talk with your doctor or a therapist to find out if counseling or medicine may be right for you.

Symptoms of depression include:

• Continued sadness, depressed mood, or crying
• Trouble getting motivated
• Loss of interest in favorite activities
• Feeling guilty, hopeless, helpless, or worthless
• Inability to feel pleasure or have fun
• Fatigue
• Sleeping too much or too little, or trouble falling or staying asleep
• Lack of energy
• Change in appetite
• Less interest in sex or intimacy
• Problems with concentration
• Thoughts of death or suicide

A person does not have to have all or most of these symptoms to be diagnosed with depression.

As you move forward, uncomfortable feelings will probably come and go, and then later lessen, and eventually pass. This may not always be the case, so it’s important to recognize when your reactions are normal and when they may be more intense than you might expect. Depression and anxiety can be serious medical conditions, but they can be effectively treated.

Strong feelings of depression or anxiety are not the only reasons to talk with someone. Talking about more mild sadness or worry can also be helpful. Let your care team know how you feel. They can help you find support and treatment if you need it.

Just seeking help for overwhelming emotions can bring feelings of empowerment: You’re doing something about it. That takes courage and strength.

Emotional effects of breast cancer treatment

Once treatment begins, it’s normal to have a range of emotions. Maybe on some days you’re feeling sad or anxious, or on other days, quiet and resolved.

People have different ways of responding emotionally as treatment progresses. Some people loudly celebrate the end of a treatment phase. Others close a treatment “chapter” from a more reflective, quiet space. Worries about the future, side effects, or what it means when you finish treatment may be on your mind. Getting the information you need, when you need it, can help you feel stronger and more confident.

As you begin treatment, it’s important to know that many breast cancer medicines cause side effects that can feel like stress, anxiety, or depression. Some treatments directly affect your emotions, while others may impact sleep, desire for food or sex, and other things that could put anyone in a bad mood. Understanding the source of any negative feelings can help you and your care team know how to treat them.

Surgery-related feelings

Surgery for breast cancer can include lumpectomy, mastectomy, and breast reconstruction, including surgery from donor sites in other parts of the body. Surgery can also include lymph node removal and, for some, removal of the ovaries to reduce the risk of future cancer. When you’re facing, undergoing, and recovering from breast surgery and surgery on any other parts of your body, it’s completely normal to have a lot of emotions, some of them intense.

Surgery itself can result in pain and fatigue; anesthesia and pain medications can cause nausea or may make you feel foggy. Your body needs time to heal after an operation, and it’s working hard to do that. Rest, good nutrition, and gentle activity will help you heal more quickly.

If you’re facing lumpectomy or mastectomy, it can help to know that everyone has their own thoughts and feelings about what their breasts mean to them. Your breasts could be important to your self-image or how your partner responds to you and to your sexual life. Or, they might mean little to you at all.

However you feel about your breasts and the rest of your body, it’s important to address any physical or emotional pain you feel about surgery. Surgical changes in a breast or loss of a breast can trigger feelings of grief. It’s normal and OK to feel sadness about changes or loss of this part of yourself. Talk with your healthcare team about your concerns.

It can also help to share your feelings about surgery with people close to you. Loved ones’ support and acceptance can relieve some of the pressure. Sometimes we imagine that others will feel differently about us if anything at all changes on our bodies. In reality, those who love us often still care for us inside and out, no matter what kind of surgery we may have had.

If you’re having difficulty with feelings about surgery, contact the Breast Cancer Helpline at (888) 753-5222 or sign up online for a match with one of our trained volunteers. Our volunteers have personal experience with breast cancer and understand how you’re feeling.

Feelings that can come up during radiation therapy

Fatigue is common with radiation therapy and may affect your mood. As treatments continue, fatigue can increase. This fatigue is due to treatment itself, but it can also be related to having to go to radiation therapy appointments every day for several weeks. If you must travel far for treatment, you might feel more tired and drained than you normally would. Just the stress of daily travel and treatment can be exhausting.

Treatment-related fatigue feels very different from regular tiredness. It can come on quickly and exhaust you. Even after a good night’s sleep, you may not feel rested.

Radiation therapy may cause changes in the shape, texture, and size of your breast or in the skin, and this can be distressing. Know that your radiation oncologist and oncology nurses can offer you treatments to help soothe skin irritation and prevent certain side effects. Treating them early may help you feel better physically and, in turn, emotionally.

Chemotherapy and your feelings

Chemotherapy is given to kill cancer cells that are growing or dividing quickly. Both chemotherapy itself and some medicines taken with it can affect your emotions. Some people feel moody or sad while taking chemotherapy. Steroids, often given with chemotherapies to protect you from allergic reactions, can make you feel jumpy, overly energetic, annoyed, angry, or anxious. Steroids can also affect your sleep.

Other side effects of chemotherapy indirectly affect mood:

• Fatigue. Like other breast cancer treatments, chemotherapy can cause or worsen fatigue. The constant tired feeling and lack of energy for activities can be frustrating. Make sure to plan ahead and pace yourself. Schedule your days so you won’t be overwhelmed and can take frequent breaks. If family or friends offer to help, let them, even if it is just giving you a ride to the store.
• Chemobrain. Some people report experiencing chemobrain, or problems with thinking, short-term memory, and concentration. You might forget why you walked into a room or discover you can’t recall what you need at the store. Being forgetful can cause frustration, anger, fear, and disappointment. Keep lists of things you want to remember, or put sticky notes in places you can’t miss, such as the bathroom door or next to the phone. Try setting a reminder for yourself on your cell phone. If you’re willing, let family and friends help with some tasks you can afford to forget right now. Do one task at a time and focus on things important to you.
• Weight changes. It is also common for people to gain or lose weight during chemotherapy treatment. Try to not be hard on yourself if this happens. Weight gain can be surprising or upsetting for some people. Chemotherapy can sometimes cause hormonal changes that make it difficult to keep off weight. Even if you take in the same number of or fewer calories than usual, you may gain weight. If gaining or losing weight has a negative impact on your body image and how you feel about yourself, reach out to your healthcare team so that they can support you. Ask for a referral to a nutritionist or other healthcare professional with experience giving dietary counseling to people with cancer.
• Hair loss. Some, but not all, chemotherapy medicines can cause hair loss or thinning. This can be distressing for many reasons. Chemo-caused hair loss can bring up feelings of deep vulnerability. Some people feel as though they look ill for the first time, or that the cancer is now public and not private. If your hair is a big part of your identity and feeling attractive, losing it can be very upsetting and may make you feel less like yourself. Making decisions ahead of time about how you want to handle hair loss can help you feel more in control:
  • Scalp cooling systems can help you keep most of your hair through chemotherapy. While many report that scalp cooling can be a very involved process, it can be worth it to be able to keep your hair.

    If scalp cooling feels like too much to manage, consider whether you want to use a scarf, wig, hat, or nothing at all. You might also choose to cut your hair shorter a little at a time before treatment so you can get used to the feeling of having less and less hair in small steps. Some people decide to take it further and shave their heads ahead of time as a way to feel more control over what’s happening. Whatever you decide, do what feels right for you.

Navigating changing emotions

If you’re feeling negative emotions that are interfering with your daily life, there are many ways to improve your mood. Always share how you’re feeling with your healthcare team. Your doctor and nurses can work with you to address negative emotions related to treatment or refer you to a therapist, nutritionist, or other professional who can give you more help.

As you undergo treatment, it’s important to recognize when your reactions are normal for you and when they feel more intense than you might expect. Feelings of sadness and worry are normal and do not mean you are coping badly. But if you have intense or frequent feelings of depression, anxiety, distress, or tearfulness, let your healthcare team know as soon as possible.