Breast Cancer: The Physical and Mental Effects

Cancer. Whenever people think about cancer they only think about the disease, the growth, and the tumors. What society fails to see is the victim behind the disease. People are always so concerned about “curing” the disease the victim of cancer is forgotten. Treating the disease has become more important than treating the patient and their innate needs as a human. In breast cancer patients’ treatments such as chemotherapy, and locoregional therapy cure the cancer but there are physical and psychological side effects that are not “cured” at the same time and can have lasting effects on a breast cancer patient’s life.

One common treatment for breast cancer is chemotherapy. Several chemotherapy drugs have been in use since the 1960’s. Combination chemotherapy became the standard treatment, which means multiple chemotherapy drugs are given to the patient at a time. The main drugs used are cyclophosphamide, epirubicin, fluorouacil, methotrexate, mitomycin, mitozantrone, doxorubicin, docetaxel, and gemcitabine. Chemotherapy can be used before or after surgery. Getting it before surgery can make the tumor smaller which can mean less surgery, for example only having the tumor removed instead of a full mastectomy. Chemotherapy can be used after surgery for multiple reasons such as the cancer cells were high grade, or more commonly, if there is a possibility that the cancer spread to other parts of the body. In this case, chemotherapy is used as a preventative measure to reduce the chances of the cancer coming back.

Some chemotherapy drugs are taken orally, but most are administered by IV. The treatment is administered in cycles. One cycle typically consists of one to five days of taking the drugs, then a break for three to four weeks, another few days of drugs, then a break. A typical course of treatment contains up to eight cycles and will take up to eight months. However, more courses could be recommended based on the type of breast cancer, and the combination of drugs used.

Locoregional therapy, which is a therapy that is restricted to a localized region of the body, is most commonly used as a treatment for Breast Cancer in the form of the mastectomy. With a mastectomy, partial or the entire breast is removed due to the cancer mass. This wasn’t always the best option though. “For almost a century, the Halsted radical mastectomy was the standard surgical treatment for breast cancer. Women receiving this treatment suffered terrible cosmetic deformity, with loss of arm function through resection of the pectoral muscles, high risk for lymphedema as the result of extensive axillary nodal dissection, and significant pain and tightness across the chest wall.”(Ganz) New locoregional therapy has developed into using radiation in the localized region to take care of the mass without having to remove the breast issue. It was less invasive, but recently, there was an increase of mastectomies because there were changes made to the techniques that have less side effects. “The recognition of the biologic significance of locoregional recurrence as an indicator rather than an instigator of increased risk for distant disease was an important step in better understanding breast cancer biology with significant clinical implications. “Systemic chemotherapy at the time of locoregional recurrence was formally evaluated in a recent randomized clinical trial that demonstrated significant improvement in disease-free survival and overall survival for this poor-prognosis group”(Wiernik). With this therapy, there is less effect on the rest of the body, but there are still major side effects, as with any therapy.

There are so many ways to treat cancer. But in every form of treatment, there are a lot of side effects. From chemotherapy and radiation, patients have to endure painful and tiring side effects of their treatment. Some chemotherapy drugs, since they are composed of chemicals, can cause nerve and muscle damage or fertility problems. It can also cause hair loss, easy bruising and bleeding, infection, anemia, nausea and vomiting, appetite changes, constipation, diarrhea, skin and nail changes such as dry skin and color change, urine and bladder changes and kidney problems, weight changes, problems with concentration, mood changes, changes in libido and sexual function, and mouth, tongue, and throat problems such as sores and pain with swallowing.

Radiation can give patients some of the same side effects as those of chemotherapy. Some of the side effects can show up during or after the treatment. Some can show up years or months later. Some may or may not be permanent. If the treatment for the breast cancer is to get a mastectomy, there are the physical side effects of the pain from the surgery itself. When you get a mastectomy, even a double mastectomy, you still might have to go through some of the other forms of treatment such as chemo and radiation. The cosmetic changes in the breast(s) that result from surgeries such as mastectomies have many long term effects from this can influence one’s psychological health.

The devastating physical effects of breast cancer are more so known than the psychological implications. Cancer in general has many psychological effects regarding the patient’s understanding and ability to cope with the disease, the prognosis, as well as the complexity and options of treatment (Ganz, pg 1). Cancer often brings psychosocial distress (Ganz, pg 2). However, breast cancer, due to the sometimes-traumatic transformation after life saving surgery, can have very detrimental psychological impacts. A patient’s social identity and self-concept often shift completely (Your Body After Breast Cancer Treatment). Women who have survived breast cancer after having a mastectomy or some kind of reconstructive surgery often experience a shift in body image and a change in self perception of their own sexuality (Ganz, pg 1, 2). Social Identity theory is defined as a “person’s sense of who they are based on group membership” and often times women feel that they lose their sense of femininity and by result their sense of identity (McLeod).

The ways to cope with the sudden dramatic changes from the lifesaving surgery can be confronted through counseling, support systems to improve one’s psychosocial health, and with help from one’s doctor (Your Body After Breast Cancer Treatment). The sooner the patient comes to terms with the changes due to their treatment the better their long term healing and understanding will be. Body positivity is an important coping mechanism as well. It is important to remain cognitively positive when overwhelmed with the negative changes that occur. Focusing on three things you like about yourself before examining oneself after the surgeries will help to increase one’s own image (Your Body After Breast Cancer Treatment, pg 1). For patients that have difficulties coping with or coming to terms with their new appearance and therefore their new self concept or identity, often feel more comfortable exploring breast reconstruction surgical options in an attempt to retain their previous self image (Your Body After Breast Cancer Treatment, pg 1 & Ganz, pg 1).

In the final analysis, women with breast cancer are defined more than by the disease they have. They can be cured from the growth, from the tumor, from the cancer but are not cured from the other physical and psychological long term side effects of the cancer. The breast cancer patient is victimized by societies inabilities to realize the cure is well beyond the tumor but instead the healing is more psychological from the change in identity and body image the patient once had.