Every year, in Portugal, 6,000 women are diagnosed with breast cancer, according to data from the Portuguese League Against Cancer. When detected at an early stage, 70 percent of the cases are treatable, but “studies show that most patients can not stop thinking of the diagnosis as a death sentence. Today, fortunately, breast cancer treatments offer the possibility of a cure in many cases and a very high survival rate of many years, “said Luzia Travado, president of the International Society of Psycho-Oncology.
In the International Month of Breast Cancer, which is marked annually in October, with the contribution of several specialists, Prevenir brought together, over several pages, emotional and lifestyle tools that, along with advances in science, Help the woman and her family, build the resilience necessary to face and be stronger than the disease. An imperative that is always current against that which is one of the pathologies most women fear.
The answers to the doubts that arise after the diagnosis
Luzia Travado, a clinical psychologist specializing in psycho-oncology, explains how to share and emotionally manage the news. These are the answers to some of the main questions women face at this stage:
What is normal for a woman to feel when she knows she has breast cancer?
Initially, it is in shock because it is an unwanted, unexpected event and a threatening territory. Then comes fear (a normal reaction to a threat) and anxiety, which are also influenced by what the woman has experienced in the case of relatives or friends who have had cancer.
The woman feels between life and death and questions herself. Will I survive, will I be able to bear this? And now? My children? My husband? I did not want to be doing this to my family … It is also normal to feel revulsion, especially in the case of the younger patients. But the great problem is to make a catastrophic elaboration of the disease.
– What can help overcome shock, fear and anxiety?
First of all, the person must know and understand the framework and stage of the disease in his case. Most patients are diagnosed at an early stage, which gives them the maximum expectation of survival and cure. For someone who knows nothing about the oncological disease and may be thinking that they are doomed to die, having a sense of the actual facts of their case is essential to resize the news.
The medical team should help her realize that, yes, she has a diagnosis, but she also has a treatment plan and there may be a solution. It is essential to prepare it for what follows and the woman should clarify her doubts, because it gives security and helps to reduce the negative imagination: those who are afraid and are not informed ends up imagining what they do not have, creating suffering.
– Should you have specialized psychological monitoring?
Specialized psychological support is justified whenever there is persistent psychological suffering. For example, in the case of women who are very much attached to the idea of catastrophe (they always feel threatened), psychological counselling helps to rationalize and correct this thinking that causes and increases suffering but whose information is skewed because, In fact, the likelihood of everything going well is higher.
It is necessary to reduce this thought to its real probability, which is achieved through techniques whose effectiveness has already been proven. In other cases, the woman may think that she will miss the opportunity to do everything she wants and that it is not worth doing projects, and neglecting her life. In these situations, it is important to help the person to be focused on what they have lost and to focus on what they have.
Psychological treatment is not a luxury accessory in oncological treatment, but rather a necessity because it also has an impact on the clinical results of the patients. Ten-year studies of women with breast cancer showed that women in depressive states of despair and loss of hope were less likely than women to adapt to the problem.
A person who accepts and adapts, who sees adversity as a problem that has a solution and not as an overwhelming mountain, has a much better quality of life than that which is blocked and does not or does not believe in anything.
See the next page: What is essential for the family to do?
Should the family also have psychological counselling?
Yes, in particular, the husband, because it is one of the main factors of psychological balance for the woman. It is necessary to make him feel part of the team, to give him an opportunity to expose his worries, his suffering, his doubts, to perceive the work that will be done and to encourage him to be a co-therapist. He also has to have someone to help him, so he does not feel alone.
– What is essential for the family to do?
First, accompanied the woman to the consultations. It is necessary for a family member, namely the husband/partner, to keep abreast of clinical information so that he can understand the plan of care and care and help the woman to remember the good parts of what the doctor said. Because it often happens the person, from the moment he hears that he has cancer, stops listening to what the doctor says.
The relative can help to dedramatize, to focus the patient on the positive data. First, you have to empathize with the patient, then say, “Yes, you’re going to have a hard time, but let’s live and get through this together. I will help you to overcome, in whatever is within my reach. ”
“Should the children be told?”
Yes. Parents think that when they do not tell, they are protecting their children, but the best option is to share what happens, because even if there are no physical changes, the children know and are sensitive to them, eventually realizing That something is not right. They may be insecure and think that the problem they feel is their fault.
“How do you break the news?”
The news is not shared, the information is shared. It goes without saying that the mother has cancer, this is an option for each family, but the information must be shared with a language appropriate to each age. If it is a small child, say “Mom is sick, she had to go to the doctor and she has to get treatment.” In the case of adolescents, they often ask if it is cancer and if the mother is going to die.
One must assume that it is cancer and find out why they ask this. It is usually due to the fact that they know the history of someone who had the disease. It is important to know the outcome of this case and, if the person has died, it is necessary to distance the idea and to mention that the mother is in treatment so that this does not happen to her.
In addition, it is important to tell the children that their help will be needed and how to help. The most important thing in the family is sharing and helping each other and knowing what they can do, what their role is because it gives them security and control.
– Is it important to tell friends?
Yes, but it is not necessary to do so as soon as the diagnosis is known, and it is also convenient to know to what extent this sharing of information is useful, because when we do, we are saying to the other, “You are important to me, I am sharing this information with you. ” It is a responsibility because when we tell the other, we also need to know if we are in a position to receive this information.
– Is there care when sharing information with parents?
We have to take into account if we are the caretakers of them and to what extent the fact that they know what is happening can be more pernicious. But overall, especially if they are in good health, it is important to know, because there is nothing better than the support of mother and father.
– What should be the relationship with the doctor?
Empathy is necessary because, if it does not exist, there will also not be the confidence necessary for the woman to face a set of treatments that, from the outset, are difficult. If it is the case, it will be preferable to seek another doctor. However, it is also important not to forget that the relationship with the specialist is bilateral. That is, the woman must be a proactive patient, you have to ask the questions that you want to be answered. You also need to help the doctor to get what you need.
See the next page: The answers to the doubts that arise during the treatments
The answers to the doubts that arise during the treatments
How to deal with the changes and effects caused by treatments on a physical and emotional level, according to Luzia Travado, a clinical psychologist who advances with recommendations that are crucial at this stage:
– What changes on a physical level due to treatments?
It depends on the treatments. In the case of chemotherapy, in addition to nausea, malaise and tiredness, the most visible effect is hair loss. Radiation therapy produces a feeling of tiredness. Hormone therapy has more discrete changes, but in the case of younger women, it has a great impact, since it causes an early menopause and all associated effects such as hot flashes and sexual changes.
In the case of surgeries, fortunately, nowadays, most retain the breast. A tumour is removed, but the breast is preserved, which, from the point of view of self-image, is less aggressive than when the breast is completely removed (mastectomy). In these cases, there may or may not be reconstruction, depending on the woman’s will.
– And, in emotional terms, what are the changes?
It varies greatly depending on the pace of treatment. There is more irritability, more anxiety; The woman is worried about the future, which leads to fear. She is sadder because she can not have a normal life because she can not do everything she likes or not pay attention to her children.
Often, when children are young, they have a hard time being with them because they tire more easily. And there is a great impact on self-esteem because there is a certain loss of self, the feeling of femininity, of attraction. But the woman can learn to manage better and to dedramatize all this, by itself or with psychological help.
Can a woman work during treatments?
Generally speaking, it is very difficult to carry out any activity with demands and schedules. The pace is generally slower. You need time to rest and take care of yourself and time to get distracted by activities you enjoy. After the treatment, the woman needs about three months to recover from the effects that result from it, such as fatigue or difficulty concentrating and memory.
When returning to work, there is a great need to have a flexible schedule, with less workload and it is important that the employer has the flexibility to do so. Often the patients themselves want to go back to work sooner, but because they know they do not have the capacity to do all the work, they postpone this restart, which is counterproductive.
– What changes in sex life?
From the moment of diagnosis, a woman’s desire is affected and the treatments themselves have a direct impact on sexuality. For example, in many cases, hormones need to be suppressed, which causes women to enter menopause early, which affects the libido and causes vaginal dryness.
It depends on each woman and her partner, but in general terms, it is possible to recover with active help from the partner in a reinforcement of intimacy, complicity between the two, dialogue and an extra dose of affection, and a strong desire on both sides to overcome the problem.
See the next page: How can the husband help?
“On a daily basis how can the husband help?”
It should offer help on practical, logistical, home and parenting issues. But it is also very important that you help the woman emotionally, especially when she is sad. Men tend to solve situations in a very pragmatic way, stopping to show affection, but in those moments, it is first necessary to be affectionate, to empathize, to comfort, and then to talk about the most practical issues and solutions.
It is important for the husband to recognize that the woman is going through a phase of suffering, to make her feel loved, to embrace her, and to give her hope, saying, “I am with you and we will overcome this together.” Only, after these steps, when the woman is already appeased, the husband can then remind him of everything he will do in his favour in this situation.
“And what can a woman do to keep her relationship strong?”
There must be recognition of the performance of the husband/partner. It is necessary to praise and thank her for her dedication, for accompanying her in the consultation or treatment. What is sadder for someone who does this is not to be recognized.
The two have to continue to do what they know best, which is to love themselves. If sexuality can be compromised, intimacy should not be. So paying attention to the other’s things, asking him how the day went is important to him, and also a way for the woman to decentred from her problem.
– How to prepare and how to deal with hair loss?
First of all, you should know when this is expected to happen (usually from the second chemotherapy session) to begin to internalize and prepare for the timing. Above all, women with young children choose to choose a head of hair. Other patients feel free enough to take on this phase and wear hats or scarves (in terms of protection from cold and heat this is also important).
In the case of those who have very long hair, it can help to cut the hair, even because long hair wigs are more difficult to maintain. It also helps the partner tell the woman that the changes she is undergoing have no bearing on her affection for her and how he thinks she is beautiful.
“And, emotionally, how can you prepare a woman who will undergo a mastectomy?”
Thinking that this is a lesser evil against a greater good, thinking “I change my breast for my health” and realizing that the alteration that will suffer will allow keeping most of the self-image intact, that only a small part has been altered. Do not overrate the chest. And later, learn to love that scar just like a war hero who displays his.
See the next page: Doubts arising after the end of treatment
The doubts that arise after the end of the treatments
Luzia Travado, president of the International Society of Psycho-Oncology, indicates ways to face the future once the treatment stage is over. These are some of the answers women need most at this time:
“Why do you say that the five-year period after the treatments is the most delicate?”
This is related to the likelihood of relapse [reappearance] of the disease in the first five years. Let’s say that the patient is in greater vigilance so that, whatever happens, it will be dealt with soon. Nowadays, this period is more called into question (it is longer), but the patients have kept these five years in mind for a long time, even because the side effects, such as tiredness, can still be felt at that time.
From the psychological point of view, it is normal for this phase to be more fragile, for fear that the disease will return. About 50 percent of women with breast cancer have severe psychological distress, with 20 percent having a tendency to have depression and 30 percent suffering from anxiety.
For these patients, psychological counselling is fundamental as a way to reduce this suffering and to return the possibility of optimizing patients’ quality of life and well-being so that they can resume their normal active life in fullness and with satisfaction. Unfortunately, health institutions still invest little in integrating psycho-oncological care into the treatment of the patient, something that has to change.
– What advises a woman not to feel stuck to the thought that cancer can come back?
That you make your life as normal as possible, that you do regular physical exercise, that you find time for it, to do things you enjoy, to be with your friends and to view life as a precious asset that happens every day, taking That the important thing is what happens today. We can not be thinking about tomorrow or else we lose what we can do and live today. If a problem arises, then, at that point, it will be solved.
– Does the frequency of support groups at this stage help?
Support groups managed by patient organizations can be an interesting resource, but women must be willing to go. Often they do not want to hear about other cases because it implies empathy and they are very focused on their own.
Following treatment, at a time when the woman has already improved her experience, it may be useful to have group therapy managed by a specialized professional who will evaluate the type of group that best suits the woman (depending on the clinical stage and Of the person’s emotional state). This group experience allows her to see that she is not alone and that there are other women who have had the same difficulty, which is very comforting.