As family physicians, it is important to consider patients with breast cancer as entire persons with concerns beyond the pathology of their oncologic disease. Being knowledgeable about current breast cancer treatment options can help improve communication between physicians and their patients. In this issue of American Family Physician, Dr. Maughan and colleagues review treatment options for breast cancer and outline how physicians can assist patients by navigating treatment protocols, recognizing adverse effects of therapy, and facilitating care for comorbidities.1
Life with breast cancer is a time of overwhelming choices and uncertainty that is influenced by each patient’s resiliency and coping strategies. Women newly diagnosed with breast cancer are often apprehensive about upcoming surgery and adjuvant therapies, and they may experience psychosocial stressors of breast cancer treatment. Physicians should be proactive in offering care and accepting the unique challenges of providing comprehensive care beyond cancer treatment.2 By extending continuity of care, physicians can further fulfill the patient-physician relationship.
When diagnosed with breast cancer, patients may experience fear that goes beyond personal mortality to include concerns about how the diagnosis and treatment may affect their family and friends. A diagnosis of breast cancer creates a paradox in which women who may characteristically identify themselves as caregivers need to relinquish this role by asking for help from others.3 This paradigm shift creates an internal struggle in patients, who may view it as a loss of autonomy.
Cancer treatment requires a significant amount of time, which many patients feel has been lost to the cancer. The patient’s emotions may shift among feelings of panic, sadness, anger, and depression. Mood swings may manifest as a result of hormonal alterations secondary to ovarian failure caused by chemotherapy. It is important that these feelings are validated and treated appropriately. Patients who have a history of mood or anxiety disorders are twice as likely to develop posttraumatic stress disorder with a breast cancer diagnosis.4
Treatments for breast cancer often cause major changes in physical appearance, leading to feelings of vulnerability in many patients. Expected physical changes include hair loss, breast or chest wall disfigurement, lymphedema, skin texture change, vaginal irritation, decreased bone density, hot flashes, and weight loss or gain. These changes not only affect patients’ physical image, but also may distort some patients’ self-worth. They may feel that their sense of womanhood has been altered and that they need to redefine their life within the limitations imposed by a breast cancer diagnosis.5
These physical and emotional changes also can profoundly affect sexuality and intimacy. Physicians often focus on patient survival and neglect to address quality-of-life issues such as sexuality. The loss of one or both breasts following mastectomy, or the scarring and burns from radiation therapy, may lead many women to feel sexually inadequate. Early menopause from chemotherapy often results in vaginal dryness, loss of libido, and problems with sexual arousal and orgasm. Physicians should engender hope for patients and their partners by encouraging them to communicate with each other and to embrace intimacy through pleasure and togetherness rather than orgasm and intercourse.6 The International Society for the Study of Women’s Sexual Health offers resources that focus on sexual medicine, available at http://www.isswsh.org.
The patient-physician relationship should be centered on mutual respect and healing. Women diagnosed with breast cancer want to be perceived and treated as though they are a part of their health care team. After a breast cancer diagnosis, it is important to encourage patients to self-educate and review patient-centered support materials, such as resources from the Breast Cancer Network of Strength (http://www.networkofstrength.org), American Cancer Society (http://www.cancer.org), and American Cancer Society Reach to Recovery program (http://www.cancer.org/docroot/ESN/content/ESN_3_1x_Reach_to_Recovery_5.asp?sitearea=SHR).