The hardest part of my job is telling a patient and her family that the biopsy showed cancer.
The initial reaction is usually disbelief: Did the lab mix up my specimen?
Sometimes the patient experiences anger at the doctor, the hospital or their partner. But always there is a tremendous fear--a fear that is palpable in the room.
"Am I going to die?" is sometimes articulated, but always felt.
The family fears losing her and she fears losing everything.
After the initial shock wears off, the first thing I tell the patient and her family is that breast cancer is no longer an automatic death sentence. Most patients with early breast cancer are cured and the majority of these women can be treated without mastectomy and even without complete lymph node removal.
"The emotional aspects of this disease can be harder to deal with than the physical ones. Cancer is a family diagnosis," says Nancy Fawzy, director of the Psychosocial Program here at the John Wayne Cancer Institute. "Everyone who cares about the patient is going to be affected in some way. There are many stages and phases that the entire family will go through. . . . [It may] take a year for things to get back to 'normal.' "
There will be many good days within that year, but dealing with the physical and psychological impact is much easier if the patient and family work together. Gathering information, talking about what is going on, and attending psycho-educational support groups have all been shown to be very helpful.
Along with the diagnosis and treatment of cancer come a whole range of negative emotions. These include anxiety, depression, anger, sadness, hopelessness, and helplessness or lack of control.
Both research and clinical experience now tell us that people who repress or suppress these feelings do not do well psychologically and even clinically. Conversely, those patients who first acknowledge that they have these negative emotions, accept them as perfectly normal given the situation, and then appropriately express them, seem to have a much better quality of life and may be better able to cope with their disease.
What are ways to appropriately express negative feelings?
Crying is one method that may actually be good. Think of it as nature's emotional washing machine. The crying will stop, and then talking with someone about feelings is helpful.
The listener does not necessarily need to do anything about the situation; just providing a shoulder to cry on, a hand to hold and nonjudgmental listening are tremendously helpful.
Keeping a journal of what is going through one's mind may also help.
The bottom line is that thoughts and feelings kept bottled up inside will serve as major stressors that can affect the emotional state and may, in turn, negatively affect the immune system and other critical physiological functions that affect health outcomes. Expressing these feelings is an ongoing process.
The one thing that patients and family members should not do is try to protect each other by keeping all their thoughts and emotions to themselves. This conspiracy of silence does not work and is more often an added emotional burden for everyone to carry.
Cancer is a chronic disease that the patient will need to be vigilant about for the rest of her life. Doing everything in her power to improve her odds of not having a recurrence is critical.
This involves following the medical treatment plan, eating a low-fat, high-fiber diet with fresh fruits and vegetables, exercising regularly, improving coping, managing stress and stopping smoking.
Breast cancer is not a death sentence. Women can live long and happily after being treated.
Any treatment plan for early breast cancer must consider quality of life because it is likely to be a long one.
Giuliano is chief of surgical oncology at the John Wayne Cancer Institute at St. John's Hospital, Santa Monica.
Next week: Giuliano examines diet and breast cancer.