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Emotional support and coping strategies for breast cancer patients

1. Dealing with Emotions

After learning that you have breast cancer, one can feel bad, this should not be the case, there is no right or wrong way to feel. Numerous feelings, such as fear, shock, and rage, as well as disbelief, melancholy, and numbness, are likely to pass through you.

Your feelings could fluctuate hourly or even from day to day. It is usual to experience moments of deep depression followed by upbeat moments. After receiving a diagnosis, the days and weeks that follow can be extremely emotional and difficult.

To cope with this situation, try to do the following:

• Think about how you coped with previous trauma or stress – you could try using these methods again now
• Use your breast care nurse – they can help you understand your diagnosis and treatment options and support you during your treatment and beyond
• Be kind to yourself – it may help to take time to rest, eat healthily, keep active and, when you can, do something you enjoy
• Talk to family and friends about how you’re feeling – you might like to read our tips on telling family and friends about your cancer, in section 4 of this page

• Fear and Worry

It’s scary to learn that you have cancer. You may be afraid or worried about:

• being in pain, either from the cancer or the treatment
• feeling sick or looking different as a result of your treatment
• taking care of your family
• paying your bills
• keeping your job
• dying

Some fears about cancer are based on stories, rumors, or wrong information. To cope with fears and worries, it often helps to be informed. Most people feel better when they learn the facts. They feel less afraid and know what to expect. Learn about your cancer and understand what you can do to be an active partner in your care.

Stress and Anxiety

It is normal to feel stressed about all the changes you are going through in your life both during and after treatment. Many people experience confusion or tension due to things like:

• If tests and treatments will be covered by insurance
• Where to go for emotional assistance
• How to obtain assistance with daily tasks
• How cancer may impact their employment obtaining transport to and from treatment sessions

Your body may not heal as effectively as it should due to stress. Being proactive and discussing difficulties like those mentioned above at the beginning of treatment is crucial.

Sadness and Depression

Many cancer patients experience sadness. They experience a sense of loss regarding their health as well as the life they led before to learning they had the condition. Even after the treatment is over, one can still feel depressed. This is a typical reaction to any severe sickness. Working through and accepting all of the changes that are occurring could take some time.

One can feel exhausted, have little energy, or not want to eat while depressed. These emotions may fade or weaken with time for some people. However, these feelings could intensify for certain people. The unpleasant emotions persist and interfere with day-to-day existence.

Depression can be treated. Below are common signs of depression. If you have any of the following signs for more than 2 weeks, talk to your doctor about treatment. Be aware that some of these symptoms could be due to physical problems, so it’s important to talk about them with your doctor.

Emotional signs:

• feelings of sadness that don’t go away
• feeling emotionally numb
• feeling nervous or shaky
• having a sense of guilt or feeling unworthy
• feeling helpless or hopeless, as if life has no meaning
• feeling short-tempered, moody

If your doctor thinks that you suffer from depression, they may give you medicine to help you feel less tense. Or they may refer you to other experts. Don’t feel that you should have to control these feelings on your own. Getting the help you need is important for your life and your health.

Guilty

If you feel guilty, realize that you’re not alone. Many individuals who have cancer do. Sometimes, people hold themselves responsible for:

• Disturbing the people they care about.
• Having the impression that they’re a burden.
• Missing a day of work.
• Having to pay for the price of cancer treatment.
• Being ashamed of feeling envious of other people’s wonderful health.
• Making decisions that they believe may have contributed to cancer.

Remember that having cancer is not your fault. No one knows why some people get cancer while others don’t. It may help you to share your feelings with someone. Let your doctor know if you would like to talk with a counselor or go to a support group

Cancer is the name given to a collection of related diseases. In all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues.

Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and divide to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place.

When cancer develops, however, this orderly process breaks down. As cells become more and more abnormal, old or damaged cells survive when they should die, and new cells form when they are not needed. These extra cells can divide without stopping and may form growths called tumors.

Many cancers form solid tumors, which are masses of tissue. Cancers of the blood, such as leukemias, generally do not form solid tumors.

Cancerous tumors are malignant, which means they can spread into, or invade, nearby tissues. In addition, as these tumors grow, some cancer cells can break off and travel to distant places in the body through the blood or the lymph system and form new tumors far from the original tumor.

Unlike malignant tumors, benign tumors do not spread into, or invade, nearby tissues. Benign tumors can sometimes be quite large, however. When removed, they usually don’t grow back, whereas malignant tumors sometimes do. Unlike most benign tumors elsewhere in the body, benign brain tumors can be life threatening.

Differences between Cancer Cells and Normal Cells

Cancer cells differ from normal cells in many ways that allow them to grow out of control and become invasive. One important difference is that cancer cells are less specialized than normal cells. That is, whereas normal cells mature into very distinct cell types with specific functions, cancer cells do not. This is one reason that, unlike normal cells, cancer cells continue to divide without stopping.

The cancer burden is rising globally, exerting significant strain on populations and health systems at all income levels. In Kenya, cancer is the 3rd leading cause of death after infectious and cardiovascular diseases. The International Agency for Research in Cancer (IARC) GLOBOCAN report for 2018 estimated 47,887 new cases of cancer annually with a mortality of 32,987.

This represents close to 45% increase in incidence compared to the previous report that estimated 37,000 new cancer cases annually with an annual mortality of 28,500 in 2012. Breast, cervix uteri, oesophagus, prostate and colorectum are the leading types of new cancer cases in both males and females across all ages, with oesophageal cancer being the leading cause of cancer deaths, followed by cervical cancer and then breast cancer.

It is sad to note that 70-80% of cancer patients in Kenya are diagnosed at an advanced disease when it is not amenable to cure. Cancer is a critical global health and human issue. Today, 9.6 million people each year will die from cancer. This number is predicted to almost double by 2030; making it the second-deadliest disease. 70% of cancer deaths occur in low-to-middle income countries. Less than 30% of low income countries have cancer treatment services available (compared to 90% in high-income countries).

Up to 3.7 million lives could be saved each year through resource appropriate strategies for prevention, early detection and timely and quality treatment. Yet, at least one third of cancers can be prevented. This is part of the justification to improve the face of health in our society by creating cancer awareness and early detection through screening and healthy lifestyles modifications towards a cancer free society.

What is Cervical Cancer?

Cervical cancer begins in the cells of the cervix. The cervix is the bottom, narrow end of the uterus (womb). The cervix joins the uterus and the vagina (birth canal). Cervical cancer typically grows slowly over time. Before cancer develops in the cervix, the cells undergo a process called as dysplasia, during which aberrant cells grow in the cervical tissue. If the abnormal cells are not killed or eliminated, they may develop into cancer cells that proliferate and spread deeper into the cervix and surrounding tissues.

KEY FACTS

• Cervical cancer is the fourth most common cancer in women globally with around 660 000 new cases and around 350 000 deaths in 2022.
• Cervical cancer is caused by persistent infection with the human papillomavirus (HPV).  Women living with HIV are 6 times more likely to develop cervical cancer compared to women without HIV.
• Prophylactic vaccination against HPV and screening and treatment of pre-cancer lesions are effective strategies to prevent cervical cancer and are very cost-effective.
• Cervical cancer can be cured if diagnosed at an early stage and treated promptly.
• In Kenya, Cervical cancer contributes approximately 12% of all cancer cases diagnosed in Kenya, and is the leading cause of cancer mortality in Kenya, with an estimated 3,200 deaths every year.

What Causes Cervical Cancer?

Human papillomavirus (HPV) is a common sexually transmitted infection that can affect the skin, genitals, and throat. Almost every sexually active person will become infected at some point in their lives, generally without symptoms. In most situations, the immune system removes HPV from the body. Persistent infection with high-risk HPV can cause abnormal cells to grow, eventually leading to cancer. Persistent HPV infection of the cervix leads to 95% of cervical malignancies if not treated. It typically takes 15-20 years.

Risk Factors for Cervical Cancer

• Multiple sexual partners
• Having sex at early age
• Sexually transmitted infections such as chlamydia, gonorrhea, syphilis and HIV/AIDS

Prevention

Increasing public knowledge and access to information and services are critical to prevention and control throughout the life cycle.

1. Vaccination between the ages of 9 and 14 is highly successful in preventing HPV infection, cervical cancer, and other HPV-related malignancies.
2. Screening begins at the age of 30 (25 years in women living with HIV) and can detect cervical illness, which, when treated, avoids cervical cancer.
3. Regular pap smear tests to detect the cancerous conditions of the cervix after 35 years
4. Safe sexual practices such as using condoms
5. Avoid smoking

HPV vaccination and other prevention steps

As of 2023, there are 6 HPV vaccines available globally. All protect against the high-risk HPV types 16 and 18, which cause most cervical cancers and have been shown to be safe and effective in preventing HPV infection and cervical cancer.

As a priority, HPV vaccines should be given to all girls aged 9–14 years, before they become sexually active. The vaccine may be given as 1 or 2 doses. People with reduced immune systems should ideally receive 2 or 3 doses. Some countries have also chosen to vaccinate boys to further reduce the prevalence of HPV in the community and to prevent cancers in men caused by HPV.

In Kenya, we still have some people and communities in rural areas who continue to link cancer disease to witchcraft. This has negatively impacting on diagnosis and treatment of the disease. Many cancer patients are being lured to take concoctions, herbal drugs, and eating certain parts of rodent species or wild fruits for cure.  

The National Cancer Institute of Kenya through its awareness creation in community level cautions against the myths and misconceptions about cancer which comes at a time the disease has been on the rise among different ages and economic classes.

Cancer is not caused by witchcraft or any form of supernatural forces, it is a disease that can affect anyone, anywhere, in any country, at any time. Cancer is a complex group of diseases with many possible causes.

There are different risks to different people for different cancers. Some cancers are known to pass down families’ hereditary like breast, ovary, colorectal/intestinal and pancreatic cancer; therefore, those who have had a family member who has had such cancer would benefit from screening to assess risk and enable them to take necessary measures at an early stage to prevent cancer.

Other cancers are associated with age, viruses and lifestyle like smoking, stress, alcohol, bad sexual habits and diet for example, lung cancer, skin cancer, throat (nasopharyngeal), cervical cancer, and food pipe (oesophageal) cancer. Also, those with persistent infection with the Hepatitis B or Hepatitis C virus have an increased risk of developing cancer of the liver.

The age could be a contributing factor because the older you are, the more likely that you will develop a cancer. This is probably due to a buildup of damage to cells in the body over time.  The body’s defenses and resistance against abnormal cells may become weaker as one gets older.

Tobacco use can cause cancer almost anywhere in your body. Smoking of tobacco causes almost nine of every 10 cases of lung cancer, it can cause cancer almost anywhere in your body, including in the—

• Bladder.
• Blood (acute myeloid leukemia).
• Cervix.
• Colon and rectum.
• Esophagus.
• Kidney and renal pelvis.
• Liver.
• Lungs, bronchi, and trachea.
• Mouth and throat.
• Pancreas.
• Stomach.
• Voice box (larynx).

The most important things you can do to avoid health risks from cancer are—

• If you don’t use tobacco—don’t start!
• If you do use tobacco—quit!

Regardless of how long you have smoked, stopping can lower your risk of cancer and other chronic diseases. At least 70 chemicals can cause cancer in smoke from cigarettes, cigars, and pipes. When you breathe in that smoke, the chemicals enter your bloodstream, where they go to all regions of your body.

Many of these chemicals can harm your DNA, which controls how your body creates new cells and guides each type of cell to accomplish its job. Damaged DNA can cause cells to grow in ways that are not expected. These atypical cells have the potential to develop into cancer. People who smoke are not the only people who can get cancer from tobacco smoke. People around them—their kids, partners, friends, coworkers, and others—breathe in that smoke, too. Smokeless tobacco products such as dipping and chewing tobacco, can cause cancer, too, including cancers of the esophagus, mouth and throat, and pancreas.

Smoking harms nearly every bodily organ and organ system in the body and diminishes a person’s overall health. Smoking causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum, as well as acute myeloid leukemia. Quitting smoking reduces the risk of cancer and many other diseases, such as heart disease and COPD, caused by smoking.

The risk of premature death and the chances of developing and dying from a smoking-related cancer depend on many factors, including the number of years a person has smoked, the number of cigarettes smoked per day, and the age at which the person began smoking. Quitting smoking improves the prognosis of cancer patients. For patients with some cancers, quitting smoking at the time of diagnosis may reduce the risk of dying by 30% to 40%.

For those having surgery, chemotherapy, or other treatments, quitting smoking helps improve the body’s ability to heal and respond to therapy. In addition, quitting smoking may lower the risk that the cancer will recur, that a second cancer will develop, or that the person will die from the cancer or other causes

Pancreatic cancer is a type of cancer that begins as a growth of cells in the pancreas. The pancreas lies behind the lower part of the stomach. It makes enzymes that help digest food and hormones that help manage blood sugar.

The most common type of pancreatic cancer is pancreatic ductal adenocarcinoma. This type begins in the cells that line the ducts that carry digestive enzymes out of the pancreas.

Pancreatic cancer rarely is found at its early stages when the chance of curing it is greatest. This is because it often doesn’t cause symptoms until after it has spread to other organs.

Your health care team considers the extent of your pancreatic cancer when creating your treatment plan. Treatment options may include surgery, chemotherapy, radiation therapy or a mix of these.

Symptoms

Pancreatic cancer often doesn’t cause symptoms until the disease is advanced. When they happen, signs and symptoms of pancreatic cancer may include:

• Belly pain that spreads to the sides or back.
• Loss of appetite.
• Weight loss.
• Yellowing of the skin and the whites of the eyes, called jaundice.
• Light-colored or floating stools.
• Dark-colored urine.
• Itching.
• New diagnosis of diabetes or diabetes that’s getting harder to control.
• Pain and swelling in an arm or leg, which might be caused by a blood clot.

Causes

It’s not clear what causes pancreatic cancer. Doctors have found some factors that might raise the risk of this type of cancer. These include smoking and having a family history of pancreatic cancer.

Risk factors

Factors that might raise the risk of pancreatic cancer include:

• Smoking.
• Type 2 diabetes.
• Chronic inflammation of the pancreas, called pancreatitis.
• Family history of DNA changes that can increase cancer risk. These include changes in the BRCA2 gene, Lynch syndrome and familial atypical multiple mole melanoma (FAMMM) syndrome.
• Family history of pancreatic cancer.
• Obesity.
• Older age. Most people with pancreatic cancer are over 65.
• Drinking a lot of alcohol.

Prevention

Screening for people with a high risk of pancreatic cancer

Screening uses tests to look for signs of pancreatic cancer in people who don’t have symptoms. It might be an option if you have a very high risk of pancreatic cancer. Your risk might be high if you have a strong family history of pancreatic cancer or if you have an inherited DNA change that increases the risk of cancer.

Pancreatic cancer screening might involve imaging tests, such as MRI and ultrasound. These tests are generally repeated every year.

The goal of screening is to find pancreatic cancer when it’s small and most likely to be cured.

Genetic testing for cancer risk

If you have a family history of pancreatic cancer, discuss it with a health care professional. The health professional can review your family history and help you understand whether genetic testing might be right for you.

Genetic testing can find DNA changes that run in families and increase the risk of cancer. If you’re interested in genetic testing, you might be referred to a genetic counselor or other health care professional trained in genetics.

Ways to Lower Risk

You might reduce your risk of pancreatic cancer if you:

• Stop smoking. If you smoke, talk to a member of your health care team about ways to help you stop. These might include support groups, medicines and nicotine replacement therapy.
• Maintain a healthy weight. If you are at a healthy weight, work to maintain it. If you need to lose weight, aim for a slow, steady weight loss of 1 to 2 pounds (0.5 to 1 kilogram) a week. To help you lose weight, exercise most days of the week. Slowly increase the amount of exercise you get. Choose a diet rich in vegetables, fruit and whole grains with smaller portions.

Thyroid cancer is a growth of cells that starts in the thyroid. The thyroid is a butterfly-shaped gland located at the base of the neck, just below the Adam’s apple. The thyroid produces hormones that regulate heart rate, blood pressure, body temperature and weight.

Thyroid cancer might not cause any symptoms at first. But as it grows, it can cause signs and symptoms, such as swelling in your neck, voice changes and difficulty swallowing.

Several types of thyroid cancer exist. Most types grow slowly, though some types can be very aggressive. Most thyroid cancers can be cured with treatment.

Thyroid cancer rates seem to be increasing. The increase may be caused by improved imaging technology that allows health care providers to find small thyroid cancers on CT and MRI scans done for other conditions (incidental thyroid cancers). Thyroid cancers found in this way are usually small cancers that respond well to treatments.

Symptoms

Most thyroid cancers don’t cause any signs or symptoms early in the disease. As thyroid cancer grows, it may cause:

• A lump (nodule) that can be felt through the skin on your neck
• A feeling that close-fitting shirt collars are becoming too tight
• Changes to your voice, including increasing hoarseness
• Difficulty swallowing
• Swollen lymph nodes in your neck
• Pain in your neck and throat

When to see a doctor

If you experience any signs or symptoms that worry you, make an appointment with your health care provider.

This being a Breastfeeding week, let’s learn something on the relationship between Cancer and Breastfeeding. Did you know that women who breastfeed have a lower risk of breast cancer especially before menopause, than women who don’t breastfeed?

Many women are not aware that breastfeeding their babies can help lower their own risk of developing breast cancer; despite the fact that most parents are aware that breastfeeding is the best way to nurture babies and offers them vital health benefits.

Breastfeeding may be more strongly linked to a lower risk of estrogen receptor-negative (Some breast cancer cells require progesterone and/or oestrogen. Hormone receptors are unique proteins found inside these cancer cells. When hormones attach to hormone receptors, the cancer cells with these receptors grow.

Hormone receptor-negative tumors are estrogen receptor-negative (ER-negative) and progesterone receptor-negative (PR- negative). Hormone receptors are not expressed in these tumors. Because of this, they either have few or no hormone receptors.

Approximately 75% to 85% of newly diagnosed breast cancers are hormone receptor-positive, these hormones cane be treated with hormone therapies; hormone theraphy drugs include aromatase inhibitors, tamoxifen, anastrozole, exemestane and letrozole. Hormone receptor-negative breast cancers are not treated with hormone therapies because they don’t have hormone receptors.

Research suggests that breastfeeding women are less likely to develop pre and post-menopausal breast cancer symptoms. And breastfeeding longer than six months can have additional benefits. Most women ignore their breast health, which results in breast cancer, due to which the number of increased breast cancer cases worldwide.

Breastfeeding protects children from cancer, it reduces not only the mother’s chances of cancer but also the child’s. It is therefore beneficial to both mother and child. Studies show that breastfeeding prevents the child from being overweight, that later reduces the risk of many cancers such as pancreatic, post-menopausal breast, endometrial, oesophagal, rectal, and kidney cancers. 

A mother’s hormones are altered by breastfeeding, which may delay the onset of her menstrual cycle and minimize her lifetime exposure to oestrogen and other hormones that may increase her risk of breast cancer. Breastfeeding may also aid in preventing breast cancer-causing mutations in cells.

Breast cancer can be detected during breastfeeding; when a woman feels a lump in the breast during breastfeeding, it could be a sign of breast cancer, and the lumps can disappear after some time but can translate to cancer as a result of mastitis, which is an infection of the breast tissue by a bacteria which blocks milk ducts. Symptoms are swelling and pain in the breast, skin warmth and redness, fever. Fibro adenomas, which are lumps that feel like marble when touched and always move beneath the skin can also be the symptoms.

HPV is a double stranded DNA virus that has long been known to be the causative agent for genital warts and has recently been determined to be responsible for cervical cancers. Cervical Cancer: This is cancer of the uterine cervix with 90% of the cancers being squamous cell in origin. Persistent infection of the cervix with HPV is the primary cause of cervical cancer.

Risk Factors of Cervical Cancer

HPV infection is contracted mainly through sexual behavior which includes multiple sexual partners, new partners, partner sex history and age of onset of sexual intercourse. There are over 100 types of HPV with types 16 and 18 accounting for 70% of cervical cancers and the remaining being caused by types 31 and 33.

Prevention:

• Responsible sexual behavior, including abstinence and use of condoms

• Vaccination

• Cervical cancer screening as per current screening guidelines

Vaccination against Human Papilloma Virus disease should be done before the onset of sexual activity for optimal protection but can be used in sexually active groups to prevent multiple or persistent infections.

Three prophylactic HPV vaccines, directed against high-risk HPV types, are currently available: the quadrivalent vaccine, the bivalent vaccine and the nonavalent vaccine.

The bivalent vaccine contains non-infectious protein antigens for HPV 16 and 18, the quadrivalent against non-infectious protein antigens for HPV 6, 11, 16, and 18 and the nonavalent, non-infectious protein antigens for HPV 6, 11, 16, 18, 31, 33, 45, 52 and 58.

The quadrivalent and nonavalent vaccines offer comparable immunogenicity, efficacy and effectiveness for the prevention of cervical cancer, which is mainly caused by HPV types 16 and 18. Target population: The recommended primary target population for HPV vaccination is girls aged 9–14 years, prior to becoming sexually active.

85% of people will get an HPV infection in their lifetime.  Almost every unvaccinated person who is sexually active will get HPV at some time in their life. Most women, including teens, become infected with HPV each year. Most HPV infections will go away on their own. But infections that don’t go away can cause certain types of cancer, this is why HPV vaccination is important.

HPV vaccination works.

HPV infections, genital warts, and cervical pre-cancers (abnormal cells on the cervix that can lead to cancer) can be prevented by HPV vaccination. Among vaccinated women, the percentage of cervical pre-cancers caused by the HPV types most often linked to cervical cancer have drops by 40 percent.

HPV vaccination is cancer prevention.

HPV is estimated to cause nearly 6700 cervical cancer cases in women every year in Kenya. HPV vaccination can prevent 5000 of these cancers by preventing the infections that cause them.

Preventing cancer is better than treating it.

HPV can cause several kinds of cancer. Only cervical cancer can be detected early with a screening test. The other cancers caused by HPV may not be detected until they are more serious. HPV vaccination prevents infections that cause these cancers.

Early protection works best.

Most children only need two doses of HPV vaccine when vaccinated before age 15 years. As a parent, take the advantage of the freely available HPV vaccination in all public health facilities in the country for girl child.

HPV vaccination provides safe, effective, and long-lasting protection.

HPV vaccine has a reassuring safety record that’s backed by over 15 years of monitoring and research.