Stress And Coping In Women With Breast Cancer

Breast  cancer  is  the  most  common  cancer  in  women  all  around  globe  and  is  the  leading  cause  of cancer  deaths  in  females.

By Fareeha Iqbal, Ayesha Farooq, Samavi Nasir

Breast Cancer:

According to World Health Organization (WHO) the number of patients diagnosed with breast cancer in 2013 were 3.7 million out of which 1.3 could not survive. In Pakistan alone, every year 90,000 new patients are diagnosed with breast cancer and about 40,000 die during the treatment process. The incidence of breast cancer is increasing at an alarming rate.    Improvement  in  technology  has  paved  a  way  for  the  early  detection  and  better  treatment; as  a  result  the  number  of  cancer  survivors  has  also  increased.  When  the  treatment  is  over,  they have  to  experience  post-treatment  side  effects.

Side effects:

1. Disrupted daily activities
2. permanent fear  of  cancer  recurrence
3. Depression  fear 
4. Anxiety

These are  the most  common side effects  at  the  diagnosis  of  the cancer,  which  continue  onwards  usually  intensifying  with  the  treatment  expenditure.  The treatment  of  Breast  Cancer  results  in  distorted  female  body,  which  negatively  affects  the emotional  health  of  a  woman.

Public perceptions:

 It  is  further  made  complex  by  public  perception  and  stereotypes where  public  believes  that  a  patient  gets  a  disease  due  to  their  wrongdoings  as  a  substitute  to  pay for  their  sins.  Such  superstitions  and  objections  from  society  add  to  the  stress  level  of  patient making  the  condition  even  worse.  There  is  now  clear  that  the  continuous  stress  state  of  the cancer  patient  influences  the  progression  of  the  disease,  however,  the  underlying  molecular mechanisms  are  still  under  study.

How stress leads cancer in chronic stage:

The exposure to prolonged chronic stress can lead to dysregulation of the neuroendocrine and the sympathetic nervous system (SNS), high levels of Glucocorticoids (GCs), dysregulation of the circadian cortisol rhythm, and dysfunction of immune system, dysregulation of hypothalamic-pituitary adrenal (HPA) axis of autonomous nervous system, which releases mediators such as the catecholamine norepinephrine (NE) and epinephrine from the SNS and the adrenal medulla and cortisol from the adrenal cortex. The high levels of GCs, lead to decreased levels of brain-derived neurotrophic factor (BDNF) and increase the levels of pro-inflammatory cytokines leading to decreased neural immune, endocrine and metabolic responses.

Mechanism of Stress leads cancer in chronic stage

Point to be noted here is it that these similar stress-activated pathways are also applicable for tumor growth, migration, angiogenesis, metastatic spread & increased rate of mortality in the patients. Even Obradovic and colleagues (Obradovic et al., 2019) described in their study that the increase in stress hormones during breast cancer growth leads to the activation of glucocorticoid receptors at distant metastatic sites.

Why women’s feel stress?

According to Hanik Endang Nihayati which is one of  the member of this study that breast cancer patients experienced more psychosocial stress than coping strategies. Their study results were 60.3% people dealing with stress conditions due to their self-image, social interaction, sexuality, socio-economic and depression factors. According to Siegel and lane stress was anything that cause threat, some people took stress as challenge and some took as threat. They are unable to cope up with stress. So the stress and coping strategies had a negative relationship. People having age less than 45 years facing more stress conditions than older one.

Stages of Stress in cancer patients:

            According to Elisabeth Kubler-Ross cancer patients have different stages namely Denial, Anger, Bargaining, depression and acceptance. In denial stage, patients have trust issues. They did not want to share their symptoms with anyone and enter in next stage when they feel nothing going to be good, feeling disappointment have unstable emotions. In third stage bargaining they delay their treatment and enter in depression. Patients feel sad, quit and helpless. The next and end stage is acceptance when cancer is turns into severe chronic disease then they accept reality and try to motivate themselves to fight against disease.

Cope up strategies:

            Although there are many ways to cope up’s the stress situations, but statistical analysis shows very a smaller number of patients who take up the stress therapy. This stress can be no doubt managed by medications and pharmacological treatments but the major role would be psychological treatment like pursuing a hobby, meditation, one to one counselling, and cognitive behavioral therapy. For example, in a study when attending an “integrated yoga -based stress reduction program”, decrease in cancer symptoms, improvement in sleep wake cycle, as well as an improvement in the immune function was observed in breast cancer patients. Thus, describing the potential of yoga and other similar psychological interventions in modulating stress responses in breast cancer patients.

Reference:

Alagizy, H. A., Soltan, M. R., Soliman, S. S., Hegazy, N. N., & Gohar, S. F. (2020). Anxiety, depression and perceived stress among breast cancer patients: single institute experience. Middle East Current Psychiatry, 27(1), 1-10.

Borgi, M., Collacchi, B., Ortona, E., & Cirulli, F. (2020). Stress and coping in women with breast cancer: unravelling the mechanisms to improve resilience. Neuroscience & Biobehavioral Reviews.

Mansoor, T., & Abid, S. (2020). Negotiating femininity, motherhood and beauty: Experiences of Pakistani women breast cancer patients. Asian Journal of Women’s Studies, 26(4), 485-502.

Nihayati, H. E., Fadila, F. L., & Fauziningtyas, R. (2020). The Relationship between Psychosocial Stress and Coping Strategies for Breast Cancer Patients. Systematic Reviews in Pharmacy, 11(3), 817-822.

Obradović, M. M., Hamelin, B., Manevski, N., Couto, J. P., Sethi, A., Coissieux, M. M., … & Bentires-Alj, M. (2019). Glucocorticoids promote breast cancer metastasis. Nature, 567(7749), 540-544.

Authors : Fareeha Iqbal, Ayesha Farooq, Samavi Nasir (Students enrolled in MS industrial biotechnology at Atta Ur Rahman school of applied biosciences ASAB, NUST Islamabad)