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:
- Disrupted daily activities
- permanent fear of cancer recurrence
- Depression fear
- 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)