Studying the Emotional Health of Women Post Breast Cancer Diagnosis
Once upon a time no one studied breast cancer survivors' emotional health. Not enough survived; both doctors and patients assumed survivors should be grateful and move on with their lives.
Now that 89% of breast cancer patients live at least five years, researchers are starting to look at survival issues. In an Australian study researchers looked at the emotional health of women two years after their breast cancer diagnosis. They found that survivors' wellbeing was "only modestly lower" than in women who had not had breast cancer. So most women were coping pretty well two years after their cancer diagnosis.
Among those who were still struggling two years later, they found that women who were well-educated and women who lived alone were more likely to have "lower levels of overall wellbeing." Researchers Susan R. Davis and Robin Bell concluded that doctors should make sure that women in these two groups get adequate emotional support as part of their follow-up care.
It would be interesting to know more about the women who lived alone in this study. Some women live along by choice, valuing their independence while maintaining strong social connections. Did these women, when faced with a crisis like breast cancer, find their social network insufficient to keep them going? Or were the women living alone not so much by choice as by divorce or the death of family members? In that group breast cancer would be an emotional trauma added to previous pain.
As to why educational level seemed to be a factor, researchers theorized, "More educated women are likely to be the best informed about their breast cancer and treatment, and their lower wellbeing results may reflect greater anxiety over decision making and their difficulty coping with a sense loss of control over their health and wellbeing."
The trend in recent years has been to make patients partners with their doctors. We frequently see patients write in to Health Central saying, "My doctor has given me the choice between Treatment A and Treatment B. What should I do?"
One important aspect of education is teaching people how to research, find facts, and apply them in daily life. Women who are accustomed in their work life to making important decisions expect to do the same with their health care. Education encourages people to believe that they are in charge of their lives, that hard work and information make a difference. A cancer diagnosis is a reminder that much in life is beyond our control.
This study suggests that the stress of all that decision-making takes an emotional toll. The saying, "The lawyer who represents himself has a fool for a client" expresses a truth that applies to many professions. Professional judgments need some distance. Doctors do not treat their own family members. Asking the patient to be in charge of her own life and death decisions may not always be the best idea.
I valued the opportunity to discuss treatment decisions with my doctors. I don't want to go back to the bad old days when doctors said, "Don't you worry your pretty head about this. I'll make you well."
Few doctors know their patients well enough to know whether mastectomy or lumpectomy with radiation is the best emotional choice for a patient who is likely to have equally good medical results from either. When two chemotherapies with different typical side effects have worked equally well in studies, it makes sense to offer the patient a choice.
However, this Australian study suggests that patients and doctors need to factor in the stress of decision-making on a patient's overall well-being. As patients, there may be times when we just need to say to our doctor, "I don't want to make this decision. I respect your medical judgment."
For those of us who want to be very involved in making treatment decisions, we need to learn not to second-guess ourselves and accept that there will be some elements of our cancer journey that we cannot control. If we live alone, we need to reach out and make the connections that will offer us the support we need. As we move on past our own treatment, reaching out can enrich our own lives and help a sister in need.