World Cancer Day: Can psychological interventions improve outcomes in people with metastatic breast cancer?

Today is World Cancer Day, an initiative designed to raise awareness and improve education and access to effective treatment options for various cancer diagnoses. ¹

Metastatic Breast Cancer

Cancer is ranked as one of the leading causes of death worldwide, with breast cancer in women being the most diagnosed. ² Increased awareness and funding has helped advance breast cancer detection, diagnosis, and treatment, resulting in a steady increase in survival rates. Indeed, breast cancer survival rates in the UK have doubled in the past 40 years. ³ However, roughly 30% of people diagnosed with breast cancer will develop metastatic, or stage 4, breast cancer. ⁴

Metastatic breast cancer (MBC) is breast cancer that has spread to another part of the body. ⁵ It is estimated that in the US alone, 73,000 – 86,000 people are diagnosed with MBC annually ⁶ and once diagnosed, the five-year survival rate for women and men is 28% and 22% respectively. ⁷

The Psychological Toll of Metastatic Breast Cancer

People with MBC experience a range of symptoms and challenges including chronic pain, fatigue, and decreased cognitive function ^{8 9 10} which can greatly impact their quality of life.  A retrospective analysis found that when compared to people with other forms of metastatic cancer, people with MBC had the lowest return to work rate. ¹¹ The reasons for this were not captured by the study, however leaving the workforce was associated with higher levels of symptom burden. ¹¹

Many people with MBC report symptoms of depression, anxiety, loneliness, and existential distress. ^{12 13 14} Existential distress, including hopelessness, remorse, disappointment, and death anxiety, can be one of the most debilitating experiences for someone facing a terminal diagnosis.^{15 16}

Use of Psychological Interventions to Ease the Emotional Burden

Numerous psychological interventions have been developed to alleviate some of the emotional burden experienced by people with MBC. These interventions have been found to not only reduce psychological burden, but also increase survival rates. ^{17 18}

Recent research has provided evidence for the use of cognitive behavioural therapy (CBT) and mindfulness-based stress reduction (MBSR) to ease the burden of an MBC diagnosis. ^{17 18}

CBT aims to identify and modify a person’s maladaptive thought processes and behaviours through cognitive restructuring and behavioural techniques. ²⁰ It can be provided both in person and in a group setting and has been found to be a cost-effective approach for treating depression in women with MBC. ¹² Furthermore, decreasing depressive symptoms in people with MBC within the first year of diagnosis has been associated with longer subsequent survival. ¹⁷

MBSR aims to alleviate stress, anxiety, depression, and pain by employing mindfulness meditation to alleviate the suffering associated with physical disorders. ²¹ An eight-week MBSR course for women with MBC was found to be acceptable and feasible by participants who also reported improved anxiety and quality of life. ¹⁹

References:

1. World Cancer Day (2022). World Cancer Day About Us. https://www.worldcancerday.org/about-us Accessed 28 January 2022.

2. Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.CA: A Cancer Journal for Clinicians, 71(3), 209–249.

3. Facts and statistics 2021. (2021). Breast Cancer Now. https://breastcancernow.org/about-us/media/facts-statistics?gclid=Cj0KCQiAosmPBhCPARIsAHOen-MS-hvD40W0-6rZTV8K7urE48bbT8jbvvxytu1B-NkKrshjIeJRMP8aApFgEALw_wcB#people%20survive%20bc Accessed 28 January 2022

4. O’Shaughnessy, J. (2005). Extending survival with chemotherapy in metastatic breast cancer.The oncologist, 10, 20-29.

5. Breast cancer.org. (2021). Metastatic Breast Cancer. https://www.breastcancer.org/symptoms/types/recur_metast Accessed 31 January 2022

6. Mayer, M., & Grober, S. (2006). Silent voices: women with advanced (metastatic) breast cancer share their needs and preferences for information, support and practical resources.Needs Assessment Survey Report, 55(56), 0-787.

7. American Cancer Society (2021). Cancer facts and figures 2021. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2021.html Accessed 31 January 2022.

8. Butt, Z., Rosenbloom, S. K., Abernethy, A. P., Beaumont, J. L., Paul, D., Hampton, D., Jacobsen, P. B., Syrjala, K. L., von Roenn, J. H., & Cella, D. (2008). Fatigue is the Most Important Symptom for Advanced Cancer Patients Who Have Had Chemotherapy. Journal of the National Comprehensive Cancer Network, 6(5), 448–455.

9. Butler, L. D., Koopman, C., Cordova, M. J., Garlan, R. W., DiMiceli, S., & Spiegel, D. (2003). Psychological distress and pain significantly increase before death in metastatic breast cancer patients.Psychosomatic Medicine, 65(3), 416-426.

10. Turner, J., Kelly, B., Swanson, C., Allison, R., & Wetzig, N. (2005). Psychosocial impact of newly diagnosed advanced breast cancer.Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 14(5), 396-407.

11. Tevaarwerk, A. J., Lee, J. W., Terhaar, A., Sesto, M. E., Smith, M. L., Cleeland, C. S., & Fisch, M. J. (2016). Working after a metastatic cancer diagnosis: Factors affecting employment in the metastatic setting from ECOG-ACRIN’s Symptom Outcomes and Practice Patterns study. Cancer, 122(3), 438–446.

12. Caplette-Gingras, A., & Savard, J. (2008). Depression in women with metastatic breast cancer: a review of the literature.Palliative & supportive care, 6(4), 377-387.

13. Kissane, D. W., Grabsch, B., Love, A., Clarke, D. M., Bloch, S., & Smith, G. C. (2004). Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis.Australian & New Zealand Journal of Psychiatry, 38(5), 320-326.

14. Vehling, S., Lehmann, C., Oechsle, K., Bokemeyer, C., Krüll, A., Koch, U., & Mehnert, A. (2011). Global meaning and meaning-related life attitudes: exploring their role in predicting depression, anxiety, and demoralization in cancer patients.Supportive Care in Cancer, 19(4), 513-520.

15. Boston, P., Bruce, A., & Schreiber, R. (2011). Existential suffering in the palliative care setting: an integrated literature review. Journal of pain and symptom management, 41(3), 604-618.

16. Kissane, D. W. (2012). The relief of existential suffering. Archives of internal medicine, 172(19), 1501-1505.

17. Giese-Davis, J., Collie, K., Rancourt, K. M., Neri, E., Kraemer, H. C., & Spiegel, D. (2011). Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 29(4), 413–420.

18. Mustafa, M., Carson-Stevens, A., Gillespie, D., & Edwards, A. G. (2013). Psychological interventions for women with metastatic breast cancer. Cochrane Database of Systematic Reviews.

19. Eyles, C., Leydon, G. M., Hoffman, C. J., Copson, E. R., Prescott, P., Chorozoglou, M., & Lewith, G. (2014). Mindfulness for the Self-Management of Fatigue, Anxiety, and Depression in Women With Metastatic Breast Cancer.Integrative Cancer Therapies, 14(1), 42–56.

20. APA Dictionary of Psychology. (2022). Cognitive-Behavior-Therapy. https://dictionary.apa.org/cognitive-behavior-therapy Accessed 28 January 2022

21. Niazi, A. K., & Niazi, S. K. (2011). Mindfulness-based stress reduction: a non-pharmacological approach for chronic illnesses. North American journal of medical sciences, 3(1), 20–23.