The effect of anxiety on breast cancer patients.

Cancer is a disease wherein abnormal cells divide without control and are able to attack other tissues. Most of the patients and their families face some degree of depression, anxiety, and fear when cancer becomes a part of their lives. They feel helpless and eager to find ways on how to get rid of it. The study focuses on anxiety among breast cancer patients. It aims at investigating cancer, its symptoms, and effects the disease has on the anxiety level of patients.

INTRODUCTION

Breast cancer is the most common cancer among women. It is known as the fast enemy that should be treated and destroyed very fast as well. Most women do not like to hear the word cancer, and feel worried and stressed over it. However, the words “breast cancer” does not always mean an end. It can be the beginning of learning how to fight, getting the facts, and finding hope.

Cancer patients usually face more psychological problems compared to other patients. The diagnosis of having cancer itself is great challenge. This is followed by lack of patient's personal control over the current treatment method and uncertainty of its outcome. Therefore, anxiety is associated with cancer; it is the most prevalent psychological symptoms perceived by cancer patients[1] as a response to a threat, and so many patients are anxious. In one study done by Ashbury et al,[2] 77% of 913 patients within 2 years of treatment recalled experiencing anxiety. However, anxiety after cancer diagnosis is not necessarily abnormal, may not present a problem, or may even be a constructive part of dealing with problems.[3]

BREAST CANCER

The most common cancer and the number one cause of cancer death amongst women in Malaysia is breast cancer. If not detected and treated promptly, breast cancer can metastasize, spreading to the lymph glands and other parts of the body including the lungs, bones, and liver.[4]

Usually, cancer is named after the body part in which it originated; thus, breast cancer refers to the erratic growth and proliferation of cells that originate in the breast tissue. The term breast cancer refers to a malignant tumor that has developed from cells in the breast. The breast is composed of two main types of tissues: glandular tissues and stromal (supporting) tissues. Glandular tissues house the milk-producing glands (lobules) and the ducts (the milk passages), while stromal tissues include fatty and fibrous connective tissues of the breast. The breast is also made up of lymphatic tissue-immune system tissue that removes cellular fluids and waste.[5]

Breast cancer is characterized by the uncontrolled growth of abnormal cells in the milk-producing glands of the breast or in the passages (ducts) that deliver milk to the nipples. The early stage of breast cancer usually refers to the cancer that is confined to the fatty tissue of the breast. It may then spread to underlying tissues of the chest wall and then to other parts of the body.[6] Furthermore, worldwide, breast cancer is the leading cause of cancer death in women, and more than one million women are diagnosed each year.[6] In addition to that, more than 500,000 women every year die from the disease worldwide.[7]

ANXIETY

Anxiety, tension, worry, stress, and strain are all common feelings and it is a part of our life today. Simple worry or stress will not drive us to look for specialist, but when these feelings become a chronics and interfere with our lives we need to do something and look for ways to manage it in order to function well.

Anxiety can be defined as an unpleasant subjective experience associated with the perception of real threat; therefore, it is a common symptom in connection with cancer.[8] Furthermore, it can be described as an emotional state characterized by feelings of unpleasant expectation and a sense of imminent danger.[9] According to Stark, et al.,[10] anxiety has both physiological and psychological components. Autonomic hyper-arousal with acceleration of heart rate and respiration, tremor, sweating, muscle tension, and gastrointestinal changes are common physiological experiences. Apprehension, feeling powerless, and fearing loss of control are psychological aspects.

According to Kazdin,[11] anxiety is an emotion that characterized by feelings of tension, worry, and stress as well as physiological changes such as increased blood pressure. Furthermore, Medical News Today[12] defines anxiety as “a general term for several disorders that cause nervousness, fear, apprehension, and worrying. These disorders affect how we feel and behave, and they can manifest real physical symptoms. Mild anxiety is vague and unsettling, while severe anxiety can be extremely debilitating, having a serious impact on daily life”.

ANXIETY IN BREAST CANCER PATIENTS

All of us feel anxious sometimes. We may worry about things that might happen or have a restless night of sleep. But, people with an anxiety problem worry so much that it affects their lives in negative ways. As stated above, anxiety is one of the most dominant psychological challenges associated with cancer. In another word, anxiety is just a normal reaction for cancer patients. Patients’ anxiety increases once they discover that they suffer from breast cancer, they may also become more anxious as cancer spreads or treatment becomes more intense. Consequently, the level of anxiety experienced by one person with cancer may differ from the anxiety experienced by another. Many anxiety cases associated with cancer were treated from this sickness, but others were not. Therefore, psychologists need to give support and hope to breast cancer's patients; they need to help them cope with their feeling and pain.

Moreover, cancer's patients may experience anxiety at different situation as while undergoing a screening test, waiting for the results, receiving a diagnosis, undergoing treatment, or anticipating a recurrence of their cancer. The anxiety associated with cancer may increase feelings of pain, interfere their ability to sleep, causes nausea and vomiting, and interfere with their quality of life. And the severe anxiety may even shorten the patient's life.

For most patients, cancer requires facing uncertainty, worries about cancer treatment effects, fear of cancer progression and death, guilt, and spiritual questioning. A study by Ashbury et al.,[2] indicated that 77% of patients within 2 years of treatment recalled experiencing anxiety. On the other hand, anxiety after cancer diagnosis is not necessarily to be normal, understanding the nature of the anxiety in cancer patient populations is important because abnormal anxiety is troublesome the psychological wellbeing of the patients Sherbourne[13] and Sheard.[14]

Interviewing some breast cancer patients reported that their anxiety is characterized by a number of typical symptoms and signs such as shivering or tremor. They find that their feelings of anxiety increase or decrease at different times. They may become more anxious as cancer spreads or treatment becomes more intense. The level of anxiety experienced by one person may differ from the level of anxiety experienced by another. Anxiety in breast cancer patients is associated with death anxiety, fear of death as a result of their symptoms. According to Pollak[15] this type of anxiety is lower for people who have a positive sense of well-being and sense of meaning in life. In addition, evidence indicates that religious beliefs influence their level of anxiety [Figure 1].

Figure 1

Anxiety framework

Many researchers have investigated the differences in anxiety level among women receiving different breast cancer treatments. Recent study done by Lim,[16] indicated that anxiety presents in all treatment types for breast cancer. Moreover, the anxiety level in women who underwent chemotherapy was highest before the first chemotherapy infusion, mediated by age and trait anxiety. This result confirms the needs for more research and studies on anxiety among breast cancer patients.

SYMPTOMS OF ANXIETY ON PATIENTS

Various symptoms are frequently reported by patients with cancer during or after treatment. Some of these symptoms are psychological in nature and others are physical in nature. Fatigue, nausea, and pain are among the most common symptoms.[17] In addition, the Villadeguadarrama Free Article[18] reported that the cancer-related anxiety may manifest as physical symptoms, such as rapid heartbeat, tightness in the chest or shortness of breath. The patient may also experience digestive symptoms, such as nausea, vomiting, or diarrhea.

Thinking about anxiety that can lead to physical symptoms, the overall symptoms of anxiety among cancer patients include: excessive, ongoing worry and tension, an unrealistic view of problems, restlessness or a feeling of being “edgy”, irritability, muscle tension, headaches, sweating, difficulty concentrating, nausea, the need to go to the bathroom frequently, tiredness, trouble falling or staying asleep, trembling, and being easily startled.[19]

Symptoms of anxiety and depression have been found to be common in patients with cancer,[20] frequently occurring around the time of diagnosis and during the period of chemotherapy.[21] High-depression burden has been found at the time when patients experience adverse effects of chemotherapy.[22] Significant difference in psychological distress has been found depending on age, gender, and living situation, with those living alone experiencing higher levels of distress in a sample of Icelandic cancer patients during the treatment period.[23]

Many studies were done to measure the anxiety symptom among cancer's patients. A study of women at high risk for breast cancer showed significantly higher levels of depressive symptoms and feelings of emotional alienation than did a standardized test group, with 27% of this population defined as having a level of psychological distress justifying psychological counseling.[24] A second study also documented an increase in distress among first-degree relatives of breast cancer patients.[25] An Israeli study found that first-degree relatives who have physical symptoms of breast pathology respond with more emotional distress than do women of normal risk in the same situation.[26]

THE EFFECT OF ANXIETY ON CANCER'S PATIENTS

Patients with cancer face most of the stressors associated with diagnosis, illness, and treatment. These stressors may generate coping strategy, which may affect the mental health.[27] Cancer affects patients’ lives and those of their families in different aspects. Cancer diagnosis and treatment brings changes in patients’ personal paths of life, in their daily activities, work, relationships, and family roles, and it is associated with a high level of patient psychological stress. This stress shows up as anxiety and/or depression.[28]

If you are really caring for someone who is having the symptoms of anxiety, encourage him or her to get help. People are differing in the way they perceive their sickness and they are also differ in the way they cope with their anxiety. Some are easily disturbed by their feeling of being anxious and other may take it as a challenge and they try to look for ways to overcome their feeling. There are many treatments for clinical depression including medicines, counseling, or a combination of both. Treatments can reduce the feeling of anxiety and improve the quality of life. Therefore, the diagnosis of anxiety in cancer is usually complicated by the overlap of anxiety and sickness symptoms such as cancer-related fatigue and pain. Many common symptoms of major depression were observed in cancer patients who do not endorse full depression symptoms.[29]

Different studies showed that various kinds of coping strategies are used to overcome the anxiety in different types and stages of cancer.[30] For instance, Reuter et al.,[31] stated that patients using ineffective coping strategies have higher levels of anxiety and depression and that benefiting from social support results in a marked reduction in the levels of anxiety and depression. Moreover, the importance of social support to good mental health outcomes is well established.[32] As well as the positive effect of good social support, the detrimental effect of negative interactions with significant others in the social environment has also become apparent in psychiatric and other conditions.[33]

Eventually, people are unique in the way they perceive and cope with the anxiety, also the way one patient uses is different from the way other uses. Undoubtedly, it is related to the personality, strength, faith, and hope patients is having toward their sickness.

CONCLUSION

Most of the breast cancer patients defined anxiety as “a mental condition.” Worry, tension, fear, and stress are interrelated to the anxiety and depression among them. Patients are differing in the way they perceive their problem as well as the way they cope with the anxiety associate with it. The huge literatures on anxiety, its effects, coping, counseling, and mental health are evidence of the extensive belief that the way people cope is somehow linked to their belief and faith. In conclusion, anxiety has a great effect on the feeling of breast cancer patients and it leads to high level of coping mechanisms.