Mental health and breast cancer diagnosis, what to expect

A cancer diagnosis may be one of the most devastating and distressing pieces of news that a person can receive, and that a doctor has to deliver.

The phenomenon has been widely studied: even in the best case scenario of doctor-patient communication, this diagnosis can trigger mental health conditions such as depression, anxiety, and stress. To examine this issue in greater depth, a Cochrane systematic review, begun in 2015 and updated in 2023, looked at how psychological interventions have a positive impact on women with non-metastatic breast cancer.

The analysis, “Psychological interventions for women with non-metastatic breast cancer”, included 60 randomized controlled trials with a total of 7,998 participants (the initial analysis in 2015 had 3,940). Its objective was to explore the psychological sequelae of being diagnosed and treated for breast cancer, and how mental health strategies benefit both the patient’s mind and body, in the context of a clinical situation that is associated with higher rates of depression and anxiety and reduced quality of life.

The review evaluated a wide range of interventions, which in many cases were combined. These included:

• Cognitive-based or mindfulness-based strategies
• Supportive, expressive, and educational strategies
• Interventions were mainly conducted face-to-face (56 studies).
• And in groups (50 studies).
• Only 10 studies analyzed individual sessions.
• In some cases, couples therapy was provided.

Most of the intervention sessions were conducted on a weekly basis, with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months.

The analysis found that women who received psychological therapy after a breast cancer diagnosis generally showed a reduced risk of depression, mood disturbance, anxiety, and stress, as well as an improvement in quality of life compared to the control group. However, it was difficult to measure the effect of these therapies on survival and the ability to cope with diagnosis and treatment, because few studies collected or reported these outcomes.

In Latin America, breast cancer is the most common type of cancer among women, with some 200,000 cases a year, representing 15% of all cancer cases. In the United States, each year around 281,000 cases are diagnosed in women, with around 43,500 deaths. The incidence of breast cancer among Latinas living in the United States is 28% lower than among non-Hispanic whites. However, disparities persist, and there are barriers to accessing care that delay diagnosis and treatment.

Previous studies specifically focused on the psychological impact of a breast cancer diagnosis, and one study found that the prevalence of clinically significant symptoms was:

• 39% for non-specific distress
• 34% for anxiety
•  31% for post-traumatic stress
• 20% for depression

This analysis concluded that mental health can be affected in at least four domains following a breast cancer diagnosis, and that these effects are common. This study, like the Cochrane review, brings attention to the clear need to mitigate the mental health impacts of a breast cancer diagnosis with an approach that addresses both body and soul.

References: 

The Cancer Atlas:About 1.3 million new cancer cases and 666,000 cancer deaths were estimated to have occurred in 2018 in Latin America and the Caribbean. The five most common cancers in 20 were female breast (200,000 new cases, 15% of all cancer cases), prostate (190,000, 14%), colorectal (128,000, 9%), lung (90,000, 7%) and stomach cancer (67,000, 5%).

What Hispanic Women and Latinas need to Know About Breast Cancer:  Hispanic women and Latinas are not homogeneous, and the risk of developing breast cancer among these women varies by national origin and genetic ancestry. In the U.S., breast cancer incidence in the overall group is 28 percent lower than in non-Hispanic white women, who have the highest incidence rate, according to recent data from the American Cancer Society.

The mental health impacts of receiving a breast cancer diagnosis: A meta-analysis:  The prevalence of clinically significant symptoms was 39% for non-specific distress (n = 13), 34% for anxiety (n = 19), 31% for post-traumatic stress (n = 7) and 20% for depression (n = 25).