The mind in breast cancer

An Austrian psychotherapist specialising in counselling breast cancer patients was in Kuala Lumpur for a conference recently to explain the psychological issues involved in a woman who has breast cancer.

WOMEN who have had mastectomy go through a mire of complex feelings which people might not be aware of.

While doctors look into the physical treatment of cancer patients, clinical psychologists, psychotherapists or psychiatrists trained in cancer patient care play an important role in addressing their psycho-social needs and serve as a link between doctors and patients.

For women who are depressed after a mastectomy, the latter would sit down with them and counsel them, said Dr Gabriele Traun-Vogt, a psychotherapist specialising in breast cancer care from the Medical University of Vienna.
“It’s normal for them not to want sex after a mastectomy. That’s because the same organ that gives pleasure in a relationship is now a source of danger,” she explained.

“Breast cancer is also a serious disease but the symptoms are not easily seen.

“They feel that their bodies have let them down,” she said.

To begin to experience healing, patients should start having a positive approach to the scarred breast, she said.

“Touch and feel the part. This is a complex mental process. People need time to realise that it is normal to have problems and they should try to regain their sense of well-being.

“They need to realise that the breast is also the ‘hurting’ part of the body and a woman should touch it lightly again to have a good feeling towards the breast again,” said Gabrielle, who has been a clinical psychologist since she was 21 and has worked with women with breast cancer for nine years.

The action is important because there is a tendency for women to avoid looking at their scarred breasts or touch them, she said.

“By touching it, you are saying to yourself that you are not hating your body.

“Start loving that hurt part by putting some nice cream on it. Buy a nice bra so that you feel better,” she said.

Being able to accept herself makes it easier for a woman to get back to her relationship, which she was not able to while undergoing and coping with treatment.

“Women usually do not share their fears with their husbands because sex is such a taboo subject, and they don’t share with other women because they feel inadequate,” she said.

While psychotherapists counsel the patient, it’s important that friends and relatives provide a listening ear, she said.

“What they need is to express their feelings. They just want to feel cared for,” she said.

Besides contending with sexuality issues, a woman may still wish to consider having children and may wonder if she can conceive, and if she can, she may have fears about the cancer recurring or that she has a shorter life-span.

Her husband too may not want the risk of raising a child all by himself in the event that she dies.

To give advice, oncologists and clinical psychologists usually work together. The oncologists would give medical information such as the risk of cancer recurring and personal prognosis while the clinical psychologists may give some guidance on coming to a decision, said Gabriele.

A woman usually needs a year to get over the chemotherapy side-effects, and she needs to discuss with her partner on how much he wants to have a child and if anything should happen, would they want to take the risk?

The greatest challenge for Gabriele is seeing young women with young children dying of breast cancer.

Usually, even doctors do not know how to help them with their issues, she said.

Under such a situation, she said she would encourage the women to bring in their children to see her as well.

“The children should know what is going on. Six- or seven-year-olds know that their mother can die from cancer and fear that they will not see their mother anymore.

“It’s important to explain to them that their mother may live for months or years and will not die ‘instantly’. That’s because they watch television and may equate death as something instant,” she said.

“It is also important to explain to children that it is not their fault that their mother has cancer because they may think that they, in some magical way, cause their mother to be sick and die.

“It is important to explain to them that cancer is a disease and it’s no one’s fault,” she said.

An example of how an incident may trigger the child to think that way – a mother has been upset with the child, which is common, and she may have said, “You really make me sick,” and when she has cancer, the boy remembers what she said and think that it was his fault and suffer from guilt as a result.

It is important for Malaysia to establish a multidisciplinary approach in cancer patient care because it requires team work from surgeons, oncologists, nurses, clinical psychologists and social workers, said Gabriele, who conducted the “Workshop Establishing Psycho-Oncology in Malaysia” in conjunction with the International Survivorship and Supportive Care Conference in Cancer recently.

“If the surgeon sees that the woman needs more help psychologically, they should know whom to call,” she said.

Psycho-oncology addresses the psychological responses of patients to cancer at all stages, and that of their families and caregivers, as well as the psychological, behavioural and social factors that may influence the disease process, said Gabriele, who oversees 400 newly diagnosed breast cancer patients every year at the university.

Are counsellors not adequate in helping cancer patients?

They usually refer more serious cases such as those suffering from severe anxiety, sleeping disorders, depression, and the danger of suicide to clinical psychologists, psychotherapists or psychiatrists trained in cancer patient, she said.

“If you are able to solve the problem in the beginning, it’ll be easier for the patients later,” she said.

In Malaysia, the field of psycho-oncology is almost unheard and in Europe, it is a relatively new discipline.

Psycho-oncology started in Austria 15 years ago and in Britain 20 years ago as the result of the patients’ rights movement. Patients want to be involved in the decision-making process and have options, said Gabriele.

“If you want to be a centre of excellence in health and medical care, international standards and guidelines require psychological support for the treatment of cancer,” she said.

thestar.com.my