Supporting the Emotional Needs of Women With Metastatic Breast Cancer

As survivorship rates for cancer have increased, so has the awareness of the emotional toll cancer has on a person rather than just the physical.

As survivorship rates for cancer have increased, so has the awareness of the emotional toll cancer has on a person rather than just the physical. In response, Lisa Tamis-Bieder, RN, BSN, OCN, of ProHEALTH Care Associates in Lake Success, NY, and colleagues recently conducted a study surveying 359 women with metastatic breast cancer about the importance of appearance. The researchers reported that 56% of the respondents stated their physical appearance significantly affected their self-esteem, a feeling especially prominent in younger women.

Tamis-Bieder spoke with Oncology Nursing News to discuss the significance of the survey findings, the importance of the nurse—patient/survivor relationship, as well as strategies to support women address the emotional toll of a breast cancer diagnosis and treatment.

We hear a lot about physical effects of cancer treatment like nausea and fatigue, but how often do you hear from patients about appearance-related issues?

It’s definitely a concern. Most of our patients have breast cancer, and many of them are young women. Hair loss has the most impact on our patients as far as appearance. Appearance concerns most of our patients, but it is especially prominent among the younger ones.

Why is hair loss and overall appearance a bigger concern for younger patients?

When you’re young, you have a certain image of what you should look like or what you should be like. Our patients, some of whom are in their 20s or 30s with breast cancer or metastatic breast cancer, compare themselves to other women. They see other women, such as moms with young children, and they compare themselves. It shouldn’t be that way. It’s difficult for anybody at any age. Older women who have children who are grown and married are still impacted by their appearance, but it’s more difficult for the young person whose life should not have been impacted in this way at such a young age.

Do you think enough attention is given by the oncology practitioner community to appearance-related issues?

There have been more programs opening up within the past few years to help with this problem. One program is Look Good Feel Better, sponsored by the American Cancer Society. It’s a session with a makeup artist to teach the women makeup application and creative ways to make head coverings using scarves or hats. Pantene also sponsors a program in conjunction with the American Cancer Society where they provide wigs to women currently in treatment for cancer free of charge.

A spa in Long Island, New York is open on Mondays for people with cancer. They provide manicures, pedicures, massages, and makeup application. It’s a really good support program for people experiencing cancer. They have to get their oncologist to sign a form saying it’s okay for them to participate in this program.

Many stores have opened up for women who have had mastectomies, whether they have chosen to have reconstruction or not. Staff members at these stores help women affected by cancer find bras and other undergarments that best suit them based on the surgery they had. These stores have a whole line of products women can try on and purchase.

Over time, more programs have developed to help women with cancer. I think there’s a greater awareness in the community of the need for women to feel good about themselves during treatment.

Why is it important to consider the emotions of a patient with cancer as well as their disease?

It is really important to see where patients are emotionally, provide support and help them understand the treatment and its side effects. If they have that support, they’re more likely to be compliant. The person who is well-informed and has support from the nurses and staff feels more secure and confident and able to get through treatment better because of this better outlook.

It’s so important for nurses and staff members to form that relationship with the patient, letting them know you’re their biggest advocate and you’re there for them. Knowing the staff is there to listen without judgement allows patients to readily talk about their concerns and fears. We’ve had women talk about their relationships with their spouses or significant others, their medication and its side effects, being put into early menopause because of their treatment and difficulty with sexual encounters. As nurses and staff members, we try to help in whatever way we can.

What tips do you have for nurses to help get these difficult conversation started?

The conversation has to take place at day 1 when the patient first steps into the office. The doctors and nurses must develop a trusting relationship and an open line of communication. We must let the patient know we are there for them and ready to discuss anything that concerns them, including treatment as well as appearance. Nurses need to be sensitive to patients’ needs and sometimes intuit what they are thinking—establishing that connection and continuing to check in with the patient to see how everything is going.

Can you provide an overview of the study you presented at ONS and the key findings?

People with metastatic breast cancer can potentially have more side effects with changes in appearance, including skin coloring, hair loss, and weight gain. There is a stronger impact on women with metastatic breast cancer because when they go through cancer the first time, they experience the hair loss and the difficulty of treatment, but they see an end to it. When one is diagnosed with metastatic breast cancer, treatment becomes indefinite, which makes it so much more difficult for patients.

Young women with metastatic breast cancer are often concerned about their relationship with a significant other, feeling bad about the relationship, and what they’ve turned into. The women feel they’re not as attractive, their self-esteem goes down, they don’t feel as beautiful or sexy, and their sexual drive goes down.

It is essential to have nurses and people in the community be aware and sensitive to the fact that the changed physical appearance of women diagnosed with metastatic breast cancer takes a toll. Nurses play a very big role in keeping the lines of communication open and forming the trusting relationship that allows patients to discuss their concerns.

What are key takeaways or recommendations as a result of this study for oncology practitioners, especially your nursing colleagues?

Recently there was a discussion about nurses or staff not being comfortable approaching the topic of the patient’s sexual life and their relationship with their significant other. It is critical that nurses and staff members be aware of all issues a patient may face, including sexual concerns, changes in appearance, lack of feeling or sensation in the breast, and drying of the vaginal lining. These concerns should not be ignored or deemed unimportant. Nurses have to feel comfortable approaching patients with these discussions. Patients should also try to bring up their concerns on their own.

There are some long-term impacts on appearance that may affect a person after treatment. Survivors who are done with treatment and moving forward with their lives should not be forgotten. Nurses and medical staff should still be available to them to answer questions and discuss the ongoing changes in their body caused by the treatment for their cancer.

Tamis-Bieder L, Brufsky A, Dickson RB, et al. Impact of metastatic breast cancer and treatment side effects on physical appearance: implications for oncology nurses. Oncol Nurs Forum. 2016;43(2):81.