Understanding Triple-Negative Breast Cancer - Episode 1
Kristie L. Kahl: Can you discuss some of the psychosocial issues that are associated with a triple-negative breast cancer diagnosis?
Dr. Ogori Kalu: Well, let me start by saying that almost everyone who is given a cancer diagnosis has some sort of psychosocial issue or concern. I mean, just the diagnosis itself evokes anxiety, fear, especially just the unknown as far as treatment, diagnosis and overall survival. And of course, the fear and anxiety related to how their cancer diagnosis affects their family. So triple-negative breast cancer patients don't necessarily have anything different or unique than other cancer patients. Only that, you know, things are more specific, I would say for breast cancer patients in general. The top reasons for high levels of anxiety, of course, are the going through the stages of diagnosis and treatment. And you know, long term survival is, of course, “What kind of treatment am I going to face?” (And there is) the anxiety over the possibility of chemotherapy, radiation treatment and surgery, the anxiety of the cancer coming back when the treatment has actually been completed, or the anxiety related to how the treatment will affect them physically, or socially, you know. Of course, the breast is part of a feeling of a woman's sexuality. So it's especially dependent on how she relates with her partner, how will the surgery affect any sexual relations, or how chemotherapy possibly affects future reproductive implications for women who are in childbearing years. So there's an array of different levels of psychosocial issues that women with cancer and triple-negative breast cancer have.
Kristie L. Kahl: We talk a lot about that fear of recurrence, how does this affect a patient through their treatment and then afterwards?
Dr. Ogori Kalu: So fear of recurrence, in particular for triple-negative breast cancer patients, is a little bit more of an issue, in the sense that triple-negative breast cancer patients have a much higher risk of recurrence compared to women who don't have triple-negative breast cancer. So that's more of a reality for them, as far as worrying about it, concerns about it and future treatment options, if possible. So when we're thinking about, you know, fear of recurrence, I think the best way that most of my colleagues tackle that issue is, of course, from the very beginning, having full disclosure and a fully honest discussion with the patient concerning their stage of diagnosis, their prognosis, and what their chances are of recurrence, and reassuring them through their whole process, that their care team will be following them, watching them very closely, to make sure that if a recurrence is to happen, it's quite an early enough stage, because we all know, the earlier we detect cancer, whether it's a primary cancer, recurrent cancer, the better chances of a long term survival and better quality of life options are available.
Kristie L. Kahl: Can you discuss scanxiety as well?
Dr. Ogori Kalu: Scanxiety is really the anxiety that a woman has coming (when) approaching the day of their next scheduled imaging, whether it's a repeat mammogram, CAT scan, MRI or PET scan (to see) whether or not the cancer has come back or whether the cancer has progressed or regressed. And I will say that scanxiety is quite common with women with breast cancer and without breast cancer, because we know that breast cancer is a big fear for women who've never had it, or maybe have a strong family history, as well as for women who have had gone through it. But for the most part, it's something that we all appreciate as providers. We all try and quell the fears of our patients, as we approach that date or are coming to that date.
In some facilities, we actually make it more of a group or team effort, something of a supportive team, where we either encourage the patient to come with someone, come with a friend, or say that we will chaperone them through that scan, that imaging, hold their hand through it, so to speak, just to quell their anxiety and fears, because, of course, it is something that's very scary and frightening to think “What am I going to have to go through in this process again, will this show a worsening of my condition?”
And of course, after the imaging is done, the anxiety of when the results come back, that's always dependent on how soon the radiologist or the physician can read that exam. So, it's really constant reassurance, and allowing them to, of course, vent their anxiety and ask those questions and feel free to have fear. We never want any patient to feel that they should hide their emotion or their feelings or their anxiety at all. Because, you know, for every woman that has anxiety, and like I said, it is quite normal for women in these situations to have anxiety, there are some people whose anxiety levels may not be so easily quelled, so easily calmed. And those women you always want to have special attention brought to because we do know that going through this treatment and some of the treatment that is given to them can actually exacerbate or cause some psychological issues with patients. So you have to be very wary of a woman's concerns and take them very seriously.
Kristie L. Kahl: To help combat some of these psychosocial issues, are there outlets that patients can seek that can help them?
Dr. Ogori Kalu: Oh, absolutely. One thing I always advise or recommend for women who are going through cancer, triple-negative breast cancer, any cancer, for that matter, is to try their best to have a support team from the very beginning. Of course, the multidisciplinary approach, in my opinion, is always best when you're having different fields of physicians or different specialists actually converging with the patient to have a treatment plan that we're all on the same page on. But also that includes a good support network and a support group. One thing we always try and elicit to patients from the beginning is to see what kind of support they have at home. Once we establish whether or not they have a good support network, we'd like to connect them to support groups, or any community groups or cancer survivorship groups that are available within the community for them to reach out to.
And of course, we discuss any kind of hobbies they have on their own before their diagnosis and encourage them to delve into those things. Whether it's journaling, or painting, playing an instrument, something that takes their mind away from the act of treatment that they're on is always a fantastic outlet. And, of course, journaling is something that is definitely encouraged even from the social psychosocial aspect of a document and your feelings and addressing them as they come along and bringing them to the attention of your physician or care team, if there's anything of concern that worries you.
So yes, there are multiple outlets and if there's nothing immediately available through your care team, there are different outlets online, including the American Cancer Society, of course, the Triple-Negative Breast Cancer Foundation, a lot of online outlets that can connect women, in fact, you know, internationally all over the world to some sort of support network, whether it's within their community or even online so that women know that they're not alone.
Kristie L. Kahl: Are there outside resources that we can offer to our patients in case they are experiencing any of this stress or anxiety?
Dr. Ogori Kalu: There are a number of advocacy groups out there, like I mentioned the Triple-Negative Breast Cancer Foundation, the American Cancer Society, of course, the Susan G. Komen Foundation. There's so many breast cancer organizations: living Beyond Breast Cancer, the Young Survivors. There are many different outlets that are available to women online. You know, it's even as simple as just googling breast cancer social support, and you'll see a whole list of different outlets. I do recommend for women who do have a diagnosis of breast cancer starting off with the American Cancer Society, only because it will allow them to utilize not only getting basic education on their cancer, but also they give different avenues for psychosocial support, financial support, education and different ways they can reach out live in their community as well.