Psychological well-being

Receiving a diagnosis of secondary breast cancer can be an extremely traumatic time for you, and for those around you, as you come to terms with what this means and try to manage the many emotions you are likely to be experiencing.

For women living with secondary breast cancer, the psychological and emotional impact can be as real and as debilitating as physical symptoms and side effects.

Accessing psychological support can help you and your loved ones to see a way forwards.

There are many forms of psychological support which are suited to different ways of discussing and dealing with emotional experiences, whether self-guided, one to one with an experienced professional or in a group with people who are going through the same situation.  Whatever your preference, there will be support to suit your needs.

Here, we explore the benefits of looking after your psychological well-being, the different forms of psychological support available and the ways in which you can cope with your emotions and the emotions of those around you.

In this section

Talking about secondary breast cancer

Some people find it difficult to discuss their cancer as it can make everything seem more real and can bring up emotions they may not feel ready to deal with.

Others may wish they could talk about their cancer but worry about upsetting or worrying their family or loved ones.

However, there are lots of benefits to be had from opening up about your cancer and how you are feeling to someone you trust, whether a loved one, professional, or someone with shared experience. This can:

  • Help you to feel less alone.
  • Help you to feel more in control.
  • Support you in finding new ways to cope.
  • Improve your quality of life and help you to feel more able to carry on with your day to day life.
  • Help you to feel more able to manage physical symptoms and side effects.
  • Improve your sleep.
  • Strengthen your relationship with a friend or loved one.

Coping with your emotions

It is very common for women diagnosed with secondary breast cancer to go through a whole range of emotions over time, including shock and denial, anger and frustration, fear and anxiety, loss of control, sadness, grief and depression.

Fear or anxiety of death in secondary breast cancer is a completely logical and natural reaction to have when faced with a diagnosis for which there is no cure. Yet the fact that it is such a rational fear can make it very difficult to overcome and to see past.  

If you are feeling, or have felt any of these emotions, you are not alone. It is not unusual to feel completely overwhelmed when you are placed under such extreme stress and this can place even more strain on you and your relationships.

A study which surveyed 227 women with advanced breast cancer found that over 30%, or approximately one third, of those questioned were experiencing depression, anxiety or both.[1]  

Younger women with advanced cancer are also known to be even more likely to suffer from depression at some point. [2]

Coping with emotions is just as important a concern as managing physical symptoms and side effects. Just as there are medicines and management strategies for symptoms such as pain and nausea, there are treatments and therapies for psychological symptoms.

In fact, we know that psychological effects of a secondary breast cancer diagnosis, when left untreated, can worsen other symptoms you are experiencing and make it much harder to stick to your treatment [3, 4].

Accepting or seeking help is not a sign of weakness or an indication that you cannot cope. It may take a lot of strength and courage to open up about how your cancer diagnosis is affecting you but this shows that you are taking control.

Seeking psychological support

No two experiences of secondary breast cancer are the same. It can affect people very differently, requiring different amounts and sorts of support at different times. There are a variety of forms of psychological support which are suited to the very different needs and preferences of different people.

Some may find psychological support from their loved ones or friendship group. Opening up to someone you know and love can help to bring you closer together and guide each other through the more difficult times, knowing that they understand what you are going through. 

Others may wish to open up to someone outside of their close circle of loved ones, to someone who is able to offer support, advice and perspective in the absence of emotions and worries shared by those who know and love them.

If you are struggling to cope with the emotions, thoughts and feelings you are experiencing, please speak to one of your health professionals. They will be able to talk things over with you and help to identify the best source of support for you.

Whilst it may feel like your consultant (or, if you have one, your breast cancer nurse) doesn’t always have the time available to discuss these sorts of things, it is important for you to let them know how you are feeling. Your psychological well-being is an important aspect of your cancer and treatment. Together, you may decide that a form of psychological support would be helpful for you.

They will be able to refer you towards a range of sources of support, such as:

Talking therapies

Counselling & psychologists. Speaking to a trained counsellor or psychologist can help you to explore the thoughts and emotions you are having. These professionals will be able to listen and to guide you through your feelings, reactions and even personal or practical issues, helping you to explore ways of coping with them. Clinical psycho-oncologists have particular expertise in the psychological and emotional impact of cancer. They are trained to help you to look at how your patterns of thinking and certain behaviours are affecting your psychological well-being. Your hospital may have a psycho-oncology service on site, where you can be referred for counselling session or a psychologist may come to see you if you are in hospital having treatment or as an inpatient.

There may be a counselling service at your GP. Alternatively, your hospital doctor (or, if you have one, your breast cancer nurse) may refer you be able to refer you towards a charity-led service.

Macmillan cancer support specialists may also be able to advise you of counselling services in your local area. If you are currently working, a counselling service may also be available through your employer so it is worth speaking to them to see if you can access support in this way.

Cancer Research UK have a range of further information on counselling. The NHS website also provides guidance on how and where to access counselling.

It may be that when you ask for a referral to these sorts of services, you are placed on a waiting list. If this feels like too long a wait to get the support you need, you may be able to self-refer or find some other sources of psychological support helpful.

Self-referral to IAPT. ‘Improving Access to Psychological Therapies’ is a programme in England that aims to make it easier and quicker for people to access talking therapies for common mental health problems such as anxiety and stress.

This means that you don’t need your GP to refer you to a counselling service. You are able to self-refer online or contact the service yourself. You can find a service local to you by going to the NHS website, typing in your area and searching for ‘psychological therapies (IAPT)’. This website also has information on where to access services if you are based in Scotland or Northern Ireland.

Macmillan have some further information on a range of psychological self-help therapies and who you can go to for psychological support to ensure that you are always able to access support when you feel you need it.

Cognitive behavioural therapy (CBT). CBT is a talking therapy which is useful for people who are struggling with anxiety, stress and depression. It focuses on the problems you are facing in the present. The therapist guides you to recognise and address particular thought patterns and behaviours which may be stopping you from feeling in control of your emotions or being able to move forwards.

Your doctor, nurse or GP will be able to refer or direct you towards courses or services providing CBT in your local area.

The mental health charity, Mind, have further information on CBT on their website, including what to expect and how to find a CBT therapist, both on the NHS and privately.

Other sources of psychological support

Support & self-help groups. There are lots of different types of support groups. Some are guided by trained therapists or other professionals. Others, generally referred to as self-help groups, are less formal, more open discussions between members who are going through similar experiences.

Some breast cancer support services and charities have support groups which women with all stages of breast cancer are free to attend. Some women with secondary breast cancer find this mix of experiences positive and useful whilst others worry that their experiences of later stage cancer will frighten women with primary breast cancer and feel unable to open up around them.

Other charities, such as Breast Cancer Now and Breast Cancer Haven, have support groups specifically for women with secondary breast cancer. Some women feel more comfortable and able to open up honestly about their feelings and experiences amongst women at the same stage as them.

These groups can be a good opportunity to talk though your feelings and experiences with people who understand exactly what you are going through. They can be a form of both emotional and practical support.

Support groups are not for everyone. You may find that hearing other peoples’ experiences of secondary breast cancer, and collectively supporting them to manage problems, is not necessarily good for your own mental health. Some people prefer to meet with their own friends and discuss everything but their cancer. This in itself can be a source of psychological support in allowing yourself to forget about things for a little while.

There is no right or wrong way of coping.

If you are unsure whether this sort of support is right for you, you can contact the organiser of the support group and ask for further information or to drop in and observe part of a session.

Those leading or organising the group are often happy for family members to come along too if you feel nervous about attending alone.

Online support groups and forums. Some people find that they feel much more able to open up and comfortable sharing their emotions and feelings online to others who are going through similar experiences. Even if you don’t feel comfortable sharing things yourself, online chats and forums can be a useful place to get support and reassurance by browsing other people’s experiences.

It is good to remember, however, that you may come across distressing information which you may not be ready to see or prefer not to know. Depending on what you are going through at the time, reading about other peoples’ experiences, whether positive or negative, may not always be what you need.

Select the conversations you enter into carefully. If you are finding online support groups and forums are having a negative impact on how you are feeling, stop using them. Remember that you are in control of what you see and you do not have to read or respond to everything.

Online mental health services & support. There are an increasing number of resources available online. You may choose to explore these options first, or alongside any face to face psychological support you might be having. Some therapists may even deliver sessions online, which can be as effective as having therapy in person.

The NHS website, Moodzone, has a wide range of information and resources to support your mental well-being.

There are also lots of self-help mobile applications available such as Headspace, which teaches and encourages users to practice mindful meditation as a way of looking after their mental (as well as physical) health. This mobile app was tested in a scientific trial with women with breast cancer. Those who used Headspace were found to have higher quality of life than those who did not [5].

The NHS website lists a range of other mobile applications which have been designed to help users to manage a wide range of different mental health concerns.

The Mind website also has a whole host of information relating to mental health and where & how to access support.

If you are feeling low in mood or anxious, please also see our Self-management advice for information on how to manage and seek support for these symptoms.

Coping with other people’s emotions

Coping with the emotions of others and their reaction to your diagnosis can be a difficult and ongoing process. It may feel like an added burden that is a struggle to manage alongside everything else. Not only are you coming to terms with living with secondary breast cancer and processing the many emotions you are likely to be feeling, you may also be faced with managing the upset, anxiety, fear, confusion or even denial of those close to you.

You may find it difficult to know who you can share things with and how much you should share.

It may feel awkward for example, bumping into acquaintances, neighbours or colleagues and knowing how to answer the question, “How are you?” or responding to “you look well!” when they may not be aware of your situation or understand that your secondary breast cancer cannot be cured and that your treatment will not finish.

Tips on how to manage other people’s reactions to your diagnosis

Share as much as you feel comfortable. If you don’t feel comfortable discussing your diagnosis and what you are currently going through, don’t. If the thought of discussing your cancer with people you don’t know very well and coping with their reaction is causing you stress, just let people know on a ‘need to know basis.’ Ask yourself, do they really need to know? You may find having a line or brief explanation rehearsed takes the pressure off when you do bump into someone unexpectedly.

Let people know if you are happy to talk. If friends or loved ones are struggling to face your diagnosis or are not willing to talk about it, let them know that you are happy to talk about it when they feel ready. Equally, if a person wants to talk to you lots about your cancer and go over every detail, don’t feel guilty letting them know if it becomes too much. You must protect yourself and look after your own mental well-being before you can support others.

Encourage them to seek support. Whilst you may feel a responsibility to support friends and loved ones and help them to deal with their emotions, this can be a real burden when you are already struggling to manage your own feelings. In encouraging them to seek support, you will be helping others, and yourself, to feel stronger and more able to cope. You can still be there for your loved ones and they are likely to feel more able to support you.

Let them know how you are feeling too. There may be times when you feel more emotionally and physically strong and able to support others through the emotions they experience in response to your diagnosis. However, there will be times when you do not have the emotional reserves or energy and you need the support of others. Tell your loved ones how you are feeling and don’t be afraid to let them know what you need (e.g. for them to sit down with you and listen to the worries you’re having). This can help to set boundaries and give you the chance to take a step back if you feel you are struggling with the burden of managing other peoples’ emotions.

Let them know how they can help. This may help friends and loved ones to be able to channel their emotions in a constructive way, have something to focus on and feel involved in supporting you.

Macmillan have a range of further information and guidance to support women with secondary breast cancer to deal with others’ reactions.   

Please also see our section on Relationships, sex & intimacy for information and guidance specific to relationships with partners.

References

  1. Grabsch B, Clarke DM, Love A, McKENZIE DP, Snyder RD, Bloch S, Smith G, Kissane DW. Psychological morbidity and quality of life in women with advanced breast cancer: a cross-sectional survey. Palliative & supportive care. 2006 Mar;4(1):47-56.
  2. Kissane DW, Grabsch B, Love A, Clarke DM, Bloch S, Smith GC. Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis. Australian and New Zealand Journal of Psychiatry. 2004 Jan 1;38(5):320-6.
  3. Palesh OG, Collie K, Batiuchok D, Tilston J, Koopman C, Perlis ML, Butler LD, Carlson R, Spiegel D. A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer. Biological psychology. 2007 Apr 1;75(1):37-44.
  4. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Archives of internal medicine. 2000 Jul 24;160(14):2101-7.
  5. Rosen KD, Paniagua SM, Kazanis W, Jones S, Potter JS. Quality of life among women diagnosed with breast Cancer: A randomized waitlist controlled trial of commercially available mobile app‐delivered mindfulness training. Psycho‐oncology. 2018 Aug;27(8):2023-30.

Page last updated: April 2020