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Ask the Expert: Managing Metastatic Breast Cancer and Your Mental Health

Written by Michelle Azu, M.D. on October 5, 2020

1. Can breast cancer cause depression? Breast cancer isn’t known to cause depression directly. Yet, managing a breast cancer diagnosis in addition to its treatments can disrupt your emotional well-being.

Although more information is needed to understand the details surrounding the association, studies have found rates of depression to be high in breast cancer patients.

A meta-analysis conducted in 2019 found the global prevalence of depression in people with breast cancer to be 32 percent.

2. Can anxiety and stress cause cancer? More studies are needed to understand the relationship between anxiety, stress, and cancer. So far, there’s no clear evidence breast cancer is caused by these factors. However, stress and anxiety can have a negative impact on your overall health and psychological well-being if they’re not managed.

Chronic stress is associated with a hit to your immune defense. One thought being studied is that a weakened immune system creates an environment where cancer can grow.

Another consideration under investigation is that chronic stress results in unhealthy behaviors, such as increased alcohol use, smoking, unhealthy eating habits, that are linked to an increased risk of developing cancer.

3. Can stress and anxiety cause cancer to spread faster? There’s no scientific information out there strong enough to support that stress or anxiety alone causes cancer to travel at a faster rate.

More studies are needed, but it’s good news that no clear link has been found. Cancer is stressful enough without having to worry that the stress of worry is making your cancer grow faster.

4. What are the emotional stages of having cancer? A range of emotions can be experienced when adjusting to a cancer diagnosis. Each person’s response is unique, but some may experience stages of grief at some point on their journey.

Stages of grief stages are often associated with death, but they can also be applied when someone experiences extreme loss, like a cancer diagnosis. The stages are:

  • denial

  • anger

  • bargaining

  • sadness or depression

  • acceptance

The emotions people with cancer feel aren’t limited to five, but knowing the cycle associated with grief can be helpful on your journey.

5. Can you get PTSD from cancer? If so, how’s it managed? Post-traumatic stress disorder (PTSD) is a mental health condition triggered by a traumatic event. Studies show PTSD rates are as high as 32 percent in people with breast cancer, with up to 75 percent having at least one symptom seen in PTSD.

Experiencing some worry after a cancer diagnosis is common, but extreme worry can become so psychologically disruptive that it interferes with routine activities.

It’s important to get the help of a mental health expert. They may help reduce discomfort for those with new or increased emotional distress after a cancer diagnosis.

6. What is chemo rage? A change in personality during cancer treatment, like chemotherapy, marked by sudden anger, irritability, or erratic behavior is often referred to as “chemo rage.”

This may be a result of various factors, but the reason behind the described condition is often linked to steroids used to support chemotherapy treatment.

If you have unexpected personality changes during treatment, it’s important to discuss them with your care team so you can get a proper evaluation and discuss your options.

7. Does your attitude affect your likelihood of surviving your cancer? There’s no clear evidence suggesting attitude impacts cancer survival. A large, prospective trial with 3 decades of follow-up didn’t identify a relationship between personality, cancer risk, or survival.

That said, there’s some evidence a positive attitude can improve the quality of your overall health.

8. Besides seeing a mental health professional, what else can I do to manage my mental health? Make a point to see, feel, and hear nature. If all three aren’t an option, even one can help boost your mood. If you can’t get outside but you have access to the internet, search for nature sounds, close your eyes, breathe deep, and listen.

Journaling can also help decrease feelings of stress and sadness. Writing your feelings may help give you a space for reflection and help manage your thoughts.

Acknowledging your feelings and practicing meditation can also be powerful tools for your well-being.

One approach may work better than another. There are many ways to try to reduce stress levels and negative feelings. Remember, your care team can provide resources for professional support if you need it. Don’t be afraid to ask.


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  • American Psychological Association. (2020). Stress in America [Press release].

  • Brown LC, et al. (2020). Posttraumatic stress disorder and breast cancer: Risk factors and the role of inflammation and endocrine function. DOI: 10.1002/cncr.32934

  • Kim ES, et al. (2017). Optimism and cause-specific mortality: A prospective cohort study. DOI: 10.1093/aje/kww182

  • Lutgendorf SK, et al. (2015). Biobehavioral approaches to cancer progression and survival: Mechanisms and interventions. DOI: 10.1037/a0035730

  • Nakaya N, et al. (2010). Personality traits and cancer risk and survival based on Finnish and Swedish registry data. DOI: 10.1093/aje/kwq046

  • Pilevarzadeh M, et al. (2019). Global prevalence of depression among breast cancer patients: A systematic review and meta-analysis. DOI: 10.1007/s10549-019-05271-3

  • Song H, et al. (2017). Perceived stress level and risk of cancer incidence in a Japanese population: The Japan Public Health Center (JPHC)- based prospective study. DOI: 10.1038/s41598-017-13362-8


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