DEAR DOCTORS: My best friend has breast cancer that has spread to her lymph nodes, and she needs to have a double mastectomy. Can you please talk about how all of this can psychologically affect you? What can I do that will help her and not be a burden?
DEAR READER: Learning that you have any form of cancer can have a profound impact on mental health. It often begins at the moment of diagnosis, when the seamless flow of daily life is suddenly bifurcated into "before" and "after". The new reality means a seemingly endless series of medical appointments, treatments that are often scary and painful, a lack of certainty those treatments will be successful, and living with the possibility of a future recurrence.
All of this can lead to a range of complex and shifting emotions, including fear, anxiety, grief, anger, helplessness, sorrow, loneliness, hopelessness and depression. These can be magnified when treatment for breast cancer includes mastectomy, which is the surgical removal of the breast. In our society, a woman's breasts are often associated with beauty, sexuality and femininity, and of course, motherhood. So in addition to the pain of surgery and the rigours of recovery, losing a breast can also often have a profound psychological effect.
Some women who have undergone a mastectomy say they struggle with body image issues after the surgery. They feel self-conscious about their altered bodies and mourn the loss of their former selves. They worry about being able to feel sexy and about being desired.
Many say that, despite the best efforts of friends and family, the changes forced upon them by the realities of cancer treatment leave them feeling isolated and alone. Your friend is likely feeling at least some of this.
Support following a mastectomy takes two basic forms -- practical and emotional. Both will be meaningful. On the pragmatic side of things, you can offer to help with daily tasks. This might be picking up kids from school, washing dishes, walking the dog, booking and tracking medical appointments, cooking a meal or doing a grocery run. When one task is done, ask for another.
As your friend gets her physical strength back, you can help her ease back into the outside world. Many women who have had a mastectomy find shopping for new clothes to be an emotional minefield.
With a bit of research, you can help her find brands that specialise in fashionable yet comfortable clothes and lingerie designed for women who have had this surgery.
Emotional support can begin by simply asking her how she feels and then listening. It is important to let your friend express her emotions, including the dark ones, and to be accepting of what she says. Being allowed to speak freely and be heard without judgement go a long way to easing the sense of isolation that is common in people dealing with a life-threatening disease.
Keep in mind that the psychological recovery following a mastectomy can take much longer than the physical one. Be patient, be kind and let your friend know that you're with her for the long run. Universal Features Syndicate
Dr Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health.
