MANAGING HORMONE THERAPY RELATED DEPRESSION AND MENTAL HEALTH IN BREAST

CANCER

Managing Hormone Therapy-Related Depression And Mental Health In Breast Cancer

Name: Shristeejote11266

Date: 12/10/21

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Introduction

According to Burstein et al. (2014), breast cancer is considered the most commonly

occurring cancer in women worldwide, presenting a significant public health challenge globally.

According to Gray, et al. (2013), Breast cancer consists of molecularly and biologically

heterogeneous diseases originating from the breast. Research also shows that the leading risk

factors associated with breast cancer significantly vary with genetic predisposition and other

types of breast cancers. On the same note, Davies et al. (2013) argues that cancer mutations in

BRCA1 or BRCA2 genes constitute the main causative factors for malignancy. However, research

shows that patients have better survival compared with other fatal cancers.

Nevertheless, breast cancer is associated with significant mental and emotional

disturbances. This paper, therefore, seeks to review contemporary literature to shed light on the

issues of mental health associated with hormone therapy as a means for breast cancer

management. In this view, this paper will also investigate the main complexities associated with

breast cancer diagnosis and development, the available treatment options for breast cancer

populations and their administration, patients' experience and role in breast cancer therapy to

help improve practice.

Breast cancer Causes and Diagnosis

Causes

According to Gray, et al. (2013), breast cancer occurs when some breast cells begin to

grow and divide rapidly than healthy cells and continue to accumulate, forming a lump or mass

which may metastasize or spread through the breast to the lymph nodes or other parts of the

body. On the same note, Burstein et al. (2014), argues that breast cancer begins in the glandular

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tissue called lobules (invasive lobular carcinoma), at the milk-producing ducts (invasive ductal

carcinoma), or in other cells or tissue within the breast. Recent research has shown that lifestyle.

Hormonal and environmental factors can increase the risk of breast cancer. However, some

studies have also provided evidence that some people can develop cancer without the risk

factors. To this extent, these studies allude that breast cancer is caused by a complex interaction

of one's genetic makeup and their environment.

According to a study by Davies et al. (2013) , it is estimated that between 5 to 10% of

breast cancers are linked to gene mutation transmitted through family generations. Umami, et al.

(2020) explains that breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These

genes increase the risk of ovarian and breast cancer significantly, and have been identified to

increase the likelihood of breast cancer. Further, risk factors can also contribute to a more

likelihood of getting breast cancer. These factors include increasing age, being a female, a

personal history of breast cancer, a personal history of breast condition, inherited genes that

increase cancer risk, a family history of breast cancer, and obesity. Also, Umami, et al. (2020)

add that Beginning your period at a younger age, Beginning menopause at an older age,

alcoholism, postmenopausal hormone therapy, and Having never been pregnant may increase the

chances of developing breast cancer.

Symptoms

According to Burstein et al. (2014), The leading symptoms of breast cancer include a

breast lump or thickening that feels different from the surrounding tissues, changes to the skin

over the breast, such as dimpling, change in the shape, appearance, or size of a breast, a newly

inverted nipple, surrounding the nipple (areola) or breast skin, peeling, scaling, crusting or

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flaking of the pigmented area of skin and pitting or redness of the skin over your breast, like the

skin of an orange. However, Davies et al. (2013) asserts that it is essential to seek prompt

evaluation upon finding a lump or a change in the breast, even if the recent mammogram was

normal.

Diagnosis

Several tests and procedures are helpful in diagnosing breast cancer, including breast

exams, mammograms, breast ultrasound biopsy, and MRI. During breast examination, both

breasts and lymph nodes in the armpit are examined for any lumps or other abnormalities

(Rocca, et al., 2018). On The other hand, Mammogram techniques involve producing an X-ray

of the breast to check for abnormalities. When abnormalities are detected, a diagnostic

mammogram can be utilized for further evaluation of the detected abnormality. According to

Gray, et al. (2013), the use of breast ultrasound refers to the use of sound waves in producing

images in the breast to determine whether a new breast lump is a solid mass or a fluid-filled cyst.

A biopsy can also be used for breast cancer diagnosis.

According to Umami, et al. (2020), a biopsy is the only definitive way to make a

diagnosis of breast cancer. The author explains that the procedure involves using a specialized

needle device guided by an X-ray or another imaging test to help extract a core of tissue from the

suspected region. The retrieved samples are then sent to a laboratory for analysis, where experts

determine whether the cells are cancerous. Lastly, magnetic resonance imaging can also be used

to detect breast cancer. In this approach, a magnet and radio waves are utilized to create pictures

of the interior of the breast. However, an MRI must not use radiation to create the images.

Additionally, it is essential to identify the stage of breast cancer in order to determine the

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prognosis and suitable treatment. To this extent, breast surgery, a bone scan, blood tests

including complete blood count, breast MRI, mammogram of the other breast, positron emission

tomography, and computerized tomography are essential (Gray, et al., 2013).

Breast cancer Treatment Methods utilized in practice

According to research, breast cancer treatment is carried out through surgery which

involves removing the breast cancer (lumpectomy) in a procedure called breast-conserving

surgery or wide local excision, which removes the tumor and a small margin of surrounding

healthy tissue. The surgery can also remove the entire breast (mastectomy), remove a limited

number of lymph nodes (sentinel node biopsy), and remove several lymph nodes (axillary lymph

node dissection), or remove both breasts. Breast cancer can also be treated through radiotherapy,

where high-powered energy beams, such as X-rays and protons, are used to kill cancer cells.

Burstein et al. (2014), observes that radiation therapy is typically done using a large machine that

aims the energy beams at a patient's body (external beam radiation). However, research also

shows that radiation can be done by placing radioactive material inside the body (brachytherapy).

According to research, chemotherapy involves the use of drugs to destroy fast-growing cells,

such as cancer cells (Umami, et al., 2020). This method is highly utilized when cancer has a high

risk of returning or spreading to another part of the body. However, studies reveal that

chemotherapy has several side effects, including nausea, vomiting, hair loss, fatigue, and an

increased risk of infection. Also, the rare side effects can include premature menopause, damage

to the heart and kidneys, infertility (if premenopausal), nerve damage, and, very rarely, blood

cell cancer (Gray, et al., 2013). Other approaches include targeted therapy drugs that attack

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specific abnormalities within cancer cells, immunotherapy uses the immune system to fight

cancer, Palliative care is specialized medical care focusing on providing relief from symptoms of

a severe illness and pain, and hormone therapy. The following section will analyze the efficacy,

psychological problems, patent perceptions, and practice improvement regarding hormone

therapy.

Hormone Therapy for Breast Cancer Treatment:

Overview

Hormone therapy (hormone-blocking therapy) is leveraged for breast cancer treatment,

which is sensitive to hormones (Davies et al., 2013). Research shows that hormone therapy can

be used before or after surgery or other treatments to decrease the chance of cancer returning.

Therefore, If cancer has already spread, hormone therapy may shrink and control it. According to

(Davies et al., 2013), the three leading treatments based on hormone therapy include surgery or

medications to stop hormone production in the ovaries and Medications that block hormones

from attaching to cancer cells (selective estrogen receptor modulators). However, hormone

therapy has several side effects, including hot flashes, night sweats, and vaginal dryness. Also,

hormone therapy is associated with severe side effects such as a risk of bone thinning and blood

clots.

Efficacy and patience paception

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A study by Adamowicz and Baczkowska-Waliszewska (2020) investigating the quality of

life during chemotherapy, how antiHER2 therapy or monotherapy of patients with advanced,

metastatic breast cancer involving 351 patients treated in the period from 2010 to 2016 (January

to December) in two centres was analysed showed that Chemotherapy compared to trastuzumab

and hormonal therapy was associated with more significant total toxicity (p = 0.03).

Furthermore, there was a significant correlation between the type of therapy and the general

average quality of women’s life measured with the EORTC-QLQ-C30 questionnaire.

Further, a statistically significant difference was established in some somatic complaints

(the scale of QLQ-BR23 symptoms) depending on the type of therapy performed. Therefore,

hormone therapy and trastuzumab therapy improved the quality of life of the treated patients in

clinical practice. In a related study by Wouters et al. (2013) investigating disentangling breast

cancer patients’ perceptions and experiences concerning endocrine therapy: nature and relevance

for nonadherence, online focus groups were used. The study resolved that to understand and to

improve women’s adherence to endocrine therapy, women’s perceptions and experiences about

endocrine therapy should be targeted in addition to common beliefs that apply to a wide range of

medicines.

Mental Health Impacts

A study by Day et al. (2019) to systematically review the evidence on adverse mental

health outcomes in breast cancer survivors found cancer survivors also had statistically

significantly increased symptoms/frequency of neurocognitive dysfunction (18 of 24 studies),

sexual dysfunctions (5 of 6 studies), sleep disturbance (5 of 5 studies), stress-related

disorders/PTSD (2 of 3 studies), suicide (2 of 2 studies), somatization (2 of 2 studies), and

bipolar and obsessive-compulsive disorders (1 of 1 study each). On the same note, Jenkins et al.

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(2014), in the study investigating whether hormone therapy for breast cancer affects cognition,

revealed that the patients (n=94) were impaired on a processing speed task (p=0.032) and a

measure of immediate verbal memory (p=0.026) after controlling for hormone replacement

therapy in both groups compared with the control group (n=35). Based on these results, specific

impairments in processing speed and verbal memory in women receiving hormonal therapy to

treat breast cancer. Furthermore, verbal memory may be especially sensitive to changes in

estrogen levels, a finding commonly reported in studies of hormone replacement therapy in

healthy women. Therefore, the increased use of hormone therapies in an adjuvant and

preventative setting and their impact on cognitive functioning should be investigated more

thoroughly. Contrarily, Ates et al. (2016), in their study investigating the psychosocial and

medical characteristics of women who initiated aromatase inhibitors or tamoxifen for breast

cancer by involving 104 women currently receiving tamoxifen or aromatase inhibitors, revealed

that patient variables, rather than the medical or treatment characteristics, were related with

emotional distress in women undergoing endocrine treatment. For that reason, medical staff must

be aware of patient factors related to distress during a long period of adjuvant endocrine therapy.

Conclusion

This paper investigated the hormone therapy-related mental health impacts for patients

with breast cancer. Therefore, the study reviewed related literature regarding the concepts of

breast cancer cause and treatment. However, the study focussed on hormone treatment. In

conclusion, the study has revealed that even though hormone theory presents significant positive

treatment outcomes to patients, the treatment method still has challenges, including adverbs and

cognitive outcomes. The study also established that patient-related aspects or variables, rather

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than the medical or treatment characteristics, were related to emotional distress in women

undergoing endocrine treatment; the study, therefore, suggests that medical staff must be aware

of patient factors related to distress during a long period of adjuvant endocrine therapy.

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