Breast Cancer — How Do You Cope?

Isabel Toca, a participant in a stress-reduction study at Sylvester, says the need for stress-management skills and emotional support starts at diagnosis and keeps going.

Isabel Toca is quick to point out how fortunate she was that her breast cancer was detected so early – almost by accident. She needed only lumpectomies for removal, a three-week course of radiation therapy, and a long-term regimen of an oral drug that treats hormone-dependent breast cancer.

But while she’s thankful that her breasts and her life have been spared, she’s also keenly aware that there’s no such thing as an “easy” cancer – one that comes without a fight, fear, or emotional trauma.

“Normal life as I knew it no longer exists,” she says.

You create a ‘new normal’ life.

Isabel Toca

She got help in that creation by joining a cancer survivors’ group that’s part of a study at Sylvester Comprehensive Cancer Center. The study was aimed at helping current and future survivors recognize and combat the many manifestations of cancer-related stress.

Toca, 59, a resident of Miami, had faithfully undergone annual mammograms and ultrasounds for years. She’d even had a few minor procedures to biopsy and remove benign cysts. But when the COVID-19 pandemic upended routine life, her January 2021 appointment was postponed until later that year.

When she returned, her doctor thought she had noticed something abnormal in Toca’s right breast. That was a false alarm, but it prompted an additional diagnostic workup that detected a minuscule lump in her left breast – so tiny, Toca says, that without the extra attention and focus, it would not have been found until much later.

It took two lumpectomies a month apart, each performed through the same small incision, to take out all the cancer cells and some lymph nodes.

Doctors say there’s less than a 5% chance of recurrence. 

“I had one of the best outcomes ever,” Toca says, but the fear and stress brought about by a cancer diagnosis start immediately and spike every time the phone rings. Undergoing surgery and radiation therapy during the COVID-19 era and its hospital visitation restrictions meant facing treatments without her husband’s support and making decisions by herself.

The sources of stress piled up:

• Waiting for test results and making major decisions at the start of treatment.
• Undergoing and recuperating from two operations.
• Going through 15 sessions of radiation therapy, with its assessments, treatment planning, targeting tattoos and markings, and raw, painful skin.
• Interacting with well-meaning friends and relatives who often didn’t know what to say or how to relate.
• Taking a pill every day for at least five years that is like “a bomb,” Toca says, because of its side effects. “Everything hurts. It affects your bones. It affects your joints. It affects your hair, affects your liver, affects your kidneys.”
• Making sure medications will not interact with others or staggering their timing to be sure they don’t.
• Dealing with many limitations that previously didn’t exist.
• Coping with increased cholesterol and other side effects of medications, “brain fog,” a case of shingles, and rollercoaster emotions when “something” in a breast required an MRI, but results suggested it’s probably benign.

“The stress is not only finding out that you have breast cancer. It’s not only the surgery. It’s not only the physical treatment but also the medications. You have to still live and try to adjust to daily life,” Toca says. “It feels like it’s never over.”

Toca joined the Sylvester breast cancer survivors’ group and research study, focusing on stress awareness, cognitive restructuring, coping, quality of life issues, social support, anger management and assertiveness. It provided training in deep breathing, muscle relaxation, imagery and meditation. The members benefit not just from the structured program, complete with exercises and homework, but from talking to and learning from each other.

“From the moment they’re diagnosed and well into survivorship, cancer patients face many emotional challenges, including anxiety, depression and distress,” says Michael Antoni, Ph.D., a lead investigator in Sylvester’s Cancer Control Research Program, professor of psychology, and the first author of a paper published in Annual Review of Psychology on how stress reduction approaches can improve outcomes for cancer patients.

“Some work has suggested that chronic distress can affect neuroendocrine signaling, producing stress hormones that could promote poorer cancer outcomes,” Antoni says, adding that stress-activated hormones have been shown to impair the immune response to cancer, increase inflammatory signaling and potentially hasten metastasis.

Patricia Moreno, Ph.D., Sylvester’s lead of evidence-based survivorship care and assistant professor in the Department of Public Health Sciences, has studied stress management techniques for patients with cancer, focusing primarily on those with breast cancer and prostate cancer.

Strategies include relaxation techniques, such as deep breathing and meditation, and cognitive behavioral therapy (CBT), which aims to help patients actively change thoughts and behaviors.

“We teach patients to discern between controllable and uncontrollable stressors,” Moreno said. “For controllable stressors, CBT techniques help them become aware of how they respond to stress and develop adaptive coping strategies. For uncontrollable stressors, relaxation techniques and social support help them manage their emotional responses.”

The researchers say psychological interventions reduce stress and promote emotional well-being, which may prolong survival. Patients receiving the interventions have increased antiviral immunity signaling and decreased inflammatory signaling – important benefits because cancer treatments can increase inflammation.

The study Toca participated in – VSMART (Videoconferenced Stress Management and Relaxation Training for Older Women With Breast Cancer) – was funded by the Florida Department of Health. The remotely delivered telehealth program was able to provide stress intervention throughout the COVID-19 pandemic.

For years, Sylvester and University of Miami researchers have conducted interventional and survivorship research studies, such as VSMart and Encuentros de Salud, to support patients with chronic conditions. Avanzando Caminos is a new study of Hispanics and Latinos who have completed cancer treatment that can help tailor future evidence-based cognitive behavioral stress management interventions for Hispanic and Latino cancer survivors.

Toca says she was supported by her faith in God and inspired by the humanity behind the 10-week stress awareness study. 

“There are people out there willing to go out of their way and do research and seek answers and also comfort strangers. I received a lot of comfort as a human being.”

She says the need for stress-management skills and emotional support doesn’t end with surgery; it’s ongoing. 

“You need coping techniques. You need help. You need to address it and not just put on a Band-Aid,” says Toca, adding that it was important to her that the data gathered from the study will go toward helping other women.

“As human beings, we still need to be nourished,” she says. “We still need to be educated.”

One thing Toca learned is that it may be hard, but she can stop, breathe deeply, and let things go during times of high-level stress.

Today, she goes to the beach to quiet her anxiety, but Sylvester’s program taught her that she can go anywhere anytime, even if only in her imagination.

“My happy place was sitting on a beach, hearing the coconut leaves, the sound of the ocean, the waves, and feeling the sun penetrate,” she says. “It’s finding your niche as to how you’re going to cope.”

For more information on cancer-related stress management studies and programs at Sylvester, please email [email protected] or visit www.TogetherAfterCancer.com. You may also call (305) 284-8288.

Kevin McClanahan is a contributing writer for UHealth’s news service.

Tags: cancer survival, Dr. Patricia Moreno, stress after cancer, survivorship program