Breast Cancer in Young Women: Emotional Support Remains Crucial

By Dr. Peter Hofland, PhD

A deadly disease. You may think you can’t get it. But it can happen to anybody. How to cope?

In September 2000, one week before turning 32, Hazel Flynt, a specialist in the study of patient-centred care, crashed into a wall she couldn’t have imagined was in front of her. The mother of a toddler daughter and an infant son was diagnosed with breast cancer. "I thought people had to be in their 50s to get cancer," the Amsterdam resident says. "And then it happened to me.” Flynt was not prepared for this devastating news. “This could not be true. I had no family history, no risk factors, so the diagnoses could not be right…. It was terribly shocking, to say the least.”

Every day an average of 30 women in The Netherlands learn that they have breast cancer. With 1 out of 9 woman getting the disease, it is the most common cancer among woman in this country. Only 5 to 8 percent of breast cancers occur in women with a clearly defined and recognized genetic predisposition for the disease. Significantly, after genetic predisposition and lifestyle factors such as smoking, drinking and obesity are taken into account, breast cancer often occurs in most cases for reasons unknown. Age is among the risk factors for developing breast cancer. Incidence rates are the highest among women from ages 50 – 69. But diagnosis of breast cancer among young women such as Flynt, is far from rare. On average 24% of all Dutch woman diagnosed are under the age of 50.

Prognosis

Five years after diagnoses, 83% of breast cancer patients in The Netherlands are ‘cured’. Although treatment is initially successful for many women, the Dutch KWFKankerbestrijding (Dutch Cancer Society) estimates that in the first five years after diagnosis, breast cancer will return in about 2% percent of young cancer patients. This is one reason for increased psycho-social effects and stress among survivors of the disease. Says Flynt: “Younger woman are especially hard-hit by feelings of vulnerability and fear”.

Aftermath of treatment

Flyn’s personal experience has opened her eyes for the many issues young woman with breast cancer face. Many of these are not widely recognized as important. Many young breast cancer patients are focused on building their professional careers or getting married and starting a family. “Younger women may want to have children. But that’s an option often eliminated by chemotherapy when patients may become menopausal as a result of their treatment,” Flynt explains. The surrounding social environment can be especially hard for younger woman when it comes to this. As a result, they are most likely to be depressed and have a negative attitude towards life in general. “Their world is turned up-side-down at a time when they are about to be socially and economically productive as colleagues, business owners, wives and mothers,” notes Flynt. “They are at a time in their lives when cancer is definitely not on their list of expectations.” Another challenge is dealing with the aftermath of treatment which may be different for each breast cancer patient. After all the procedures and treatments, the medical system drops away. And while the special attention from loved ones, family and friends remains for some time, it will also fade with time. “It is not uncommon for patients to be told that ‘now they are cured they should act like it’,” notes one psychiatrist dealing with the psycho-social impact of breast cancer.

Research findings from The Netherlands, presented in 2004 during an international cancer symposium, show that two out of three woman who were under the age of 50 when diagnosed with breast cancer, often face serious problems more than 10 years after their initial diagnosis. These findings indicate that more than one-third of woman suffer emotional stress. Serious problems at work (20%), financial problems (17%) and sexual dysfunction (34%) are also mentioned. "It's hard to say that things are back to normal when one survives breast cancer," explains Flynt. Interestingly, women over age 50 when they where initially diagnosed seem to suffer less long term effects of cancer diagnoses and treatment.

“Younger woman may not allow themselves enough time to deal with the effects of the disease as older woman, who have had more life experience,” says Dr. Lonneke van de Pol-Franse, a senior researcher at the Comprehensive Cancer Centre South in Eindhoven, The Netherlands. “Although new drugs, new treatment regimens, and better diagnostic techniques have improved the outlook for many, patients have strong needs for information and supportive, communicative relationships with healthcare providers, both of which can significantly affect their emotional health and possibly health outcomes,” notes Van de Poll-Franse. “Even the way information is presented may influence patient treatment decisions”, she explains.

Although women in general have greater options in breast cancer treatment compared to a decade ago, with new drugs and procedures opening up a whole new era of effective treatment, communication still remains crucial in coping with the disease. Follow-up care for breast cancer patients Follow-up care for breast cancer survivors may involve mammography - an X-ray examination of the breast - plus clinical breast exams in order to determine whether the cancer has returned. Some physicians also opt to use additional tests, including bone scans, blood tests and X-rays to determine the presence of cancer, despite a lack of evidence that these improve survival rates. While scientists believe that these tests do not necessarily reduce patients' anxieties about having a relapse, patients involved in discussing the various treatment options with their doctor and then being involved in their treatment decisions, generally feel better emotionally and physically than those who are not.

Breast cancer patients may have high information requirements. Research into the information needs of patients shows that their most important needs are related to the disease itself, how it acts in the body, the chance of recurrence, treatment, coping with side-effects and impact on and quality of life. Helping patients make informed choices about their treatment and follow-up care can therefore be made easier when options are clearly laid out.

How to talk to your doctor

Young breast cancer patients who are experiencing physical and emotional problems can take steps to help themselves. There are loads of medical remedies for many of the late effects of breast cancer treatment. First and foremost, letting a doctor know about these symptoms is an important step. Says one oncologists: “Cancer patients need to make the most of their time with their doctor by preparing how they will explain their problems fully and consistently”. On the other hand, research seems to indicate that women want very specific information, and healthcare professionals must be prepared to provide it throughout treatment. Physicians should be encouraged to talk to their patients about follow-up treatment, testing and care and inform them that some of the more complex tests for recurrent cancer are not necessarily associated with improved quality of life. Then again, breast cancer patients should realize that their condition does not necessarily have to be a prison sentence either. Even knowing they aren't alone in having physical or emotional side effects of their treatment can be a great help. Many survivors focus so intensely on just getting through their disease that they don't realize there could be side effects down the line. Doctors need to let these women know they're not crazy. What they're experiencing is what a lot of other women in their age group experience,"explains Flynt.

Peter Hofland, PhD is a medical consultant and freelance medical writer. He primarily write about cancer and infectious diseases for various international publications and lives in Almere, The Netherlands and Chandler, Arizona (USA). You can contact him at p.hofland@hotmail.com" s_oidt="0">p.hofland@hotmail.com 

For More information For more information on breast cancer care contact any of the following organizations in The Netherlands: Dutch Breast Cancer foundation (Borstkankervereniging Nederland) Internet: http://www.kankerpatient.nl/bvn/  E-mail: info@borstkankervereniging.nl

Quote

Children who eat fries raise breast cancer risk - - MSNBC.com

 

"The importance of a healthy diet has been emphasized many times. Unfortunately, people - parents - in the so-called developed nations are still disregarding this. If parents really love their children and want to be responsible for the happiness and wellbeing of their children, they should reduce the intake of ‘junk food’ such as the legendary ‘happy meal’. Maybe their children will be thankfully happy in later years..."

The Economic Impact of New Drug Therapy

By Peter Hofland, PhD

Policymakers often raise the question “Do ‘new’ and innovative drugs costs too much?”.  Although innovative ‘new’ drugs may be more expensive than alternative, existing, drug therapies, they are extensively reviewed for their benefits and costs and are considered to be among the most cost effective treatments available. Furthermore, ‘new’ drugs are also expected to reduce mortality in diseases that claim many lives today, such as cancer.

So, are ‘new’ and innovative drugs too expensive? Outlays for drug spending are generally based on calculating the estimated benefits they produce.  But how can these estimated benefits best be calculated?  If drug costs are considered to be a social investment, policymakers may want to determine the return that such an investment yields (in economic terms: ROI or Return on Investment) and whether this return justifies the outlay. One possible way of evaluating the costs is to find out how ‘new’ or innovative drugs have benefited or improved patients’ health and how this contributes to savings within the healthcare system.  But cost calculation should also consider the benefits outsides the healthcare system. Often referred as indirect costs cost reductions outside the healthcare system may be considerable. For example, ‘new’ and innovative drugs may help patients to be more active and productive.  They may reduce the effects of cancer related  pain and suffering – and as a result - reduce so called intangible costs. This could lead to reduced absenteeism from work, increased economic productivity and subsequently to higher profits for employers and higher wages for employees.  Finally, ‘new’ and innovative drugs may help people to live longer.  The added years of life naturally generate more costs for society but also yield major benefits. 

In an attempt to predict disease patterns, the Battelle Memorial Institute (Columbus, Ohio, USA) closely investigated healthcare systems, spending patterns and demographics in the United States, United Kingdom, Germany and France.  Each of the 4 separate studies indicate that the availability of ‘new’ and innovative drugs continued to drive mortality rates down – accounting for 28% to 65% in breast cancer and 3% to 6% in lung cancer by 2015.  The Battelle reports further indicated that the costs of innovative ‘new’ and innovative drugs outweigh their costs. Based on this data, policymakers evaluating the rising costs of healthcare may conclude that extra drug spending – especially spending used for new and innovative drugs, may be legitimate.

Reduced need for Hospitalisation

But what effect does extra drug spending have on hospitalisation and inpatient costs? A study by Professor Frank Lichtenberg, Courtney C. Brown Professor of Business at the Columbia School of Business in New York, (NY, USA), evaluating drugs prescribed in outpatient visits by disease for 1980 and 1991 based on data in the National Ambulatory Care Survey provided by the US National Centre for Health Statistics, seems to suggest that hospital stays declined faster in diseases where ‘new’, innovative drugs were prescribed.  Lichtenberg’s findings indicated that an increase of 100 prescriptions resulted in 16.3 fewer hospital days.  Extrapolating these figures, he concluded that  an increase  of US $ 1.00 in drug spending yields US $ 3.65 reduction of hospital expenditure. Even if the costs associated with additional work for a physician are included (Lichtenberg estimates this at US $ 1.54 per prescription) each additional US $ 1 in ‘new’ drug spending still yields a reduction of US $ 2.11 in hospital costs.

Lichtenberg’s conclusions are supported by a study by Kenneth Manton and XiLiang Gu, published in 2001, evaluating the effects of ‘new’, innovative drugs and the decline in disability and institutionalisation of the elderly. The two researchers concluded that the introduction of new drugs as a result of biomedical research (for example in cancer related osteoporosis) are consistent with an accelerated decline in disability rates. They noticed that the proportion of those 65 years of age and older that were in a nursing home or other institution, fell from 6.8% in 1982 to 6.1% in 1989 and to 4.2% in 1999.  This reduction in nursing home stays translated into incredible savings of US $ 18.9 billion. Manton and Gu therefore concluded that ‘new’ and innovative prescription drugs are an important element in an appropriate disease management strategy avoiding or shortening the institutionalising of the elderly. 

Lichtenberg’s  estimates, however, do not assign any value to indirect and intangible costs associated with the reduction of lost work and the economic impact on society or leisure time that are the result of a decline in hospitalisation. Psychosocial factors are also left out. If all these effects would be included, they would most likely substantially increase the value of ‘new’ and innovative drug therapy.

In the United States alone, the total cost savings as a result of ‘new’, innovative drug spending are expected to exceed US$ 420 billion over a 10 year period.  Unfortunately, this does not necessarily mean that ‘new’ and innovative drug spending reduces the cost of healthcare in general.  Cost-effectiveness should not be misunderstood to imply costs savings. Some drugs actually reduce overall healthcare costs, while other raise overall costs but simultaneously producing other indirect and intangible benefits.

The ascribed value of ‘new’ and innovative drugs is often determined by comparing the drug to other potential interventions. If the alternative produces fewer benefits for the same costs or the same benefits for higher costs, the new drug can be considered cost-effective.

Based on the available data, ‘new’ and innovative drugs are an important element in disease management strategies.  If policymakers want to establish the cost-effectiveness and estimated benefits it is important to understand how ‘new’ and innovative drugs contribute to disease management in for example cancer care. Existing economic evaluations have shown that it is fair to assume that advances in drug discovery, development and production yield direct economic benefits and that  ‘new’ drugs may not costs to much.