Coping With Breast Cancer

By Sarah Swan

Current statistics suggest that between one in seven and one in eight women will develop breast cancer at some point in their lives. Being diagnosed with breast cancer can leave you feeling anxious and depressed, fearful of the treatment to come and concerned about your mortality. The treatment itself can have a significant impact on y

• Language: English
• Publisher: Sequoia Books
• Release date: Jul 17, 2023
• ISBN: 9781914110238

Book preview

Praise for Coping With Breast Cancer

In this book, a clinical psychologist who is also a breast cancer survivor describes the cancer journey and adds evidence-based psychological techniques to help us understand, explore and deal with the various emotions we might experience, written in a way that that you can select the approach that best fits with your personal experience and priorities.

~ Professor Trisha Greenhalgh, Doctor and breast cancer survivor, Oxford, UK

If you have been affected by breast cancer or know anyone who has, I can’t recommend this highly enough. You won’t find a more moving, compassionate and helpful book on this subject

~ Dr Joe Oliver, coauthor of the Mindfulness and Acceptance Workbook for Self Esteem; founder of Contextual Consulting

In reading this book I’ve discovered many things. I already knew that Sarah is a highly experienced and skilled clinical psychologist, as well as being a wife, a mother, a daughter, a sister and a friend. After reading this book I can confidently say that Sarah is also a highly skilled storyteller - she takes the reader on a journey through her experience and powerfully incorporates the perspectives from her different life roles. I see the values of openness, generosity, humour, courage and above all humanity - shining through every page. Sarah has skillfully combined a devastating life experience with evidence based behavioural science to write a book that truly brings to life Acceptance and Commitment Therapy and makes it a useful, accessible and practical guide. Bravo!

~ Ross McIntosh, Work Psychologist

This book is a very welcome source of support for women diagnosed with breast cancer. Sarah writes with honesty and compassion about her personal struggles with her own cancer diagnosis. What makes this book unique is Sarah’s skilful blending of her personal experience of breast cancer, with her skills gained through many years of working as a clinical psychologist

~ Dr Joanna Levene, Consultant Clinical Psychologist in Cancer Services

Coping With

Breast Cancer

Coping With

Breast Cancer

How to Navigate the Emotional Impact

Throughout Your Journey

Dr Sarah Swan

Every possible effort has been made to ensure that the information contained in this book is accurate at the time of going to press. The publishers and author(s) cannot accept responsibility for any errors and omissions, however caused. No responsibility for loss or damage occasioned to any person acting, or refraining from action, as a result of the material contained in this publication can be accepted by the editor, the publisher or the author.

First published in 2023 by Sequoia Books

Apart from fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publisher, or in the case of reprographic reproduction in accordance with the terms and licenses issued by the CLA. Enquiries concerning reproduction outside these terms should be sent to the publisher using the details on the website www.sequoia-books.com

©Sarah Swan 2023

The right of Sarah Swan to be identified as author of this work has been asserted in accordance with the Copyright, Designs and Patents act 1988.

ISBN

Print: 9781914110221

EPUB: 9781914110238

A CIP record for this book is available from the British Library

Library of Congress Cataloguing-In-Publication Data

Name: Sarah Swan

Title: Coping With Breast Cancer/Sarah Swan

Description: 1st Edition, Sequoia Books UK 2023

Subjects: R: Medicine

Print: 9781914110221

EPUB: 9781914110238

Library of Congress Control Number: 2023909729

Print and Electronic production managed by Deanta Global

To my wonderful husband, Al, for all your love, support, care, understanding and humour. I know this journey would have been so much harder without you. And to my amazing sons, Dylan and Jake. You are always my reason to get through the hard times and I am so proud of the kind, funny, intelligent young men you have become.

Contents

Figures

Foreword

The Unique Perspective

Acknowledgements

1 Introduction

Part 1: The Emotional Impact

Part 2: Breast Cancer and Its Treatment

Part 3: About This Book

Part 4: Introducing Myself

Part 5: Introduction to the Act Model

2 Diagnosis

3 Telling People

4 Surgery

5 Treatment

6 Body Image

7 Living in the Present

8 Conclusion

Part 1: Reviewing the Act Philosophy

Part 2: Further Support

Epilogue

Appendix I – Checklist of Skills

Appendix II – Summary Worksheet

Appendix III – Choice Point Worksheet

References

Glossary of Terms

About the Author

Figures

1.1 The ACT Triflex

5.1 The Choice Point

7.1 The Choice Point Example

8.1 The Cycle of Struggling with Emotions

Foreword

When I was diagnosed with breast cancer in 2019, I knew I was going to have to use my skills as a clinical psychologist to help me cope with the distress that this inevitably caused. Early on in my journey, I had the urge to write, as a way of processing my experiences. I immediately thought it had the potential for a book, but never thought this would come to fruition. But with the support of the Association of Clinical Psychologists, Sequoia Books, friends, family and colleagues, I committed to writing the book.

I began to realise what a unique position I held; facing a difficult life event that many others face, but with the knowledge and experience of a long career in helping people with their emotional experiences. Suddenly, it dawned on me that there could be any number of difficult or challenging experiences that other clinical psychologists may have faced. And, like me, they would in all likelihood have valuable skills to share with others facing the same situation. And so, the idea for the series was born.

It is an honour to launch the series with my book, Coping with Breast Cancer. And it has been my pleasure to support other clinical psychologists with their writing in order to produce a series of books that will help to bring valuable psychological ideas to a wide audience. With the knowledge and skills of the writers, I am confident that this series will benefit many people facing difficult and challenging situations and give them helpful skills to cope.

Dr Sarah Swan

Coping With… Series Editor

Consultant Clinical Psychologist

The Unique Perspective

The Association of Clinical Psychologists (ACP-UK) is delighted to be publishing these important Coping With … books. In these pages clinical psychologists have taken the courageous step of sharing how they applied their skills to their own lives, in order to help others facing similar difficulties and challenges.

The profession of clinical psychology spans many types of psychological approaches across all areas of the lifespan and of individual experiences – from physical health, psychological distress and mental illness, to cognitive difficulties, family challenges and workplace problems. Clinical psychologists have rigorous training not only in psychological therapies but also in research methods and evidence-based practice. They draw on these aspects to inform everything they do, including looking after themselves. These books evidence the flexibility and creativity with which we can use and apply our skills, both to help ourselves and others.

It is not often that clinicians share their first-hand experiences of challenging situations and how they have applied what they have learnt in their training and the many years of experience that follow. I feel very proud of my clinical psychology colleagues who have written this series of books, not only for everything that they have experienced with courage and insight, but for the generosity and openness with which they want to help other people. It is not easy to combine subjective personal experience with an external clinical perspective, yet in these books they share the breadth of knowledge and training that the profession brings us.

Dr Penelope Cream

Clinical & Health Psychologist

Director of Operations, ACP-UK

Acknowledgements

I am grateful to so many people who helped me (and continue to help me) through my breast cancer journey. There are too many people to thank them all individually, but I will mention a few: Thank you to my parents, who gave me the solid base from which I could grow, supporting me to cope with adversity. Rebecca, thank you for asking about the difficult stuff that others shy away from, for listening and for being alongside me throughout my journey. Rachel, thank you for being such a kind and loyal friend over so many years and for your thoughtfulness while I was ill. Helen R, thank you for your kindness and compassion and for literally being there whenever I, Al or the boys needed you. So many other friends and family members offered practical and emotional support for which Al and I will always be grateful.

I sadly lost two friends to cancer while I was going through treatment. Both were incredible women. Caroline Musson was a talented artist whose work appears on the cover of this book. Sarah Bailey was an HR director for Apple. Both inspired me in so many ways. They supported me at the beginning of my cancer journey, and I hope they felt supported by me as they stoically, and with dignity, faced the end of their lives.

Arabella Kurtz and Penelope Cream, from ACP-UK, supported this book and the forthcoming series from its inception and helped give me the confidence to see it through. Thank you to those who read and provided helpful comments and support on my early draft: Joe Oliver, Ross McIntosh and Jo Levene.

And thanks, of course, to Al, Dylan and Jake. They have supported the writing of this book by allowing me the time to write, by giving me permission to share some of their stories and by showing their pride in my efforts to share my experiences for the benefit of others. You are my world, and I am grateful for every day I spend with you.

1 Introduction

Part 1: The Emotional Impact

What is the emotional impact of breast cancer diagnosis and treatment?

Being diagnosed with breast cancer is probably one of the hardest things you will go through. It can leave you feeling in shock, concerned about your mortality and fearful of what lies ahead. But the impact does not stop there. Unlike many other illnesses, the treatment for breast cancer often leaves you feeling significantly worse rather than better. It leads to marked changes in your appearance which can impact your self-esteem. Sleep and energy levels can be severely depleted, leaving you vulnerable to feeling even more emotional. All of this can impact your relationships, particularly intimate relationships, which can create further difficulties.

While the UK National Health Service (NHS) provides excellent treatment for breast cancer, this largely focuses on medical interventions. There are lots of information available regarding the different types of treatments, but in my experience, little related to helping you to cope with the emotional fallout. There are excellent support services attached to NHS cancer units that offer a range of complementary therapies. These can be incredibly helpful. But access to high-quality evidence-based psychological interventions to help you to cope is limited. Other people, including some healthcare professionals, can respond as though it is abnormal to have intense emotions in response to your illness or treatment. Women may feel judged for ‘not coping’.

A study of 25 independent research projects explored the link between depression and mortality in cancer patients. It showed that mortality rates were up to 25% higher in patients with depressive symptoms, increasing to up to 39% for those with a diagnosis of depression (Satin, Linden & Phillips, 2009). I must point out that this does not in any way mean that you are to blame for not managing your mood effectively if your cancer is incurable. But it does suggest that our emotional well-being is important to consider and is one factor that can influence disease progression. And having ways to manage the inevitable emotional ups and downs of breast cancer diagnosis and treatment is going to make your journey more bearable.

Part 2: Breast Cancer and Its Treatment

How common is breast cancer in the UK?

Breast cancer is the most common type of cancer among women in the UK (World Cancer Research Fund, 2021). Current statistics suggest that between one in seven and one in eight women will develop breast cancer at some point in their lives (Breast Cancer Now, 2021; World Cancer Research Fund, 2021). From 2016 to 2018, there were around 55,900 new breast cancer cases in the UK each year, which means more than 150 diagnoses made each day (Cancer Research UK, 2021).

Eighty per cent of breast cancers occur in women over the age of 50. The older you are, the higher your risk. Men can also get breast cancer, although this is rare and mostly in men over 60 (Breast Care Now, 2021).

You may have heard about some factors that can increase the risk of breast cancer: being overweight, not exercising regularly, consuming more than the recommended amount of alcohol, taking the oral contraceptive pill or having hormone replacement therapy for many years. But the fact is, you can develop breast cancer without any of these, and it is mainly just bad luck. You are not to blame for developing breast cancer. ‘The two biggest reasons why women get breast cancer are simply because they are women, and are getting older’ (Greenhalgh & O’Riordan, 2018). There are also a very small number of breast cancers that are genetic (e.g. BRCA) which can then be passed on through families. Your genetic make-up is obviously not within your control.

What are the survival rates in the UK?

Breast cancer is the second most common cause of cancer death in women in the UK. This accounted for around 11,500 deaths in 2018 (Cancer Research UK, 2021).

However, since the early 1970s, breast cancer mortality rates have decreased by almost 40%. And they have decreased by almost 20% during the 2010s (Cancer Research UK, 2021).

Almost 9 out of 10 women diagnosed with breast cancer in England survive their disease for five years or more (Cancer Research UK, 2021). And around 3 out of 4 survive for 10 years or more.

Breast cancer is one of the most well-researched illnesses in any kind of medicine. People often said to me, ‘If you’re going to get cancer, breast cancer is the one to get.’ This wasn’t always entirely reassuring to me, but there is some truth in this, as there is such a range of treatments available. And given the ever-improving survival rates, these treatments are becoming more and more effective. ‘Cancer trials researching survival rates take a long time to be published due to the length of time patients are followed up for. Since treatments are improving all the time, this means that your chances of survival are at least as good as the odds reported in published trials – and very often considerably better, because new treatments are always being developed’ (Greenhalgh & O’Riordan, 2018).

What are the most common treatments?

The most common primary breast cancer treatment is surgery. Eighty-one per cent of women diagnosed will have some form of surgery, either a lumpectomy or a single or double mastectomy. Surgery is the most effective cure. Sixty-three per cent of women diagnosed have radiotherapy and 34% have chemotherapy. Both radiotherapy and chemotherapy damage cancer cells and healthy cells, but cancer cells find it difficult to repair themselves and therefore die. In primary breast cancer, both are used to reduce the risk of cancer recurring (Cancer