Some Current Findings Regarding Breast Cancer Survivors and Well-Being

By Dr. Eleanor Moreh

Breast cancer is a highly prevalent medical problem.  Current data indicate that each year in the United States more than 192,000 women are diagnosed with breast cancer (National Cancer Institute, 2009). It is the most frequently diagnosed cancer among women, accounting for nearly 1/3 of cancer cases.

Although 98% of women with localized cancer are expected to survive 5 years or more, survival rates decrease for those with regional and metastatic breast cancer (American Cancer Society, 2009). Despite the relatively high survival rates, breast cancer is the second leading cause of cancer death among women after lung cancer, with 40,170 deaths from breast cancer each year. Breast cancer rates have increased over the past 20 years, but mortality has decreased. This is probably due in part to screening and early detection. Currently there are more than 2,500,000 breast cancer survivors in the United States (American Cancer Society, 2009).

For women with breast cancer, surgery is often followed by chemotherapy, radiation therapy, and hormone therapy for five years from the initial diagnosis. These treatments present additional difficulties for a woman who is already coping with having a life-threatening disease.

Considering the difficulties posted by treatment for breast cancer, it is tempting to presume that completion of such treatment is a welcomed event.  However, there is some evidence that patients may be particularly distressed when their treatment for breast cancer ends. Most current health psychology research suggests that women may experience disrupted adjustment during the months following the end of breast cancer treatment, in part due to the loss of a safety net associated with regular treatment, coupled with uncertainty regarding the cancer recurrence.

            For my doctoral dissertation, I recently completed a study of seven women diagnosed with breast cancer based on levels of depression and anxiety at the time of diagnosis and post treatment for breast cancer (Moreh, 2011).  The purposes of this study were (a) to determine whether women with breast cancer experience psychological distress at the termination of therapy treatment, and (b) to identify factors predicting distress.

The findings of my study indicated that levels of anxiety increased immediately after the end of breast cancer treatment while the relative level of depression decreased. Nonetheless, women acknowledged significant concerns about the ongoing physical symptoms, emotional adjustment, potential recurrence, and the process of returning to or building a new normal life after breast cancer. 

Women who (a) perceived greater control over their cancer, (b) saw their cancer as an acute rather than chronic condition, and (c) attributed cancer to controllable causes or believed that behavioral or psychological factors could prevent recurrence were more likely to make behavior changes and engage in positive health practices.

To summarize, breast cancer patients actively attempt to create a new normal life following treatment, and changes in health practices appear to be an important part of this process.  Assessing women's beliefs about their breast cancer and providing psychoeducational interventions that address post-treatment behavior and emotional changes may assist in promoting breast cancer survivors' psychological and physical well- being.

By Dr. Katie Barnes

In his 2008 book, Spark: The revolutionary new science of exercise and the brain, John J. Ratey, M.D. makes one compelling argument after another for the ways in which exercise can alleviate and even reverse conditions such as anxiety, depression,  ADD,  menopause, and the aging brain.  In this short-hand version of his remarkable text, I hope to convince you of the same in regards to exercise's effects on learning, anxiety and depression.

How exercise works on the brain:

            Scientists know that exercise improves learning on three levels:  first, it optimizes your mindset (elevates specific neurotransmitters) to improve alertness, attention, and motivation.  Second, it prepares and encourages nerve cells to bind to one another, which is the cellular basis for processing and storing new information.  Third, it spurs the development of new nerve cells from stem cells in the hippocampus, the area responsible for learning and memory, also the first area to degenerate in Alzheimer's disease. 

            Exercise also diminishes anxiety by working on both the body and the brain.  It provides distraction from worries or invasive thoughts, it reduces muscle tension that feeds into the body-mind anxiety loop much like prescribed beta-blockers do, and it increases serotonin, which works at nearly every junction of the anxiety circuitry, promoting a calmed sensation, improving the performance of the prefrontal cortex to inhibit fear, and calming the amygdala or "anxious fear" center.  By sparking the sympathetic nervous system or the "calming" system, exercise inhibits the amygdala's functioning and makes new pathways with alternative, "healthy" thoughts.  Thus, it can create an alternative reality, free of anxious thoughts.  Finally, exercise creates a sense of self-mastery, which raises self-esteem, combating both anxiety and depression. 

            If depression is defined as an absence of movement toward anything, then exercise is the way to divert those negative signals and trick the brain into coming "out of hibernation."  MRI imaging studies have shown that the brain's gray matter, white matter and hippocampus are significantly more deteriorated in depressed persons than in those who are not depressed.  Those studies have also shown physical regrowth of all three of these areas relative to how much one begins to exercise.  If depression is a state in which the brain's neuronal connections are shut down and deteriorated, then reforming these connections through exercise is tremendously effective treatment.  Ratey lists three clinical studies supporting this notion.  For example, in 1999, a large study done at Yale University found that a group of depressed participants who exercised by walking or jogging for 30 minutes, three times a week, saw an equal drop in symptoms as the group of participants assigned to take Zoloft, and not exercise.  Blumenthal concluded that exercise was as effective as medication in treating depression (Blumenthal, 1999).   

How much and what type should I do?           

Now one might ask how much exercise is ideal, and what type of exercise is effective for building my brain?  The definitive answer is that more research needs to be done in order for us to know specific amounts.  However, Ratey notes the following:  a 2007 experiment showed that cognitive flexibility improves after just one thirty-five minute treadmill session at either 60 or 70 percent of maximum heart rate.  Aerobic exercise that significantly elevates the heart rate is what has been shown to elevate the "feel-good" and motivating neurotransmitters.  To optimize learnability and brain plasticity, what Ratey suggests is to either choose a sport that simultaneously challenges the cardiovascular system and the brain, such as tennis or volleyball, or do a ten-minute aerobic warm-up before something nonaerobic and skill-based, such as rock climbing or yoga.  The more complex the movements, the more complex the synaptic connections that are made. 

In tackling depression, one study compared a group of participants exercising at a high-intensity level, 3-5 times per week (burning 8 calories per pound of body weight per week), and a group exercising at a low-intensity (burning 3 calories per pound per week).  The high-intensity group lowered their depression scores by half, and the low-intensity group lowered their depression scores by one-third.  So, both amounts of exercise were effective, but the effectiveness directly correlated with the amount of energy expended per week.  Aerobic exercises such as running are most highly recommended, at least 3 times per week for at least 35 minutes per session, to best alleviate symptoms of anxiety and depression.  Finding something that you enjoy and are most likely to stick to is key, so that the effects have the chance to impact your life and keep you feeling and performing well.   

For more on this topic, read Spark: The revolutionary new science of exercise and the brain, by John J. Ratey, M.D., with Eric Hagerman (2008).      

On the ten-below-zero-day, it was on,
near the patients' chair, the old heater
kept by the analyst's couch, at the end,
like the infant's headstone that was added near the foot
of my father's grave. And it was hot, with the almost
laughing satire of a fire's heat,
the little coils like hairs in Hell.
And it was making a group of sick noises-
I wanted the doctor to turn it off
but I couldn't seem to ask, so I just
stared, but it did not budge. The doctor
turned his heavy, soft palm
outward, toward me, inviting me to speak, I
said, "If you're cold-are you cold? But if it's on
for me . . ." He held his palm out toward me,
I tried to ask, but I only muttered,
but he said, "Of course," as if I had asked,
and he stood and approached the heater, and then
stood on one foot, and threw himself
toward the wall with one hand, and with the other hand
reached down, behind the couch, to pull
the plug out. I looked away,
I had not known he would have to bend
like that. And I was so moved, that he
would act undignified, to help me,
that I cried, not trying to stop, but as if
the moans made sentences which bore
some human message. If he would cast himself toward the
outlet for me, as if bending with me in my old
shame and horror, then I would rest
on his art-and the heater purred, like a creature
or the familiar of a creature, or the child of a familiar,
the father of a child, the spirit of a father,
the healing of a spirit, the vision of healing,
the heat of vision, the power of the heat,
the pleasure of the power.

This concludes the second issue of our quarterly newsletter, TRANSFORMATIONS. We hope you have enjoyed reading, and remember to check your inbox in October for the next issue!

Best,

Chris, Katie, Eleanor, and Victoria